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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 Maui and Hawaii 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 $45.00. 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 $590 deductible for prescription drugs. Once the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, you will pay a $5 copay for preferred generic drugs at a standard or mail pharmacy, and 25% coinsurance for standard generic, preferred brand, and non-preferred drugs. After your total drug costs reach $2000, you will enter the catastrophic coverage phase and pay nothing for Part D covered drugs.
Additional Benefits
The Devoted CHOICE PLUS Hawaii (PPO) plan offers a wide range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, but outpatient services and ambulatory surgical centers often have no copay. The plan also covers ambulance services, emergency care, primary care, and preventive services. The plan includes coverage for hearing, vision, and dental services, with copays for exams and varying cost-sharing for other services. Diagnostic, radiological, and home health services are covered, with no copay for home health. The plan also covers skilled nursing facilities with a copay for some days, and acupuncture with no copay.
Inpatient Hospital See details
Inpatient Hospital services are covered, with a copay of $375 for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered stays and Upgrades for Inpatient Hospital-Acute are not covered. Inpatient Hospital Psychiatric services are covered, with a copay of $375 for days 1-5, and no copay for days 6-90; however, Additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay between $0 and $475, and Observation Services have a $375 copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay between $50 and $50. Ambulatory Surgical Center (ASC) Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Devoted CHOICE PLUS Hawaii (PPO) plan, with a $60 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under 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 under the Devoted CHOICE PLUS Hawaii (PPO) plan. Emergency Services have a $125 copay, while Urgently Needed Services have a copay between $0 and $50. Worldwide Emergency Transportation has a $250 copay and 20% coinsurance, while Worldwide Emergency Coverage and Worldwide Urgent Coverage each have a $125 copay.
Primary Care See details
Under the Devoted CHOICE PLUS Hawaii (PPO) plan, primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services are covered. Chiropractic services and routine chiropractic care have a $20 copay, physician specialist services have a $50 copay, and mental health specialty services, other health care professional services, psychiatric services, and opioid treatment program services have a $50 copay for individual and group sessions.
Preventive Services See details
The Devoted CHOICE PLUS Hawaii (PPO) plan covers a range of preventive services, including Medicare-covered preventive services, annual physical exams, health education, weight management programs, alternative therapies, therapeutic massage, 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. However, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, adult day health services, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, counseling services, enhanced disease management, telemonitoring services, remote access technologies, and counseling services are not covered.
Hearing Services See details
Hearing exams are covered with a $50 copay, including routine hearing exams and fitting/evaluation for hearing aids. Prescription hearing aids are covered with a copay between $199 and $499 for all types, but hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a $50 copay, and eyewear with a combined maximum benefit of $1500 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $50 copay, and other dental services with a $1,500 maximum benefit per year. Oral exams, dental X-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatments, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are all covered. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Devoted CHOICE PLUS Hawaii (PPO) plan. For Medicare Part B Insulin Drugs, there is a $35 copay and 20% coinsurance. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Devoted CHOICE PLUS Hawaii (PPO) plan. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0% to 18% coinsurance and no copay, Prosthetics/Medical Supplies with a coinsurance for Medicare-covered Prosthetic Devices and Medical Supplies, and Diabetic Equipment. However, Durable Medical Equipment for use outside the home, 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, lab services with no copay, and outpatient X-ray services with no copay. Diagnostic Procedures/Tests have a copay between $0 and $95, while diagnostic radiological services have a maximum copay of $300, and therapeutic radiological services have 20% coinsurance.
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. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Devoted CHOICE PLUS Hawaii (PPO) plan. Despite the benefit being covered, none of the sub-services are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Devoted CHOICE PLUS Hawaii (PPO), but require prior authorization. For days 1-20, there is no copay, for days 21-52 the copay is $200, and for days 53-100, there is no copay; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The "Devoted CHOICE PLUS Hawaii (PPO)" plan covers acupuncture with no copay, and other services including "Other 2" with no copay. However, over-the-counter items, meal benefits, 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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