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DEVOTED CHOICE MA ONLY 007 HI (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CHOICE MA ONLY 007 HI (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 007 HI (PPO) in 2026, please refer to our full plan details page.
DEVOTED CHOICE MA ONLY 007 HI (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Hawaii. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that DEVOTED CHOICE MA ONLY 007 HI (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 007 HI (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 007 HI (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 $110.00. 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 007 HI (PPO).
Additional Benefits
The Devoted Choice MA Only 007 HI (PPO) plan offers comprehensive medical coverage with many key services featuring no copay or low cost-sharing. Members enjoy no copay for primary care visits, preventive services, home health care, and laboratory tests, while specialist visits and outpatient therapies require copays ranging from $35 to $50. Inpatient hospital stays require a $425 daily copay for the first four days followed by no copay for days five through ninety, and emergency room visits carry a $115 copay which is waived if you are admitted. This plan also includes valuable supplemental benefits, such as dental coverage up to a $1,000 annual limit with no copay for preventive care and routine vision exams with no copay or a low $20 copay. Prescription hearing aids are available with copays between $599 and $899, while durable medical equipment features no copay and a 15% coinsurance. Additionally, many diagnostic services and outpatient x-rays are covered with no copay, helping you manage your out-of-pocket health costs effectively.
Inpatient Hospital See details
DEVOTED CHOICE MA ONLY 007 HI (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $425 daily copay for days 1 through 4 and no copay for days 5 through 90. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED CHOICE MA ONLY 007 HI (PPO) covers outpatient services with no coinsurance, offering ambulatory surgical center and blood services with no copay. Outpatient hospital services require a copay of $0 to $375, observation services cost a $425 copay per stay, and outpatient substance abuse sessions have a $50 copay, with prior authorization required for these services.
Partial Hospitalization See details
Partial hospitalization services are covered by DEVOTED CHOICE MA ONLY 007 HI (PPO) with a $70.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
DEVOTED CHOICE MA ONLY 007 HI (PPO) covers ambulance services with prior authorization, requiring no copay to a $350 copay along with coinsurance for ground transport, and a 20% coinsurance plus a copay for air transport. Transportation services are not covered by this plan.
Emergency Services See details
DEVOTED CHOICE MA ONLY 007 HI (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services range from no copay to a $40 copay with no coinsurance, and worldwide emergency services are covered up to $25,000 with copays up to $350 and a 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED CHOICE MA ONLY 007 HI (PPO) provides primary care physician visits with no copay and no coinsurance, while specialist, physical therapy, and mental health services require copays between $35 and $50 with no coinsurance. Telehealth options are covered with a $0 to $50 copay and no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by DEVOTED CHOICE MA ONLY 007 HI (PPO) with no copay and no coinsurance for annual physical exams, kidney disease education, and diabetes self-management. While fitness, nutrition, and home safety benefits feature no copay and no coinsurance, alternative therapies and therapeutic massage require no copay and up to 50% coinsurance. Excluded sub-services include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, adult day health, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access technologies, and counseling.
Hearing Services See details
Hearing services are partially covered by DEVOTED CHOICE MA ONLY 007 HI (PPO), which offers routine exams for a $50 copay and no coinsurance, and prescription hearing aids with no coinsurance and copays ranging from $599 to $899. 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 MA ONLY 007 HI (PPO) vision services are partially covered, as other eye exam services are not covered. Routine eye exams are available with no copay to a $20 copay and no coinsurance, while eyewear is covered with no copay, no coinsurance, and a $400 combined annual limit.
Dental Services See details
Dental Services under DEVOTED CHOICE MA ONLY 007 HI (PPO) are partially covered up to a $1,000 annual limit, with preventive care offered at no copay and no coinsurance. While restorative and endodontic services have no copay and 0% to 50% coinsurance, 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 007 HI (PPO) with no copay and no coinsurance, subject to prior authorization. Medicare Part B chemotherapy, radiation, and other drugs require no copay and between no coinsurance and 20% coinsurance, while Part B insulin is covered with a $35 copay and between no coinsurance and 20% coinsurance.
Dialysis Services See details
DEVOTED CHOICE MA ONLY 007 HI (PPO) covers Dialysis Services with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Medical equipment is covered by DEVOTED CHOICE MA ONLY 007 HI (PPO) with no copays, though prior authorization is required. Durable medical equipment has a 15% coinsurance, prosthetics and medical supplies carry a 0% to 20% coinsurance, and diabetic equipment is partially covered with a 0% to 15% coinsurance on supplies, while therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the DEVOTED CHOICE MA ONLY 007 HI (PPO) plan, with prior authorization required. Diagnostic tests and procedures have no coinsurance and a copay of $0 to $95, lab services and outpatient X-rays have no copay, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the DEVOTED CHOICE MA ONLY 007 HI (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the DEVOTED CHOICE MA ONLY 007 HI (PPO) plan with no coinsurance and required prior authorization, though only some services are covered in practice. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered, carrying copays ranging from $20 to $30.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) services are covered by DEVOTED CHOICE MA ONLY 007 HI (PPO) with no coinsurance, featuring no copay for days 1 through 20 and a $190 daily copay for days 21 through 100. Prior authorization is required, no prior three-day hospital stay is needed, and additional days beyond the standard 100 days are not covered.
Other Services See details
Other services are partially covered by DEVOTED CHOICE MA ONLY 007 HI (PPO), featuring unlimited acupuncture with no copay and 50% coinsurance, and additional preventive services with no copay and no coinsurance. Over-the-counter items and meal benefits are not covered under this plan.
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