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DEVOTED C-SNP CHOICE PREMIUM 009 OK (PPO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED C-SNP CHOICE PREMIUM 009 OK (PPO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED C-SNP CHOICE PREMIUM 009 OK (PPO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP CHOICE PREMIUM 009 OK (PPO C-SNP) is a PPO C-SNP 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 C-SNP CHOICE PREMIUM 009 OK (PPO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
DEVOTED C-SNP CHOICE PREMIUM 009 OK (PPO C-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about DEVOTED C-SNP CHOICE PREMIUM 009 OK (PPO C-SNP).
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 C-SNP CHOICE PREMIUM 009 OK (PPO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $28.20. 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 $615.00 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 $8000.00 (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 $8000.00 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 C-SNP CHOICE PREMIUM 009 OK (PPO C-SNP) plan has an annual drug deductible of $615. For Tier 6 Select Care Drugs, members enjoy no copay for 1-month, 2-month, or 3-month supplies through standard pharmacies and mail order. Tier 1 Preferred Generic drugs require an $18 copay for a 1-month supply, while Tier 2 Generic drugs require a $19 copay for a 1-month supply. For higher-tier medications, cost sharing is based on coinsurance rather than flat copays. Tier 3 Preferred Brand drugs carry a 21% coinsurance and Tier 4 Non-Preferred drugs carry a 33% coinsurance for standard pharmacy and mail-order fills. Tier 5 Specialty Tier drugs require a 25% coinsurance for a 1-month supply under this plan.
Additional Benefits
The DEVOTED C-SNP CHOICE PREMIUM 009 OK (PPO C-SNP) plan provides robust medical coverage, featuring no copay and no coinsurance for primary care visits, home health services, and covered preventive care. For specialist visits, members will pay a copay between $45 and $50, while inpatient hospital stays require a daily copay of $375 for the first 5 to 6 days followed by no copay for the remainder of the stay. Emergency care is available with a $130 copay, which is waived upon hospital admission, while urgently needed care ranges from no copay to a $45 copay. Supplemental benefits under this plan include comprehensive dental services with a $2,000 annual maximum and no copay for most preventive and comprehensive care. Vision benefits feature routine exams with no copay to a $45 copay and a $400 annual allowance for eyewear, while hearing care covers up to two prescription hearing aids per year with copays ranging from $399 to $699. Furthermore, members benefit from an over-the-counter allowance of up to $50 every three months with no copay.
Inpatient Hospital See details
DEVOTED C-SNP CHOICE PREMIUM 009 OK (PPO C-SNP) partially covers inpatient hospital services with no coinsurance, requiring a daily copay of $375 for days 1 through 6 of acute stays and days 1 through 5 of psychiatric stays, with no copay for remaining days. Non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by DEVOTED C-SNP CHOICE PREMIUM 009 OK (PPO C-SNP) with no coinsurance, featuring no copays for ambulatory surgical center and blood services. Outpatient hospital services have a copay of $0 to $475 ($375 per stay for observation services) and substance abuse sessions have a $45 copay, with prior authorization required for most of these services.
Partial Hospitalization See details
Partial hospitalization is covered by DEVOTED C-SNP CHOICE PREMIUM 009 OK (PPO C-SNP) with a $130.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
DEVOTED C-SNP CHOICE PREMIUM 009 OK (PPO C-SNP) covers ground ambulance services with no copay to a $340.00 copay, while air ambulance services require a 20% coinsurance. Transportation services are not covered under this plan.
Emergency Services See details
Emergency services are covered by DEVOTED C-SNP CHOICE PREMIUM 009 OK (PPO C-SNP) with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed care has no copay to a $45 copay and no coinsurance, while worldwide emergency services are covered up to $25,000 with copays up to $340 and 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED C-SNP CHOICE PREMIUM 009 OK (PPO C-SNP) provides primary care physician services with no copay and no coinsurance, and telehealth benefits with a $0 to $45 copay and no coinsurance. Specialist visits, physical therapy, mental health, and podiatry services require prior authorization and carry a copay ranging from $45 to $50 with no coinsurance, while chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by DEVOTED C-SNP CHOICE PREMIUM 009 OK (PPO C-SNP) with no copay and no coinsurance for covered options like annual exams, fitness benefits, and nutritional therapy. Sub-services that are not covered under this plan include PERS, in-home safety assessments, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, therapeutic massage, 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 C-SNP CHOICE PREMIUM 009 OK (PPO C-SNP), featuring a $45 copay and no coinsurance for routine exams with prior authorization required and no deductible. Up to two prescription hearing aids are covered per year with a copay between $399 and $699 and no coinsurance, though OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
DEVOTED C-SNP CHOICE PREMIUM 009 OK (PPO C-SNP) offers partially covered vision services with no deductible and no coinsurance, featuring a $0 to $45 copay for routine eye exams while other eye exam services are not covered. Covered eyewear, including contacts, eyeglasses, and upgrades, has no copay and no coinsurance up to a combined limit of $400 per year.
Dental Services See details
Dental services are partially covered by DEVOTED C-SNP CHOICE PREMIUM 009 OK (PPO C-SNP), featuring a $2,000 annual maximum for combined in-network and out-of-network care. Medicare-covered dental services require a $45 copay and no coinsurance, while other covered preventive and comprehensive services have no copay and no coinsurance, although implants, orthodontics, maxillofacial prosthetics, and select diagnostic and preventive services are not covered.
Home Infusion bundled Services See details
DEVOTED C-SNP CHOICE PREMIUM 009 OK (PPO C-SNP) covers Home Infusion bundled Services with no copay, though prior authorization is required. Medicare Part B drugs used during these infusions, including chemotherapy and insulin, carry no coinsurance to 20% coinsurance, with insulin also requiring a $35 copay.
Dialysis Services See details
DEVOTED C-SNP CHOICE PREMIUM 009 OK (PPO C-SNP) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to access this covered benefit.
Medical Equipment See details
DEVOTED C-SNP CHOICE PREMIUM 009 OK (PPO C-SNP) partially covers medical equipment with no copays and prior authorization required, though diabetic therapeutic shoes and inserts are not covered. Covered durable medical equipment requires 20% to 50% coinsurance, while prosthetics, medical supplies, and diabetic supplies range from no coinsurance to 20% or 50% coinsurance.
Diagnostic and Radiological Services See details
DEVOTED C-SNP CHOICE PREMIUM 009 OK (PPO C-SNP) covers diagnostic and radiological services, with prior authorization required. Members pay no copay for lab services, diagnostic radiological services, and outpatient X-rays, a $0 to $95 copay with no coinsurance for diagnostic procedures and tests, and a 20% coinsurance for therapeutic radiological services.
Home Health Services See details
DEVOTED C-SNP CHOICE PREMIUM 009 OK (PPO C-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
DEVOTED C-SNP CHOICE PREMIUM 009 OK (PPO C-SNP) covers some cardiac rehabilitation services with no copay and no coinsurance, but specific sub-services including cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
DEVOTED C-SNP CHOICE PREMIUM 009 OK (PPO C-SNP) covers Skilled Nursing Facility (SNF) care with no coinsurance and no prior 3-day hospital stay requirement. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100 under prior authorization, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
DEVOTED C-SNP CHOICE PREMIUM 009 OK (PPO C-SNP) provides partial coverage for other services with no copay and no coinsurance, which includes non-Medicare covered diabetic shoes, additional preventive services, and up to $50 every three months for over-the-counter items. Acupuncture and meal benefits are not covered under this plan.
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