A non-government entity
DEVOTED CHOICE 001 OH (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CHOICE 001 OH (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED CHOICE 001 OH (PPO) in 2026, please refer to our full plan details page.
DEVOTED CHOICE 001 OH (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Ohio. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that DEVOTED CHOICE 001 OH (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about DEVOTED CHOICE 001 OH (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For DEVOTED CHOICE 001 OH (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $395.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $10100.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10100.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The DEVOTED CHOICE 001 OH (PPO) plan features an annual drug deductible of $395. Under this plan, Tier 1 preferred generic drugs have no copay for up to a 3-month supply at standard pharmacies and through standard mail order. For Tier 2 generic drugs, you will pay a low copayment starting at $5.00 for a 1-month supply, with standard mail order offering a reduced $12.50 copay for a 3-month supply. For brand-name and specialty medications, the plan charges a coinsurance percentage. Tier 3 preferred brand drugs and Tier 4 non-preferred drugs both require a 25% coinsurance for 1-month, 2-month, and 3-month supplies. Specialty Tier 5 drugs carry a 28% coinsurance for a 1-month supply through standard pharmacies and mail order.
Additional Benefits
The DEVOTED CHOICE 001 OH (PPO) plan offers robust coverage for essential medical services, featuring no copay and no coinsurance for primary care visits, preventive services, and home health care. If you require hospital services, inpatient stays require a $380 copay for days 1 through 5, with no copay for days 6 through 90. Specialists, outpatient services, and emergency care are also covered, though they carry varying copays and require prior authorization in some cases. For supplemental care, this plan provides valuable dental, vision, and hearing benefits to keep your out-of-pocket costs manageable. Dental care features no copay for many services alongside a $1,500 annual limit, while covered eyewear requires no copay up to a $350 yearly maximum. Additionally, skilled nursing facility stays offer no copay for the first 20 days, followed by a daily copay of $218 for days 21 through 100.
Inpatient Hospital See details
DEVOTED CHOICE 001 OH (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $380 copay for days 1 through 5 and no copay for days 6 through 90. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED CHOICE 001 OH (PPO) covers outpatient services with no coinsurance, though prior authorization is required for most services. There is no copay for ambulatory surgical center and blood services, a $40 copay for outpatient substance abuse sessions, and outpatient hospital copays ranging from $0 to $480 depending on the service.
Partial Hospitalization See details
DEVOTED CHOICE 001 OH (PPO) covers partial hospitalization with a $70.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
DEVOTED CHOICE 001 OH (PPO) covers ground ambulance services with a copay of $0 to $315 and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required for both. Transportation services, including trips to plan-approved and any health-related locations, are not covered.
Emergency Services See details
DEVOTED CHOICE 001 OH (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, and urgently needed services with a copay ranging from no copay to $45 and no coinsurance. Worldwide emergency and urgent services are covered up to a $25,000 maximum, requiring a $130 copay and no coinsurance for care, and a $315 copay with 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED CHOICE 001 OH (PPO) provides primary care physician services with no copay and no coinsurance, while specialist, therapy, and mental health services require copays ranging from $40 to $50 with no coinsurance. Additional telehealth benefits are covered with copays from $0 to $45 and no coinsurance, though podiatry and chiropractic services are not covered.
Preventive Services See details
DEVOTED CHOICE 001 OH (PPO) partially covers preventive services with no copay and no coinsurance for covered benefits like annual physical exams, fitness programs, and health education. However, several sub-services are not covered, including in-home support, personal emergency response systems, therapeutic massage, and caregiver support.
Hearing Services See details
Hearing services are partially covered by DEVOTED CHOICE 001 OH (PPO), offering routine hearing exams for a $40 copay and no coinsurance, and up to two prescription hearing aids per year for a $199 to $499 copay and no coinsurance. OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
DEVOTED CHOICE 001 OH (PPO) offers partially covered vision services, featuring one routine eye exam per year with a $0 to $40 copay, no coinsurance, and no deductible, though other eye exam services are not covered. Covered eyewear has no copay, no coinsurance, and no deductible, with a combined maximum benefit of $350 per year for contacts, lenses, frames, and upgrades.
Dental Services See details
DEVOTED CHOICE 001 OH (PPO) offers partially covered dental services with a combined annual benefit maximum of $1,500, though maxillofacial prosthetics, implant services, and orthodontics are not covered. Covered Medicare dental services require a $40 copay and no coinsurance, while other covered preventive and comprehensive dental services feature no copay and coinsurance ranging from no coinsurance up to 50%.
Home Infusion bundled Services See details
Home infusion bundled services are covered by DEVOTED CHOICE 001 OH (PPO) with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy, radiation, and insulin, feature a coinsurance ranging from no coinsurance to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
DEVOTED CHOICE 001 OH (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
DEVOTED CHOICE 001 OH (PPO) partially covers medical equipment with no copay, requiring prior authorization for services. Durable medical equipment has a 20% to 50% coinsurance, while prosthetics, medical supplies, and diabetic supplies range from no coinsurance to 20% or 50% coinsurance. Diabetic therapeutic shoes and inserts are not covered under this plan.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED CHOICE 001 OH (PPO) with prior authorization required, featuring no copay for lab services, outpatient X-rays, and diagnostic radiological services. Diagnostic procedures and tests have no coinsurance with a copay ranging from $0 to $95, while therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home health services are covered by DEVOTED CHOICE 001 OH (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
DEVOTED CHOICE 001 OH (PPO) technically covers Cardiac Rehabilitation Services with no coinsurance, but because all individual sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are not covered, the benefit is not covered in practice.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by DEVOTED CHOICE 001 OH (PPO) with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
DEVOTED CHOICE 001 OH (PPO) partially covers other services, providing additional preventive services not covered by Medicare with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and meal benefits are not covered under this plan.
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