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Devoted LIBERTY CHOICE Ohio (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Devoted LIBERTY CHOICE Ohio (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Devoted LIBERTY CHOICE Ohio (PPO) in 2025, please refer to our full plan details page.
Devoted LIBERTY CHOICE Ohio (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 4.5 out of 5 stars in 2025.
It's important to know that Devoted LIBERTY CHOICE Ohio (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 LIBERTY CHOICE Ohio (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 LIBERTY CHOICE Ohio (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 $174.70. 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 $14000.00 (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 $14000.00 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 LIBERTY CHOICE Ohio (PPO).
Additional Benefits
The Devoted LIBERTY CHOICE Ohio (PPO) plan offers a range of benefits, including inpatient hospital stays, with a copay of $375 for days 1-4, and no copay for days 5-90. Outpatient services have varying copays, while emergency services have a $110 copay. Primary care visits have a $35 copay, and specialist visits have a $45 copay. Preventive services, such as annual exams, have no copay, and the plan covers hearing, vision, and dental services with copays. Hearing aids are covered with a copay between $599 and $899, vision exams have a $20 copay, and dental services have a $45 copay for Medicare services. The plan also covers home health services with no copay, and skilled nursing facility stays with no copay for certain days.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization. For days 1-4, the copay is $375, and for days 5-90, there is no copay. Additional days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $475, observation services with a $425 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services have a $45 copay for both individual and group sessions, and outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Devoted LIBERTY CHOICE Ohio (PPO) plan with a $70 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Devoted LIBERTY CHOICE Ohio (PPO) plan. Ground ambulance services have a copay of $0-$350, while air ambulance services have a 20% coinsurance; transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Devoted LIBERTY CHOICE Ohio (PPO) plan. Emergency Services have a $110 copay, while Urgently Needed Services have a copay between $0 and $45. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $110 copay, and Worldwide Emergency Transportation has a $350 copay and 20% coinsurance.
Primary Care See details
Primary Care for the Devoted LIBERTY CHOICE Ohio (PPO) plan covers primary care physician services, occupational therapy services with a $35 copay, physician specialist services with a $45 copay, mental health specialty services with a $45 copay for individual and group sessions, other health care professional services with a $0-$45 copay, psychiatric services with a $45 copay for individual and group sessions, physical therapy and speech-language pathology services with a $45-$50 copay, additional telehealth benefits with a $0-$45 copay, and opioid treatment program services with a $45 copay. Chiropractic services are partially covered, as routine chiropractic care is not covered, and podiatry services are not covered.
Preventive Services See details
The Devoted LIBERTY CHOICE Ohio (PPO) plan covers preventive services, including no copay for Medicare-covered preventive services, annual physical exams, health education, weight management programs, alternative therapies, nutritional/dietary benefits, fitness benefits, home and bathroom safety devices and modifications, kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit. In-home safety assessment, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss, therapeutic massage, adult day health services, home-based palliative care, in-home support services, support for caregivers, additional smoking cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, and counseling services are not covered.
Hearing Services See details
Hearing Services include routine hearing exams with a $45 copay, and fitting/evaluation for hearing aids. Prescription hearing aids are covered with a copay between $599 and $899 for all types, but inner ear, outer ear, and over-the-ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a $20 copay. Eyewear is covered with a combined maximum benefit of $250 every year for both in-network and out-of-network services.
Dental Services See details
Dental services include coverage for Medicare dental services with a $45 copay, and other dental services with a $250 annual maximum. Other covered services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 20% coinsurance, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Devoted LIBERTY CHOICE Ohio (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment coverage under the Devoted LIBERTY CHOICE Ohio (PPO) plan includes Durable Medical Equipment (DME) with an 18% coinsurance and no copay, but Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have no copay, with a coinsurance for Medicare-covered Prosthetic Devices and Medical Supplies, and Prosthetic Devices have a 0-20% coinsurance. Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests with a copay between $0 and $95, and lab services with no copay. Therapeutic Radiological Services have a coinsurance of at most 20%, and outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered by the Devoted LIBERTY CHOICE Ohio (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Devoted LIBERTY CHOICE Ohio (PPO) plan. Although the plan covers Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, these services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Devoted LIBERTY CHOICE Ohio (PPO) plan, but require prior authorization. For days 1-20 and 61-100, there is no copay, but for days 21-60, the copay is $214.
Other Services See details
The Devoted LIBERTY CHOICE Ohio (PPO) plan does not cover acupuncture, over-the-counter items, or meal benefits. Other services that are not covered include Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), and many others.
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