A non-government entity
Devoted CHOICE Georgia (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Devoted 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 CHOICE Georgia (PPO) in 2025, please refer to our full plan details page.
Devoted CHOICE Georgia (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Greater Georgia. The overall rating for this plan is not yet available for 2025.
It's important to know that Devoted CHOICE Georgia (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 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 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.
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 $590.00 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 $6350.00 (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 $6350.00 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 Georgia (PPO) plan has an "Enhanced Alternative" drug benefit. The plan has a $590 deductible for prescription drugs. In the initial coverage phase, after the deductible is met, you will pay either no copay or 25% coinsurance depending on the drug tier and pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Devoted CHOICE Georgia (PPO) plan offers comprehensive coverage, including inpatient hospital stays with a copay, outpatient services, and partial hospitalization. Primary care, specialist visits, and mental health services are available with copays. The plan also covers emergency services, ambulance services, and offers benefits for hearing, vision, and dental care, all with varying copays or coinsurance. Additional benefits include preventive services, home health services with no copay, and skilled nursing facility stays, also with a copay. The plan covers durable medical equipment, diagnostic services, and home infusion services. However, it does not cover certain services such as cardiac rehabilitation, acupuncture, and some other specialized services.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, there is a $350 copay for days 1-7, and no copay for days 8-90. For Inpatient Hospital Psychiatric, there is a $350 copay for days 1-6, and no copay for days 7-90. Additional Days for Inpatient Hospital Psychiatric, Non-Medicare-covered Stay for Inpatient Hospital Psychiatric, and Upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services for Devoted CHOICE Georgia (PPO) include coverage for outpatient hospital services with a copay between $0 and $450, observation services with a $350 copay, and ambulatory surgical center services with no copay. The plan also covers outpatient substance abuse services, including individual and group sessions, each with a copay of $35, and outpatient blood services with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered, with a $70 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Devoted CHOICE Georgia (PPO). Ground ambulance services have a copay between $0 and $290, while air ambulance services have a 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Devoted CHOICE Georgia (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a copay between $0 and $45, and Worldwide Emergency Transportation has a 20% coinsurance and a $290 copay.
Primary Care See details
The Devoted CHOICE Georgia (PPO) plan covers primary care physician services, chiropractic services (with a $20 copay), occupational therapy (with a $35-$45 copay), physician specialist services (with a $35 copay), mental health specialty services (with a $35 copay), other health care professional services (with a $0-$35 copay), psychiatric services (with a $35 copay), physical therapy and speech-language pathology services (with a $35-$50 copay), additional telehealth benefits (with a $0-$35 copay), and opioid treatment program services (with a $35 copay). Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Devoted CHOICE Georgia (PPO) plan covers preventive services, including Medicare-covered preventive services, annual physical exams, health education, weight management programs, alternative therapies, nutritional/dietary benefits, fitness benefits, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. 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 are not covered. Home and bathroom safety devices and modifications are also covered.
Hearing Services See details
Hearing services include routine hearing exams for a $35 copay, fitting/evaluation for hearing aids, and prescription hearing aids with a copay between $399 and $699, but not prescription hearing aids for the inner ear, outer ear, or over the ear. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a $35 copay, and eyewear benefits including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, with a combined maximum benefit of $1,000 every year. Routine eye exams are covered once per year.
Dental Services See details
Dental Services includes coverage for Medicare Dental Services with a $35 copay, and other dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery. This plan does not cover maxillofacial prosthetics, implant services, or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. Medicare Part B Insulin Drugs have a $35 copay and 20% coinsurance, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Devoted CHOICE Georgia (PPO) plan. The coinsurance for Dialysis Services is between 20% and 20%.
Medical Equipment See details
Medical equipment coverage includes Durable Medical Equipment (DME) with a 0-20% coinsurance and Prosthetic Devices with a 0-20% coinsurance, while Medical Supplies have a 20% coinsurance and Diabetic Equipment is partially covered, with Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts not covered. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures and tests with a copay between $0 and $95, lab services with no copay, and radiological services with a copay up to $300 and coinsurance up to 20%. Outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered by the Devoted CHOICE Georgia (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Devoted CHOICE Georgia (PPO) plan. All sub-services, including Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, and Medicare-covered 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 the Devoted CHOICE Georgia (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
The Devoted CHOICE Georgia (PPO) plan's "Other Services" benefit covers some services, but does not cover 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, or Self-Directed Personal Assistance Services.
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