Plan year 2027 · Medicare AdvantageCMS files of Sept. 22 and Oct. 1, 2026

Devoted Dual Choice 004 NE, 2027

H9802Contract004Plan

PPO D-SNP · special needs plan, dual-eligible · 42 counties in Nebraska

Run by Devoted Health Insurance Company of Nebraska (contract H9802), sold as Devoted Health, owned by Devoted Health, Inc.

Renews for 2027

2026 star rating, contract H9802: not rated (too new)

Devoted Dual Choice 004 NE (H9802-004) costs $0 a month in 2027, down $14.40 from 2026, with an in-network out-of-pocket limit of $4,900 ($4,400 in 2026).

What changes from 2026 to 2027?

The changed lines are marked and come first. In-network amounts; members keep paying the Part B premium unless the plan reduces it.
What you pay or get	2026	2027	Change
Monthly premium	$14.40	$0	down $14.40
In-network out-of-pocket limit	$4,400	$4,900	up $500
Drug deductible	$615	$700	up $85
Specialist visit	$35 copay	$40 copay	up $5
Hospital stay, in network	$300 a day for days 1–6, then $0 a day for days 7–90	$400 a day for days 1–6, then $0 a day for days 7–90	up $500for a 5-day stay
Skilled nursing facility, in network	$0 a day for days 1–20, then $218 a day for days 21–100	$10 a day for days 1–20, then $221 a day for days 21–100	up $230for a 30-day stay
Counties served	14	42	up 28
Drug tier 1, preferred generic	25% of the cost	$0	changed
Drug tier 2, generic	25% of the cost	$0	changed
Drug tier 3, preferred brand	25% of the cost	11% of the cost	down 14 points
11 lines do not change
Part B premium reduction, monthly	none	none	no change
Primary care visit	$0 copay	$0 copay	no change
Emergency room	$130 copay	$130 copay	no change
Medical deductible, in network	none	none	no change
Ground ambulance, in network	$0 copay	$0 copay	no change
Comprehensive dental, yearly limit	not offered	not offered	no change
Eyewear, yearly limit	$400 a year	$400 a year	no change
Hearing aids, yearly limit for both ears	not offered	not offered	no change
Over-the-counter items, yearly	$200 a year	$200 a year	no change
Drug tier 4, non-preferred drug	25% of the cost	25% of the cost	no change
Drug tier 5, specialty tier	25% of the cost	25% of the cost	no change

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS plan benefit package files, 2027 and 2026; CMS plan crosswalk from 2026 to 2027 (Oct. 1, 2026). Plan details can change during the year; confirm on Medicare Plan Finder.

What will prescriptions cost?

Your share for a 30-day supply at a retail pharmacy, as filed with CMS; tiers whose share changes are marked
Tier	What the tier holds	2026	2027
Tier 1	Preferred Generic	25% of the cost	$0
Tier 2	Generic	25% of the cost	$0
Tier 3	Preferred Brand	25% of the cost	11% of the cost
Tier 4	Non-Preferred Drug	25% of the cost	25% of the cost
Tier 5	Specialty Tier	25% of the cost	25% of the cost

Source: CMS plan benefit package files, 2027 and 2026. Insulin is capped at $35 a month by law. A drug's tier is set by the plan's formulary.

How does it compare with plans sold where it is?

In the counties it serves, 12 dual-eligible special needs plans are sold for 2027, this one included. Against the others, 11 a higher one. On the premium, 5 the same, 6 a higher one.

Out-of-pocket limits of the 12 dual-eligible special needs plans

$0 to under $2,0000 plans

$2,000 to under $4,0000 plans

$4,000 to under $6,000 (this plan)1 plan

$6,000 to under $8,0001 plan

$8,000 to $10,00010 plans

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).

Where is it sold, and what does it cost there?

The premium and the out-of-pocket limit are the same in all 42 counties: $0 a month and $4,900.

Nebraska

Adams Boone Buffalo Burt Butler Cass Clay Custer Douglas Fillmore Franklin Frontier Furnas Gage Gosper Greeley Hall Hamilton Harlan Howard Kearney Lancaster Merrick Nance Nemaha Nuckolls Otoe Pawnee Phelps Richardson Saline Sarpy Saunders Seward Sherman Thayer Thurston Valley Washington Webster Wheeler York

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).

Who runs this plan?

Plan ID: H9802-004
Legal name of the contract: Devoted Health Insurance Company of Nebraska
Sold as: Devoted Health
Parent company: Devoted Health, Inc.
Plan type: PPO D-SNP
2026 star rating of the contract: not rated (too new) overall; health plan not rated, drug plan not rated
Members, September 2026: 86
Plan website, as filed with CMS: www.devoted.com

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS 2026 Star Ratings (October 2025); CMS monthly enrollment by plan and by county, September 2026 (CMS hides counts under 11). CMS publishes the 2027 Star Ratings in October 2026.

What else should you check?

Other 2027 plans in Douglas, NEWhere most of its members live; premiums and limits side by side
Every Devoted Health plan for 2027Its contracts, counties and plans that end
The other 7 plans of contract H9802Same company, same contract
Is your prescription covered?Coverage share and tier for 2,259 drugs

Data, not advice. These are the plan's filed amounts, not a quote for you; confirm on Medicare Plan Finder or call the plan before you enroll.