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Devoted CHOICE PLUS Hawaii (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Devoted CHOICE PLUS Hawaii (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Devoted CHOICE PLUS Hawaii (PPO) in 2025, please refer to our full plan details page.
Devoted CHOICE PLUS Hawaii (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Honolulu, Kauai Counties. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Devoted CHOICE PLUS Hawaii (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 PLUS Hawaii (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 PLUS Hawaii (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $23.00. 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 $590.00 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 $10000.00 (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 $10000.00 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 PLUS Hawaii (PPO) plan has an "Enhanced Alternative" drug benefit. The plan has a deductible of $590. After you meet your deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy. For preferred generic drugs at a standard pharmacy or through the mail, you will pay a $10 copay. For standard generic, preferred brand, and non-preferred drugs, you will pay 25% coinsurance at standard pharmacies and through the mail. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Devoted CHOICE PLUS Hawaii (PPO) plan offers a range of benefits with varying cost-sharing. For inpatient hospital stays, you'll pay a copay of $400 for days 1-5, and no copay for days 6-90. Outpatient services have copays ranging from $0 to $525, while emergency services have a $125 copay. This plan also covers services like primary care, preventive services, hearing, vision, and dental, with copays and coinsurance amounts depending on the specific service. Additional benefits include home health services with no copay, skilled nursing facility care with a copay, and coverage for various medical equipment.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization. For Inpatient Hospital-Acute, you pay a $400 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you also pay a $400 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay of $0-$525, Observation Services with a $425 copay, and Ambulatory Surgical Center (ASC) Services with no copay. Outpatient Substance Abuse Services are covered, with Individual and Group Sessions each having a copay of $60, and Outpatient Blood Services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Devoted CHOICE PLUS Hawaii (PPO) plan and requires prior authorization. The copay for this benefit is $70.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Devoted CHOICE PLUS Hawaii (PPO) plan. Ground ambulance services have a copay between $0 and $250, 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 CHOICE PLUS Hawaii (PPO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a copay between $0-$55. Worldwide Emergency Transportation has a $250 copay and 20% coinsurance, while Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered, with varying copays. Chiropractic services have a $20 copay, routine chiropractic care has a $20 copay for up to 24 visits per year. Occupational Therapy Services have a copay between $0 and $45. Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits have a copay between $0 and $60. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a $60 copay. Podiatry Services are not covered.
Preventive Services See details
The Devoted CHOICE PLUS Hawaii (PPO) plan covers preventive services, including Medicare-covered services, annual physical exams, health education, personal emergency response systems, weight management programs, alternative therapies, therapeutic massage, nutritional/dietary benefits, fitness benefits, home and bathroom safety devices and modifications, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. In-home safety assessments, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, and counseling services are not covered.
Hearing Services See details
Hearing services are covered, including routine hearing exams with a $60 copay, and fitting/evaluation for hearing aids. Prescription hearing aids are partially covered, with a copay between $199 and $499 for all types of prescription hearing aids (2 per year), but inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a $60 copay, and eyewear with a combined maximum plan benefit coverage of $1500 every year for in-network and out-of-network services. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Devoted CHOICE PLUS Hawaii (PPO) covers dental services, including oral exams and dental x-rays with no copay, and other diagnostic, preventive, restorative, and adjunctive dental services. The plan does not cover maxillofacial prosthetics, implant services, and orthodontics, and has a maximum benefit of $1,500 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, are covered with a $35 copay and 20% coinsurance for Medicare Part B Insulin Drugs. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are covered with between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Devoted CHOICE PLUS Hawaii (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 30%, and Prosthetics/Medical Supplies with no copay and coinsurance for Medicare-covered devices and supplies. Diabetic Equipment is covered, but Diabetic Supplies and Therapeutic Shoes/Inserts are not.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests, Lab Services, and Radiological Services. Diagnostic Procedures/Tests have a copay between $0 and $95, Lab Services have no copay, Diagnostic Radiological Services have a maximum copay of $300, Therapeutic Radiological Services have 20% coinsurance, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Devoted CHOICE PLUS Hawaii (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 covered by the Devoted CHOICE PLUS Hawaii (PPO) plan, but the plan states that these services are "not covered". The plan does not provide any additional information about cost sharing for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Devoted CHOICE PLUS Hawaii (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for acupuncture and other services not usually covered by Medicare plans, while over-the-counter items, meal benefits, and other services are not covered. Also, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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