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DEVOTED CHOICE MA ONLY 002 OH (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CHOICE MA ONLY 002 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 MA ONLY 002 OH (PPO) in 2026, please refer to our full plan details page.
DEVOTED CHOICE MA ONLY 002 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 MA ONLY 002 OH (PPO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about DEVOTED CHOICE MA ONLY 002 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 MA ONLY 002 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. Additionally, this plan comes with a Part B Premium reduction of $184.70. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $13900.00 (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 $13900.00 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
Prescription drugs are not covered by DEVOTED CHOICE MA ONLY 002 OH (PPO).
Additional Benefits
The DEVOTED CHOICE MA ONLY 002 OH (PPO) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, home health services, and routine preventive care. Inpatient hospital stays require no coinsurance and a $425 daily copay for the first four days, while emergency room visits have a $115 copay that is waived if you are admitted. Outpatient services and specialist visits are also covered with no coinsurance, requiring a $45 copay for specialists and outpatient copays ranging from no copay up to $475. Ancillary benefits include dental care with a $1,000 annual maximum and no copay, alongside routine vision exams with a copay ranging from no copay to $20 and a $400 yearly eyewear allowance. Hearing services are covered with a $45 copay for routine exams and copays between $599 and $899 for prescription hearing aids. Additionally, skilled nursing facility stays feature no copay for the first 20 days and a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
Inpatient hospital services are covered under the DEVOTED CHOICE MA ONLY 002 OH (PPO) plan with no coinsurance, featuring a $425 daily copay for days 1 through 4 and no copay for days 5 through 90. Unlimited additional days are covered for acute stays, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED CHOICE MA ONLY 002 OH (PPO) covers outpatient services with no coinsurance, including no copay for ambulatory surgical center and blood services, a $45 copay for substance abuse sessions, and copays ranging from no copay up to $475 for outpatient hospital and observation services. Prior authorization is required for these covered services.
Partial Hospitalization See details
DEVOTED CHOICE MA ONLY 002 OH (PPO) covers partial hospitalization services with a $70.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
DEVOTED CHOICE MA ONLY 002 OH (PPO) covers ambulance services with prior authorization, requiring a copay ranging from no copay to $350 with no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. While some transportation services are covered, trips to plan-approved or any health-related locations are not covered in practice.
Emergency Services See details
Emergency services are covered by DEVOTED CHOICE MA ONLY 002 OH (PPO) with a $115 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, while urgently needed services feature no coinsurance and a copay ranging from no copay to $40. Worldwide emergency and urgent care are also covered up to a $25,000 maximum benefit, requiring a $115 copay and no coinsurance for medical services, and a $350 copay with 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED CHOICE MA ONLY 002 OH (PPO) offers primary care physician services and telehealth with no copay and no coinsurance, while specialist and mental health visits require a $45 copay and no coinsurance. Physical, occupational, and speech therapies are covered with copays ranging from $35 to $50 and no coinsurance, but podiatry and chiropractic services are not covered.
Preventive Services See details
DEVOTED CHOICE MA ONLY 002 OH (PPO) offers partially covered preventive services with no copay and no coinsurance for covered care, including annual physical exams, kidney disease education, and fitness benefits. However, several additional services are not covered under this benefit, such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, and caregiver support.
Hearing Services See details
DEVOTED CHOICE MA ONLY 002 OH (PPO) covers routine hearing exams and fittings with a $45.00 copay, no coinsurance, and no deductible, subject to prior authorization. Prescription hearing aids are partially covered with a copay between $599.00 and $899.00 and no coinsurance, though OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by DEVOTED CHOICE MA ONLY 002 OH (PPO), featuring one annual routine eye exam with a $0 to $20 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, providing a combined maximum benefit of $400 per year for contacts, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered by DEVOTED CHOICE MA ONLY 002 OH (PPO) with a $1,000 annual maximum for both in- and out-of-network care, featuring no copay and 0% to 50% coinsurance for most diagnostic, preventive, and restorative services. Medicare-covered dental services require a $45 copay and no coinsurance, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by DEVOTED CHOICE MA ONLY 002 OH (PPO) with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy, radiation, and other drugs, carry no coinsurance to 20% coinsurance, while insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
DEVOTED CHOICE MA ONLY 002 OH (PPO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
DEVOTED CHOICE MA ONLY 002 OH (PPO) covers medical equipment with no copay, requiring a 20% coinsurance for durable medical equipment and between no coinsurance and 20% coinsurance for prosthetic devices, medical supplies, and diabetic supplies. Diabetic equipment is partially covered, as diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED CHOICE MA ONLY 002 OH (PPO) covers diagnostic and radiological services with prior authorization required. Diagnostic services feature no coinsurance, with no copay for lab services and a $0 to $95 copay for diagnostic procedures. Radiological services include no copay for outpatient X-rays, copays starting at $0 for diagnostic radiology, and a 20% coinsurance for therapeutic radiology.
Home Health Services See details
DEVOTED CHOICE MA ONLY 002 OH (PPO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by DEVOTED CHOICE MA ONLY 002 OH (PPO) with no coinsurance, though prior authorization is required. Some services are covered, but cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by DEVOTED CHOICE MA ONLY 002 OH (PPO), as additional days beyond the Medicare-covered limit are not covered. Covered stays require no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100.
Other Services See details
DEVOTED CHOICE MA ONLY 002 OH (PPO) provides partial coverage for other services, offering 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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