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DEVOTED CHOICE 001 GA (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CHOICE 001 GA (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 GA (PPO) in 2026, please refer to our full plan details page.
DEVOTED CHOICE 001 GA (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Greater Atlanta. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED CHOICE 001 GA (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 GA (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 GA (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 $370.00 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 $13900.00 (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 $13900.00 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 GA (PPO) Medicare plan features an annual drug deductible of $370. Under this plan, you will enjoy no copay for Tier 1 preferred generic and Tier 2 generic drugs filled through a standard pharmacy or standard mail order. This coverage applies to one-month, two-month, and three-month supplies of these essential generic medications. For brand-name and specialty medications, your costs are determined by coinsurance percentages. You will pay a 19% coinsurance for Tier 3 preferred brand drugs and a 25% coinsurance for Tier 4 non-preferred drugs through standard pharmacy and standard mail-order channels. Tier 5 specialty medications require a 28% coinsurance for a one-month supply.
Additional Benefits
The DEVOTED CHOICE 001 GA (PPO) plan offers comprehensive medical coverage with no copay for primary care visits, home health services, and preventive care. For specialized care, members can expect predictable costs, such as $30 to $50 copays for specialist visits and a $350 daily copay for the first week of an inpatient hospital stay. While most outpatient and diagnostic services feature no coinsurance, certain services like durable medical equipment and dialysis require a 20% coinsurance. Beyond standard medical care, this plan provides excellent supplemental benefits, including preventive dental care with no copay and up to a $3,500 annual limit for combined dental services. You also receive a $350 annual allowance for eyewear, routine hearing exams, and a $100 over-the-counter allowance every three months with no copay. These additional benefits help you save on everyday health expenses while maintaining flexible, high-quality care.
Inpatient Hospital See details
DEVOTED CHOICE 001 GA (PPO) covers inpatient hospital care with no coinsurance, requiring prior authorization and a $350 daily copay for the first 7 days of acute stays (no copay for days 8-90) and the first 5 days of psychiatric stays (no copay for days 6-90). This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED CHOICE 001 GA (PPO) covers outpatient services with no coinsurance, featuring a copay of $0 to $450 for outpatient hospital services and $350 per stay for observation services. Under this plan, there is no copay for ambulatory surgical center and blood services, while outpatient substance abuse sessions require a $30 copay.
Partial Hospitalization See details
Partial hospitalization is covered by DEVOTED CHOICE 001 GA (PPO) with a $70.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by DEVOTED CHOICE 001 GA (PPO), where ground ambulance services have a copay of up to $315 with no coinsurance, and air ambulance services require a 20% coinsurance with no copay. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
DEVOTED CHOICE 001 GA (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services range from no copay to a $40 copay with no coinsurance, and worldwide emergency services are covered up to $25,000 with copays up to $315 and 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED CHOICE 001 GA (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits, mental health, and physical therapy services require copays ranging from $30 to $50 with no coinsurance. Chiropractic and podiatry services are not covered under this plan.
Preventive Services See details
Preventive services are partially covered under DEVOTED CHOICE 001 GA (PPO) with no copay and no coinsurance for annual physical exams, kidney disease education, fitness benefits, and nutritional therapy. However, several sub-services are not covered, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, additional tobacco cessation, enhanced disease management, telemonitoring, remote access technologies, and counseling.
Hearing Services See details
DEVOTED CHOICE 001 GA (PPO) offers partially covered hearing services, which include one routine hearing exam per year for a $30 copay and no coinsurance, alongside unlimited fitting evaluations. Up to two prescription hearing aids are covered annually with no coinsurance and a copay ranging from $399 to $699, though OTC hearing aids and inner-ear, outer-ear, and over-the-ear prescription models are not covered.
Vision Services See details
DEVOTED CHOICE 001 GA (PPO) provides partial coverage for vision services, including one routine eye exam per year with a $0 to $30 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $350 annual combined limit for contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered by DEVOTED CHOICE 001 GA (PPO), which offers a $3,500 annual maximum benefit for combined in- and out-of-network care. Covered preventive services feature no copay and no coinsurance, comprehensive services have no copay and up to 50% coinsurance, and Medicare-covered dental requires a $30 copay and no coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
DEVOTED CHOICE 001 GA (PPO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Under this plan, Medicare Part B chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by DEVOTED CHOICE 001 GA (PPO) with no copay and a 20% coinsurance, and prior authorization is required.
Medical Equipment See details
DEVOTED CHOICE 001 GA (PPO) partially covers medical equipment with no copay and coinsurance ranging from 0% to 20% (flat 20% coinsurance for durable medical equipment), subject to prior authorization. Covered services include durable medical equipment, prosthetics, and diabetic supplies, 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 GA (PPO), though prior authorization is required. Lab services and outpatient X-rays have no copay, diagnostic procedures and tests have a copay ranging from $0 to $95 with no coinsurance, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
DEVOTED CHOICE 001 GA (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 001 GA (PPO) with no coinsurance, though prior authorization is required. Medicare-covered cardiac and intensive cardiac rehabilitation services require a $30 copay, while pulmonary rehabilitation services have a $25 copay and supervised exercise therapy (SET) for peripheral artery disease (PAD) costs a $20 copay.
Skilled Nursing Facility (SNF) See details
DEVOTED CHOICE 001 GA (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a prior 3-day hospital stay is not required, additional days beyond the 100-day limit are not covered.
Other Services See details
DEVOTED CHOICE 001 GA (PPO) provides partial coverage for other services, offering no copay and no coinsurance for additional preventive services and over-the-counter (OTC) items up to $100 every three months. However, acupuncture, meal benefits, and certain other services are not covered under this plan.
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