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DEVOTED CHOICE 001 OK (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CHOICE 001 OK (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED CHOICE 001 OK (PPO) in 2026, please refer to our full plan details page.
DEVOTED CHOICE 001 OK (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Oklahoma City. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED CHOICE 001 OK (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 001 OK (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 001 OK (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 $7700.00 (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 $7700.00 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 001 OK (PPO) Medicare plan features an annual prescription drug deductible of $375. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 2 generic drugs when using standard retail pharmacies or standard mail order. This coverage applies to one-month, two-month, and three-month supplies of these lower-tier medications. For higher-tier prescription medications, your cost sharing is based on coinsurance rather than flat copays. You will pay a 19% coinsurance for Tier 3 preferred brand drugs and a 25% coinsurance for Tier 4 non-preferred drugs. Tier 5 specialty medications require a 28% coinsurance for a one-month supply filled at standard pharmacies or through standard mail order.
Additional Benefits
The DEVOTED CHOICE 001 OK (PPO) plan provides comprehensive medical coverage with predictable out-of-pocket costs, featuring no copay and no coinsurance for primary care doctor visits and preventive care. For inpatient hospital stays, members pay a daily copay of $295 for the first six days and no copay for days seven through 90, with no coinsurance required. Outpatient hospital services range from no copay up to a $395 copay, while emergency room visits carry a $130 copay that is waived if admitted. This plan also includes valuable supplemental benefits, such as dental coverage up to $2,500 annually with no copay for preventive services and 0% to 50% coinsurance for comprehensive care. Routine eye exams range from no copay to a $40 copay, while covered eyewear has no copay, coinsurance, or deductible up to a $300 yearly limit. Additionally, members benefit from no copay for home health services and receive a quarterly $60 allowance with no copay for eligible over-the-counter items.
Inpatient Hospital See details
DEVOTED CHOICE 001 OK (PPO) covers inpatient acute and psychiatric hospital services with no coinsurance, requiring a $295 daily copay for days 1 through 6 and no copay for days 7 through 90. Prior authorization is required, while upgrades, additional psychiatric days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by DEVOTED CHOICE 001 OK (PPO) with no coinsurance, featuring a $0 to $395 copay for outpatient hospital services, a $295 copay per stay for observation services, and a $40 copay for outpatient substance abuse sessions. Ambulatory surgical center and blood services are covered with no copay and no coinsurance, with prior authorization required for most outpatient services.
Partial Hospitalization See details
Partial hospitalization is covered by DEVOTED CHOICE 001 OK (PPO) with a $105.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
DEVOTED CHOICE 001 OK (PPO) covers ambulance services with prior authorization, requiring a $0 to $315 copay plus coinsurance for ground transport, and a 20% coinsurance plus a copay for air transport. For transportation benefits, some services are covered, but trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
DEVOTED CHOICE 001 OK (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if admitted within 24 hours, and urgently needed services with no copay to a $45 copay and no coinsurance. Worldwide emergency and urgent care are covered up to $25,000 with a $130 copay and no coinsurance, while worldwide emergency transportation requires a $315 copay and 20% coinsurance.
Primary Care See details
DEVOTED CHOICE 001 OK (PPO) offers primary care physician services with no copay and no coinsurance, while telehealth services feature a $0 to $45 copay and no coinsurance. Specialist visits, mental health, and physical therapies require copays ranging from $40 to $50 with no coinsurance, but podiatry, routine chiropractic, and other chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by DEVOTED CHOICE 001 OK (PPO) with no copay and no coinsurance for covered care such as annual physicals, fitness benefits, and glaucoma screenings. This benefit does not cover in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access, or counseling.
Hearing Services See details
DEVOTED CHOICE 001 OK (PPO) partially covers hearing services, offering one routine hearing exam per year with a $40 copay and no coinsurance. Up to two prescription hearing aids are covered annually with no coinsurance and copayments between $399 and $699, though OTC hearing aids and inner ear, outer ear, or over the ear prescription models are not covered.
Vision Services See details
Vision services are partially covered under DEVOTED CHOICE 001 OK (PPO), which includes one routine eye exam per year with a $0 to $40 copay and no coinsurance, while other eye exam services are not covered. Covered eyewear options like contacts, lenses, and frames have no copay, no coinsurance, and no deductible, up to a combined maximum plan benefit of $300 per year.
Dental Services See details
DEVOTED CHOICE 001 OK (PPO) dental services are partially covered up to a combined in- and out-of-network annual maximum of $2,500, offering preventive care with no copay and no coinsurance. Medicare-covered dental requires a $40 copay and no coinsurance, while covered comprehensive services have no copay and 0% to 50% coinsurance, though maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED CHOICE 001 OK (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this plan, Medicare Part B chemotherapy, radiation, and other Part B drugs have no copay and 0% to 20% coinsurance, while Part B insulin requires a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by DEVOTED CHOICE 001 OK (PPO) with no copay and a 20% coinsurance, and prior authorization is required.
Medical Equipment See details
DEVOTED CHOICE 001 OK (PPO) medical equipment benefits are partially covered with no copay, though prior authorization is required for all services. Durable medical equipment carries a 20% coinsurance, and prosthetic devices, medical supplies, and diabetic supplies range from no coinsurance to 20% coinsurance, but diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED CHOICE 001 OK (PPO), with prior authorization required. Outpatient lab services have no copay and no coinsurance, while diagnostic tests require no coinsurance and a copay ranging from $0 to $95. Diagnostic radiological services feature copays starting at $0 with no coinsurance, outpatient X-rays have no copay with coinsurance, and therapeutic radiological services require a minimum 20% coinsurance plus a copay.
Home Health Services See details
Home health services are covered by DEVOTED CHOICE 001 OK (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
DEVOTED CHOICE 001 OK (PPO) does not cover Cardiac Rehabilitation Services, including intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services.
Skilled Nursing Facility (SNF) See details
DEVOTED CHOICE 001 OK (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior 3-day hospital stay is not required, and additional days beyond the standard 100 days are not covered.
Other Services See details
DEVOTED CHOICE 001 OK (PPO) partially covers other services, offering over-the-counter (OTC) items and additional preventive services with no copay and no coinsurance. Acupuncture, meal benefits, and certain other services are not covered, but eligible OTC items feature a maximum benefit of $60 every three months.
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