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DEVOTED CHOICE 008 HI (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CHOICE 008 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 008 HI (PPO) in 2026, please refer to our full plan details page.
DEVOTED CHOICE 008 HI (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Maui and Hawaii Counties. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that DEVOTED CHOICE 008 HI (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 008 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 008 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.
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 $375.00 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 008 HI (PPO) prescription drug plan features an annual drug deductible of $375. For Tier 1 preferred generic and Tier 2 generic medications, members pay no copay for one-, two-, or three-month supplies filled at standard retail pharmacies or through standard mail order. For higher-tier medications, prescription costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 19% coinsurance, while Tier 4 non-preferred drugs carry a 25% coinsurance for all supply durations. Tier 5 specialty drugs require a 28% coinsurance for a one-month supply at standard pharmacies or through standard mail order.
Additional Benefits
The DEVOTED CHOICE 008 HI (PPO) Medicare plan offers robust healthcare coverage featuring low out-of-pocket costs, including no copay for primary care visits, annual physical exams, and home health services. Specialist visits require a standard $50 copay, while inpatient hospital stays feature a $375 daily copay for the first five days and no copay for days six through 90. Skilled nursing facility care is also covered with no copay for the first 20 days. For ancillary benefits, the plan provides a $1,500 annual dental limit with no copay for most preventive services, as well as routine vision exams and eyewear with no copay up to a $200 annual maximum. Members also receive hearing aid coverage with copays between $399 and $699, no copays for lab services and x-rays, and a $20 quarterly allowance for over-the-counter items.
Inpatient Hospital See details
DEVOTED CHOICE 008 HI (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $375 daily copay for days 1 through 5 and no copay for days 6 through 90. While acute stays include unlimited additional days, psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
DEVOTED CHOICE 008 HI (PPO) covers outpatient services with no coinsurance, featuring a $0 to $475 copay for hospital services, a $375 copay per stay for observation services, and a $50 copay for substance abuse sessions. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, though prior authorization is required.
Partial Hospitalization See details
Partial hospitalization services are covered by DEVOTED CHOICE 008 HI (PPO) with a $60.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the DEVOTED CHOICE 008 HI (PPO) plan, with ground ambulance services requiring a copay ranging from no copay to $315 and air ambulance services requiring a 20% coinsurance with no copay. Prior authorization is required for ambulance services, and transportation services to health-related locations are not covered.
Emergency Services See details
DEVOTED CHOICE 008 HI (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgently needed services with no copay to a $50 copay and no coinsurance. Worldwide emergency services are covered up to a $25,000 limit, with a $130 copay and no coinsurance for emergency or urgent care, and a $315 copay and 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED CHOICE 008 HI (PPO) primary care benefits feature no copay and no coinsurance for primary care physician visits, and a $50 copay with no coinsurance for specialists, mental health, and therapy services. Routine chiropractic care is partially covered with a $15 copay and no coinsurance for up to 12 visits per year (other chiropractic services are not covered), whereas podiatry services are not covered.
Preventive Services See details
DEVOTED CHOICE 008 HI (PPO) preventive services feature no copay and no coinsurance for annual physical exams, kidney disease education, and other standard preventive screenings. Additional preventive services are partially covered with no copay, but coinsurance ranging from 0% to 50% applies to alternative therapies and therapeutic massage, while sub-services like in-home safety assessments, medical nutrition therapy, and personal emergency response systems are not covered.
Hearing Services See details
Hearing services are partially covered by DEVOTED CHOICE 008 HI (PPO), featuring a $50 copay and no coinsurance for one annual routine exam, as well as unlimited fitting evaluations. Up to two prescription hearing aids are covered per year with copays ranging from $399 to $699 and no coinsurance, though OTC, inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by DEVOTED CHOICE 008 HI (PPO), as other eye exam services are not covered. Covered routine eye exams have no copay to a $50 copay and no coinsurance, while eyewear is covered with no copay, no coinsurance, and a $200 annual maximum limit.
Dental Services See details
Dental services are partially covered by DEVOTED CHOICE 008 HI (PPO) with a $1,500 annual maximum benefit for combined in- and out-of-network care. Most covered preventive and comprehensive services have no copay and 0% to 50% coinsurance (Medicare-covered dental requires a $50 copay and no coinsurance), but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED CHOICE 008 HI (PPO) covers Home Infusion bundled Services with no copay, while associated Medicare Part B chemotherapy, radiation, and other drugs require no copay and no coinsurance to 20% coinsurance. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance, with prior authorization required for infusion services.
Dialysis Services See details
DEVOTED CHOICE 008 HI (PPO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment is partially covered by DEVOTED CHOICE 008 HI (PPO) with no copays, though prior authorization is required and diabetic therapeutic shoes or inserts are not covered. Durable medical equipment carries a 20% coinsurance, while covered prosthetics, medical supplies, and diabetic supplies range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
DEVOTED CHOICE 008 HI (PPO) covers diagnostic and radiological services, with prior authorization required for these benefits. Lab services and outpatient X-rays have no copay, diagnostic procedures range from no copay up to a $95 copay with no coinsurance, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
DEVOTED CHOICE 008 HI (PPO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by DEVOTED CHOICE 008 HI (PPO) with no coinsurance and required prior authorization, though only some services are covered. Specifically, cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by DEVOTED CHOICE 008 HI (PPO) with no coinsurance, featuring no copay for days 1 through 20 and a $149 daily copay for days 21 through 100. Prior authorization is required, and a 3-day inpatient hospital stay is not required prior to admission, though additional days beyond the standard 100 days are not covered.
Other Services See details
DEVOTED CHOICE 008 HI (PPO) covers select other services, including acupuncture with no copay and 50% coinsurance, and additional preventive services with no copay and no coinsurance. Over-the-counter (OTC) items are also covered with no copay and no coinsurance up to $20 every three months, though meal benefits are not covered.
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