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DEVOTED CHOICE 010 GA (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CHOICE 010 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 010 GA (PPO) in 2026, please refer to our full plan details page.
DEVOTED CHOICE 010 GA (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Augusta and Savannah. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED CHOICE 010 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 010 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 010 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 $460.00 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 010 GA (PPO) Medicare plan features an annual prescription drug deductible of $460. For Tier 1 (Preferred Generic) and Tier 2 (Generic) medications, members enjoy no copay for 1-month, 2-month, and 3-month supplies filled at standard pharmacies or through standard mail order. This makes generic prescription drugs highly affordable and accessible under this plan. For brand-name and specialty medications, costs are structured as coinsurance rather than set copays. Tier 3 (Preferred Brand) drugs require a 22% coinsurance, while Tier 4 (Non-Preferred) drugs carry a 25% coinsurance for standard retail and mail-order options. Specialty medications in Tier 5 require a 27% coinsurance for a 1-month supply.
Additional Benefits
The DEVOTED CHOICE 010 GA (PPO) plan offers robust medical coverage with predictable out-of-pocket costs, featuring no copay or coinsurance for primary care visits and routine preventive services. Specialist visits require a $30 copay, while emergency services have a $115 copay that is waived if you are admitted to the hospital. For inpatient hospital stays, you will pay a $350 daily copay for the first seven days of acute care, after which there is no copay. This plan also includes valuable supplemental benefits, such as dental coverage up to a $3,500 annual limit with no copay for most preventive and comprehensive services. Vision care features no copay for eyewear up to a $350 yearly limit, and prescription hearing aids are covered with copays between $399 and $699. Additionally, members receive a $100 over-the-counter allowance every three months with no copay to help cover health-related items.
Inpatient Hospital See details
DEVOTED CHOICE 010 GA (PPO) inpatient hospital benefits are partially covered with no coinsurance, requiring prior authorization. For acute stays, you pay a $350 copay per day for days 1-7 and no copay for days 8 and beyond, while psychiatric stays require a $350 copay per day for days 1-5 and no copay for days 6-90. Upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services under DEVOTED CHOICE 010 GA (PPO) are covered with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay of $0 to $450, observation services require a $350 copay per stay, and outpatient substance abuse sessions carry a $30 copay, all with no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by DEVOTED CHOICE 010 GA (PPO) with a $70.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
DEVOTED CHOICE 010 GA (PPO) covers ground ambulance services with a copay of $0 to $350 and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both of which require prior authorization. Routine transportation services to plan-approved or health-related locations are not covered under this plan.
Emergency Services See details
DEVOTED CHOICE 010 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 feature no coinsurance and a copay ranging from no copay to $40, while worldwide emergency services are covered up to $25,000 with copays up to $350 and 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED CHOICE 010 GA (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $30 copay and no coinsurance. Mental health, psychiatric, and physical therapies are covered with copays ranging from $30 to $50 and no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
DEVOTED CHOICE 010 GA (PPO) covers preventive services, including annual physical exams, kidney disease education, and diabetes training, with no copay and no coinsurance. Additional preventive benefits are partially covered with no copay and no coinsurance, excluding sub-services like in-home safety assessments, personal emergency response systems, therapeutic massage, and home-based palliative care.
Hearing Services See details
Hearing services are partially covered by DEVOTED CHOICE 010 GA (PPO), which offers routine hearing exams for a $30 copay and no coinsurance, alongside unlimited fitting evaluations. Prescription hearing aids are covered with no coinsurance and a copay between $399 and $699 for up to two aids per year, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
DEVOTED CHOICE 010 GA (PPO) covers vision services, including one routine eye exam per year with a $0 to $30 copay and no coinsurance, though other eye exam services are not covered. Eyewear is also covered with no copay, no coinsurance, and a $350 annual combined maximum benefit for contacts, lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered under DEVOTED CHOICE 010 GA (PPO), featuring a $3,500 annual maximum benefit for both in-network and out-of-network care. Most preventive and comprehensive services have no copay and no coinsurance, while Medicare-covered dental has a $30 copay and no coinsurance, and restorative, endodontics, and prosthodontics have no copay and 0% to 50% coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED CHOICE 010 GA (PPO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs carry no copay and 0% to 20% coinsurance, while Part B insulin has a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the DEVOTED CHOICE 010 GA (PPO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
DEVOTED CHOICE 010 GA (PPO) covers medical equipment with no copay, requiring a 20% coinsurance for durable medical equipment and between no coinsurance to 20% coinsurance for prosthetics, medical supplies, and diabetic supplies. This benefit is partially covered, as diabetic therapeutic shoes and inserts are not covered, and prior authorization is required.
Diagnostic and Radiological Services See details
DEVOTED CHOICE 010 GA (PPO) covers diagnostic and radiological services with prior authorization, offering lab services with no copay and no coinsurance, and diagnostic tests with a $0 to $95 copay and no coinsurance. Outpatient X-rays feature no copay but require coinsurance, while therapeutic radiological services carry both a copay and a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the DEVOTED CHOICE 010 GA (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
DEVOTED CHOICE 010 GA (PPO) offers Cardiac Rehabilitation Services with no copay and no coinsurance, but only some services are covered as cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
DEVOTED CHOICE 010 GA (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with no coverage provided for additional days.
Other Services See details
DEVOTED CHOICE 010 GA (PPO) covers select other services with no copay and no coinsurance, including 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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