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DEVOTED CHOICE 005 CO (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CHOICE 005 CO (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED CHOICE 005 CO (PPO) in 2026, please refer to our full plan details page.
DEVOTED CHOICE 005 CO (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Southwest Colorado Area. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that DEVOTED CHOICE 005 CO (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 005 CO (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 005 CO (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 $7000.00 (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 $7000.00 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 005 CO (PPO) Medicare plan features an annual drug deductible of $375. Under this plan, you will pay no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) drugs filled for 1-month, 2-month, or 3-month supplies at standard pharmacies or through standard mail order. This makes standard generic medications highly accessible and affordable for plan members. For higher-tier medications, cost-sharing is based on a coinsurance percentage rather than flat copays. Tier 3 (Preferred Brand) drugs require a 19% coinsurance, and Tier 4 (Non-Preferred) drugs require a 25% coinsurance for 1-month, 2-month, or 3-month supplies. Specialty medications in Tier 5 carry a 28% coinsurance for a 1-month supply through standard pharmacies or standard mail order.
Additional Benefits
The Devoted Choice 005 CO (PPO) plan offers comprehensive coverage with no copay and no coinsurance for primary care visits, preventive screenings, and home health services. Specialist office visits require a $35 copay, while inpatient hospital stays incur a $295 daily copay for the first several days before transitioning to no copay. Outpatient procedures and diagnostic services like labs and X-rays are also highly affordable, often requiring no copay and no coinsurance. For extra health needs, the plan features dental coverage with no copay for preventive care up to a $2,000 annual limit, as well as vision and hearing benefits with no-copay options and allowances for eyewear and hearing aids. Emergency care is available with a $130 copay, which is waived upon admission, while medical equipment and dialysis services generally require a 20% coinsurance. This plan successfully minimizes out-of-pocket costs by offering no copays for routine care and clear, flat copays for specialized medical services.
Inpatient Hospital See details
DEVOTED CHOICE 005 CO (PPO) partially covers inpatient hospital services with no coinsurance, excluding upgrades, non-Medicare-covered stays, and additional psychiatric days. Acute stays require a $295 daily copay for days 1 through 6 and no copay thereafter, while psychiatric stays require a $295 daily copay for days 1 through 5 and no copay for days 6 through 90.
Outpatient Services See details
DEVOTED CHOICE 005 CO (PPO) covers outpatient services with no coinsurance, though prior authorization is required for most treatments. Outpatient hospital copays range from $0 to $395, observation services cost a $295 copay per stay, and outpatient substance abuse sessions have a $35 copay, while ambulatory surgical center and blood services are offered with no copay.
Partial Hospitalization See details
DEVOTED CHOICE 005 CO (PPO) covers partial hospitalization services with a $70.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Ambulance services are covered by DEVOTED CHOICE 005 CO (PPO) with prior authorization, featuring a copay ranging from no copay to $315 and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. Transportation services to health-related locations are not covered.
Emergency Services See details
DEVOTED CHOICE 005 CO (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 a $25,000 limit with a $130 copay and no coinsurance, while worldwide emergency transportation requires a $315 copay and 20% coinsurance.
Primary Care See details
DEVOTED CHOICE 005 CO (PPO) offers primary care physician services with no copay and no coinsurance, while specialist visits require a $35 copay and no coinsurance. Most other covered services, such as physical and occupational therapies, have copays ranging from $35 to $50 with no coinsurance, though podiatry and certain non-routine chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by DEVOTED CHOICE 005 CO (PPO), offering annual physical exams, kidney disease education, and routine screenings with no copay and no coinsurance. While supplemental benefits like fitness programs have no copay, alternative therapies and therapeutic massages carry a 0% to 50% coinsurance, and services such as in-home safety assessments, PERS, and medical nutrition therapy are not covered.
Hearing Services See details
Hearing services are partially covered by DEVOTED CHOICE 005 CO (PPO), featuring a $35 copay and no coinsurance for one routine hearing exam per year, plus unlimited fitting evaluations. Up to two prescription hearing aids are covered annually with a copay ranging from $399 to $699 and no coinsurance, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
DEVOTED CHOICE 005 CO (PPO) partially covers vision services, offering one annual routine eye exam with a $0 to $35 copay, no coinsurance, and no deductible, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and a $300 annual maximum benefit for contacts, lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by DEVOTED CHOICE 005 CO (PPO), which features a $2,000 annual maximum benefit for combined in- and out-of-network care. Preventive and select comprehensive services require no copay and no coinsurance, other comprehensive services have no copay and 0% to 50% coinsurance, and Medicare-covered dental has a $35 copay and no coinsurance; however, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by DEVOTED CHOICE 005 CO (PPO) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs require between no coinsurance and 20% coinsurance, while Medicare Part B insulin carries a $35 copay and up to 20% coinsurance.
Dialysis Services See details
DEVOTED CHOICE 005 CO (PPO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
DEVOTED CHOICE 005 CO (PPO) partially covers medical equipment with no copays, though prior authorization is required and diabetic therapeutic shoes or inserts are not covered. Durable medical equipment has a 20% coinsurance, while covered prosthetics, medical supplies, and diabetic supplies carry a coinsurance ranging from no coinsurance to 20%.
Diagnostic and Radiological Services See details
DEVOTED CHOICE 005 CO (PPO) covers diagnostic and radiological services with prior authorization. Diagnostic services have no coinsurance, offering lab services with no copay and diagnostic procedures with a copay ranging from $0 to $95. Outpatient X-rays and diagnostic radiology have no copay, though X-rays require coinsurance and therapeutic radiology carries a 20% coinsurance.
Home Health Services See details
DEVOTED CHOICE 005 CO (PPO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by DEVOTED CHOICE 005 CO (PPO) with no coinsurance and require prior authorization, though only some services are covered. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered, carrying copayments ranging from $25 to $35.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by DEVOTED CHOICE 005 CO (PPO) 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, though a prior three-day hospital stay is not, and additional days beyond the standard 100-day limit are not covered.
Other Services See details
DEVOTED CHOICE 005 CO (PPO) provides other services with partial coverage, including unlimited acupuncture with no copay and 50% coinsurance, alongside over-the-counter items and additional preventive services with no copay and no coinsurance. Meal benefits are not covered under this plan.
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