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DEVOTED C-SNP CHOICE PREMIUM 010 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 010 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 010 OK (PPO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP CHOICE PREMIUM 010 OK (PPO C-SNP) is a PPO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Northeast Oklahoma Area. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED C-SNP CHOICE PREMIUM 010 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 010 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 010 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 010 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 $7200.00 (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 $7200.00 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 010 OK (PPO C-SNP) plan features an annual prescription drug deductible of $615. Under this plan, you will pay no copay for Tier 6 Select Care Drugs through standard pharmacies and standard mail-order services. For standard fills, Tier 1 Preferred Generic drugs carry an $18 copay for a one-month supply, while Tier 2 Generic drugs require a $19 copay. Higher-tier medications transition to coinsurance, with Tier 3 Preferred Brands requiring 21% coinsurance and Tier 4 Non-Preferred Drugs requiring 33% coinsurance. Specialty drugs in Tier 5 are covered at a 25% coinsurance rate for a one-month supply through standard networks. These structured costs help you budget effectively for your prescription needs under this PPO C-SNP plan.
Additional Benefits
The DEVOTED C-SNP CHOICE PREMIUM 010 OK (PPO C-SNP) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care, telehealth, and home health services. For inpatient hospital stays, members pay a $375 daily copay for the first several days of care and no copay for subsequent days, while outpatient hospital services range from no copay to a $475 copay. Emergency room visits carry a $130 copay, which is waived if you are admitted to the hospital within 24 hours. Specialist visits require a $40 to $50 copay, while routine dental and vision exams are highly affordable with options for no copay. The plan also includes valuable allowances, such as a $2,000 annual limit for covered dental services and a $400 yearly allowance for eyewear. Additionally, members can take advantage of a $50 quarterly allowance for over-the-counter items with no copay or coinsurance.
Inpatient Hospital See details
Inpatient hospital care is covered by DEVOTED C-SNP CHOICE PREMIUM 010 OK (PPO C-SNP) with no coinsurance, but is only partially covered since upgrades, non-Medicare-covered stays, and additional psychiatric days are excluded. For Medicare-covered acute stays, you pay a $375 daily copay for days 1 through 6 and no copay for days 7 and beyond, while psychiatric stays require a $375 daily copay for days 1 through 5 and no copay for days 6 through 90.
Outpatient Services See details
Outpatient services are covered under the DEVOTED C-SNP CHOICE PREMIUM 010 OK (PPO C-SNP) plan with no coinsurance, featuring copays ranging from $0 to $475 for outpatient hospital services and $375 per stay for observation services. Ambulatory surgical center and outpatient blood services are available with no copay and no coinsurance, while outpatient substance abuse sessions require a $40 copay.
Partial Hospitalization See details
Partial hospitalization is covered by DEVOTED C-SNP CHOICE PREMIUM 010 OK (PPO C-SNP) with a $130.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
DEVOTED C-SNP CHOICE PREMIUM 010 OK (PPO C-SNP) covers ground ambulance services with a copay ranging from no copay to $340, and air ambulance services with a 20% coinsurance. Prior authorization is required for all ambulance services, and transportation services to health-related locations are not covered.
Emergency Services See details
DEVOTED C-SNP CHOICE PREMIUM 010 OK (PPO C-SNP) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, and urgently needed services with a copay ranging from no copay to $45 and no coinsurance. Worldwide emergency and urgent care are covered up to a $25,000 maximum limit with a $130 copay and no coinsurance, while worldwide emergency transportation requires a $340 copay and 20% coinsurance.
Primary Care See details
DEVOTED C-SNP CHOICE PREMIUM 010 OK (PPO C-SNP) provides primary care physician services and telehealth benefits with no copay and no coinsurance, while specialist, therapy, and mental health services require copayments ranging from $40 to $50 with no coinsurance. Chiropractic services are not covered in practice as routine and other chiropractic sub-services are excluded from coverage.
Preventive Services See details
DEVOTED C-SNP CHOICE PREMIUM 010 OK (PPO C-SNP) preventive services are partially covered with no copay and no coinsurance for covered options like annual physical exams, fitness benefits, and kidney disease education. Non-covered sub-services include in-home safety assessments, personal emergency response systems, 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 technologies, and counseling.
Hearing Services See details
Hearing services are partially covered by DEVOTED C-SNP CHOICE PREMIUM 010 OK (PPO C-SNP), offering routine exams for a $40 copay and no coinsurance, and up to two prescription hearing aids per year for a $399 to $699 copay and no coinsurance. Fitting evaluations are covered with no copay or coinsurance and no deductible, but OTC hearing aids and 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 C-SNP CHOICE PREMIUM 010 OK (PPO C-SNP), featuring eye exams with a $0 to $40 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $400 annual maximum for contacts, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered by DEVOTED C-SNP CHOICE PREMIUM 010 OK (PPO C-SNP), featuring a $40 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered services up to a $2,000 annual limit. Other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED C-SNP CHOICE PREMIUM 010 OK (PPO C-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, require a coinsurance ranging from no coinsurance to 20%, with insulin also carrying a $35 copay.
Dialysis Services See details
DEVOTED C-SNP CHOICE PREMIUM 010 OK (PPO C-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required before receiving these covered services.
Medical Equipment See details
DEVOTED C-SNP CHOICE PREMIUM 010 OK (PPO C-SNP) covers medical equipment with no copays, requiring 20% to 50% coinsurance for durable medical equipment and no coinsurance to 20% coinsurance for prosthetics and medical supplies. Diabetic equipment is partially covered with no copay and no coinsurance to 50% coinsurance for diabetic supplies, while diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the DEVOTED C-SNP CHOICE PREMIUM 010 OK (PPO C-SNP) plan, with prior authorization required. Lab services and outpatient X-rays have no copay and no coinsurance, diagnostic procedures carry a $0 to $95 copay and no coinsurance, and therapeutic radiology services require a copay and 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the DEVOTED C-SNP CHOICE PREMIUM 010 OK (PPO C-SNP) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by DEVOTED C-SNP CHOICE PREMIUM 010 OK (PPO C-SNP) with no coinsurance, though prior authorization is required. While some services are covered, standard cardiac rehabilitation ($40 copay), intensive cardiac rehabilitation ($40 copay), pulmonary rehabilitation ($35 copay), and supervised exercise therapy for peripheral artery disease ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
DEVOTED C-SNP CHOICE PREMIUM 010 OK (PPO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and allowing admission without a prior 3-day hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, while additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by DEVOTED C-SNP CHOICE PREMIUM 010 OK (PPO C-SNP), excluding acupuncture, meal benefits, and highly integrated dual eligible SNP services. Covered benefits include over-the-counter items up to $50 every three months, non-Medicare diabetic shoes, and additional preventive services, all offered with no copay and no coinsurance.
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