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Devoted LIBERTY CHOICE Georgia (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Devoted LIBERTY CHOICE Georgia (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Devoted LIBERTY CHOICE Georgia (PPO) in 2025, please refer to our full plan details page.
Devoted LIBERTY CHOICE Georgia (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 2025.
It's important to know that Devoted LIBERTY CHOICE Georgia (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 LIBERTY CHOICE Georgia (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 LIBERTY CHOICE Georgia (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 $160.00. 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 $14000.00 (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 $14000.00 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 LIBERTY CHOICE Georgia (PPO).
Additional Benefits
The Devoted LIBERTY CHOICE Georgia (PPO) plan offers coverage for a variety of services, including inpatient and outpatient hospital care, with varying copays. Emergency services, primary care, and preventive services are also covered, each with their own copay structure. The plan also includes coverage for hearing, vision, and dental services, with specific copays and annual maximums. Additional benefits include ambulance and transportation services, home health services, and skilled nursing facility care, with some services requiring prior authorization. The plan provides coverage for home infusion services, medical equipment, and dialysis services. However, some services like chiropractic, podiatry, and many "other services" are not covered by the plan.
Inpatient Hospital See details
Inpatient Hospital services are covered, with a copay of $325 for days 1-4, and no copay for days 5-90. Additional days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered. Inpatient Hospital Psychiatric services are covered, with a copay of $325 for days 1-4, and no copay for days 5-90; however, additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay between $0 and $425, Observation Services have a copay of $325, and Ambulatory Surgical Center Services have no copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay of $45, and Outpatient Blood Services include a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Devoted LIBERTY CHOICE Georgia (PPO) plan with a $70 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Devoted LIBERTY CHOICE Georgia (PPO) plan. Ground ambulance services have a copay of $0 - $350, and air ambulance services have a 20% coinsurance, while transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Devoted LIBERTY CHOICE Georgia (PPO) plan. Emergency Services have a $110 copay, and Urgently Needed Services have a copay between $0 and $45. Worldwide Emergency Coverage has a $110 copay, Worldwide Urgent Coverage has a $110 copay, and Worldwide Emergency Transportation has a $350 copay and 20% coinsurance.
Primary Care See details
The Devoted LIBERTY CHOICE Georgia (PPO) plan covers primary care physician services, occupational therapy services with a $35 copay, physician specialist services with a $50 copay, and physical therapy and speech-language pathology services with a $50 copay. The plan also covers mental health specialty services, psychiatric services, and opioid treatment program services, with a minimum copay of $45 and a maximum copay of $45. The plan's additional telehealth benefits have a copay between $0 and $50. Chiropractic Services are partially covered, with Routine Chiropractic Care not covered, and Podiatry Services are not covered.
Preventive Services See details
The Devoted LIBERTY CHOICE Georgia (PPO) plan covers preventive services including health education, weight management programs, alternative therapies, nutritional/dietary benefits, fitness benefits, home and bathroom safety devices, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. The plan does not cover in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, therapeutic massage, adult day health services, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, and counseling services.
Hearing Services See details
Hearing exams are covered with a $50 copay. Routine hearing exams are limited to one per year, and fitting/evaluation for hearing aids is unlimited. Prescription hearing aids are covered, with a copay between $599 and $899, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, nor are OTC hearing aids.
Vision Services See details
Vision services include eye exams with a $20 copay, and eyewear with a combined maximum benefit of $250 every year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The Devoted LIBERTY CHOICE Georgia (PPO) plan covers Medicare Dental Services with a $50 copay, and other dental services including Oral Exams, Dental X-Rays, and more, with a maximum benefit of $250 per year. However, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 20% coinsurance, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered by the Devoted LIBERTY CHOICE Georgia (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Devoted LIBERTY CHOICE Georgia (PPO) plan. Durable Medical Equipment (DME) has a 20% coinsurance, while Prosthetic Devices have a 0-20% coinsurance and Medical Supplies have a 20% coinsurance; however, Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $95, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $300, and Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Devoted LIBERTY CHOICE Georgia (PPO) plan with no copay and no coinsurance; however, additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but none of the sub-services are covered. These include Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Devoted LIBERTY CHOICE Georgia (PPO) plan, but require prior authorization. For days 1-20 and 61-100, there is no copay, but there is a $214 copay for days 21-60.
Other Services See details
Other Services are not covered by the Devoted LIBERTY CHOICE Georgia (PPO) plan. Specifically, acupuncture, over-the-counter items, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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