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DEVOTED CHOICE MA ONLY 003 GA (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CHOICE MA ONLY 003 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 MA ONLY 003 GA (PPO) in 2026, please refer to our full plan details page.
DEVOTED CHOICE MA ONLY 003 GA (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Georgia. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED CHOICE MA ONLY 003 GA (PPO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about DEVOTED CHOICE MA ONLY 003 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 MA ONLY 003 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. Additionally, this plan comes with a Part B Premium reduction of $184.70. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
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
Prescription drugs are not covered by DEVOTED CHOICE MA ONLY 003 GA (PPO).
Additional Benefits
The DEVOTED CHOICE MA ONLY 003 GA (PPO) plan provides comprehensive medical coverage, featuring no copay and no coinsurance for primary care, preventive services, and home health care. Inpatient hospital stays require a $425 daily copay for days 1 through 4 and no copay for days 5 through 90, with no coinsurance. Emergency room visits have a $115 copay, which is waived upon admission, while urgent care ranges from no copay to $40. For additional health benefits, members receive preventive dental care with no copay up to a $1,000 annual maximum, alongside routine vision exams and up to $400 for eyewear with no copay. Hearing exams require a $50 copay, while prescription hearing aids range from a $599 to $899 copay. Skilled nursing facility stays are covered with no copay for the first 20 days, and durable medical equipment is available with no copay and a 20% coinsurance.
Inpatient Hospital See details
DEVOTED CHOICE MA ONLY 003 GA (PPO) covers inpatient hospital acute and psychiatric services with no coinsurance, requiring a $425 daily copay for days 1 through 4 and no copay for days 5 through 90. While unlimited additional acute care days are covered, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
DEVOTED CHOICE MA ONLY 003 GA (PPO) offers outpatient services with no coinsurance, featuring no copays for ambulatory surgical center and outpatient blood services. Outpatient hospital services have a copay ranging from $0 to $525, observation services carry a $425 copay per stay, and outpatient substance abuse sessions require a $50 copay, with prior authorization needed for most services.
Partial Hospitalization See details
DEVOTED CHOICE MA ONLY 003 GA (PPO) covers partial hospitalization services with a $70.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Ambulance services are covered under DEVOTED CHOICE MA ONLY 003 GA (PPO) with prior authorization, featuring a copay ranging from no copay to $350 with 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
Emergency services are covered by DEVOTED CHOICE MA ONLY 003 GA (PPO) with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require no coinsurance and a copay ranging from no copay to $40, while worldwide emergency care is covered up to $25,000 with varying copays and up to 20% coinsurance for transportation.
Primary Care See details
DEVOTED CHOICE MA ONLY 003 GA (PPO) offers primary care physician services and select telehealth benefits with no copay and no coinsurance. Specialist visits, physical therapy, occupational therapy, and mental health services are covered with copayments ranging from $35 to $50 and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services under the DEVOTED CHOICE MA ONLY 003 GA (PPO) are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, and fitness benefits. This benefit is partially covered, excluding sub-services such as in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, and therapeutic massages.
Hearing Services See details
DEVOTED CHOICE MA ONLY 003 GA (PPO) provides partially covered hearing services, featuring routine hearing exams for a $50 copay and no coinsurance. Prescription hearing aids are covered with a copay ranging from $599 to $899 and no coinsurance, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by DEVOTED CHOICE MA ONLY 003 GA (PPO), featuring a $0 to $50 copay and no coinsurance for annual routine eye exams, though other eye exam services are not covered. Eyewear is covered with no copay or coinsurance up to a $400 annual limit for contacts, frames, lenses, and upgrades.
Dental Services See details
Dental services through DEVOTED CHOICE MA ONLY 003 GA (PPO) are partially covered up to a $1,000 yearly maximum for in- and out-of-network care, offering preventive services with no copay and no coinsurance. Medicare-covered dental has a $50 copay and no coinsurance, while covered comprehensive services have no copay and 0% to 50% coinsurance, excluding implant services, orthodontics, and maxillofacial prosthetics which are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered under DEVOTED CHOICE MA ONLY 003 GA (PPO) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs carry a coinsurance ranging from no coinsurance to 20%, while Part B insulin is covered with a $35 copay and a coinsurance of no coinsurance to 20%.
Dialysis Services See details
DEVOTED CHOICE MA ONLY 003 GA (PPO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
DEVOTED CHOICE MA ONLY 003 GA (PPO) covers medical equipment with no copays, subject to prior authorization. Durable medical equipment requires a 20% coinsurance, prosthetics and medical supplies carry no coinsurance to 20% coinsurance, and diabetic equipment is partially covered with no coinsurance to 20% coinsurance for supplies while diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED CHOICE MA ONLY 003 GA (PPO) covers diagnostic and radiological services with prior authorization required, featuring no copay and no coinsurance for lab services. Outpatient diagnostic tests require a $0 to $95 copay with no coinsurance, while radiological services range from no copay for x-rays to a minimum 20% coinsurance and copays for therapeutic radiology.
Home Health Services See details
Home Health Services are covered under the DEVOTED CHOICE MA ONLY 003 GA (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
DEVOTED CHOICE MA ONLY 003 GA (PPO) covers some Cardiac Rehabilitation Services with no copay and no coinsurance, though prior authorization is required. However, cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by DEVOTED CHOICE MA ONLY 003 GA (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, and while a prior three-day inpatient hospital stay is not needed, additional days beyond the standard 100 days are not covered.
Other Services See details
DEVOTED CHOICE MA ONLY 003 GA (PPO) offers partial coverage for other services, providing additional preventive services not covered by Medicare with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and meal benefits are not covered under this plan.
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