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DEVOTED C-SNP CHOICE PLUS 016 GA (PPO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED C-SNP CHOICE PLUS 016 GA (PPO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED C-SNP CHOICE PLUS 016 GA (PPO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP CHOICE PLUS 016 GA (PPO C-SNP) is a PPO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Georgia. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED C-SNP CHOICE PLUS 016 GA (PPO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
DEVOTED C-SNP CHOICE PLUS 016 GA (PPO C-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about DEVOTED C-SNP CHOICE PLUS 016 GA (PPO C-SNP).
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 C-SNP CHOICE PLUS 016 GA (PPO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $25.40. 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 has a $775.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $615.00 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:
Sign up for DEVOTED C-SNP CHOICE PLUS 016 GA (PPO C-SNP)
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Drug Coverage
The DEVOTED C-SNP CHOICE PLUS 016 GA (PPO C-SNP) plan features an annual drug deductible of $615. Under this plan, Tier 1 preferred generic drugs require an $18 copay for a 1-month supply at standard pharmacies and standard mail order, while Tier 2 generic drugs carry a $19 copay. Additionally, Tier 6 select care drugs are available with no copay for standard 1-month, 2-month, or 3-month supplies. For higher-tier medications, cost sharing transitions to coinsurance at standard pharmacies and standard mail order. Tier 3 preferred brand drugs require a 25% coinsurance and Tier 4 non-preferred drugs require a 31% coinsurance. Tier 5 specialty drugs also carry a 25% coinsurance for a 1-month supply at standard pharmacies and standard mail order.
Additional Benefits
The DEVOTED C-SNP CHOICE PLUS 016 GA (PPO C-SNP) plan offers comprehensive medical coverage with no copay for primary care visits, home health services, and preventive care. For inpatient hospital stays, members pay a $2,230 copay per acute stay and a $2,080 copay per psychiatric stay with no coinsurance. Outpatient services, diagnostic procedures, and emergency care are also covered, with outpatient services featuring no copays and coinsurance ranging from 0% to 50% depending on the service. This plan also includes valuable supplemental benefits, such as a dental allowance of up to $4,000 with no copay or coinsurance for most services, alongside a $300 annual limit for eyewear. Skilled nursing facility stays feature no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100. Additionally, members receive a $50 quarterly over-the-counter allowance and hearing aid coverage with copays ranging from $399 to $699 per device.
Inpatient Hospital See details
DEVOTED C-SNP CHOICE PLUS 016 GA (PPO C-SNP) partially covers inpatient hospital services, featuring no coinsurance alongside a $2,230 copay per acute stay and a $2,080 copay per psychiatric stay. While acute stays include unlimited additional days, non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
DEVOTED C-SNP CHOICE PLUS 016 GA (PPO C-SNP) covers outpatient services with no copays, though coinsurance and prior authorization requirements apply to most benefits. Outpatient hospital and ambulatory surgical services feature a coinsurance ranging from no coinsurance to 50%, while outpatient substance abuse and blood services require 30% coinsurance.
Partial Hospitalization See details
DEVOTED C-SNP CHOICE PLUS 016 GA (PPO C-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to access these covered services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered under the DEVOTED C-SNP CHOICE PLUS 016 GA (PPO C-SNP) plan, as transportation to plan-approved or health-related locations is not covered. Covered ground ambulance services require prior authorization and have no copay and coinsurance ranging from no coinsurance to 45%, while air ambulance services require prior authorization and have no copay and 45% coinsurance.
Emergency Services See details
Emergency services are covered by DEVOTED C-SNP CHOICE PLUS 016 GA (PPO C-SNP) with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require no copay and a 0% to 20% coinsurance (up to $40 per visit), while worldwide emergency, urgent, and transportation services are covered with no copay or coinsurance up to a $25,000 maximum limit.
Primary Care See details
DEVOTED C-SNP CHOICE PLUS 016 GA (PPO C-SNP) covers primary care physician services with no copay and no coinsurance, and telehealth benefits with no copay and 0% to 30% coinsurance. Specialist visits, occupational, physical, speech, mental health, psychiatric, podiatry, and opioid treatment services are covered with no copay and 30% coinsurance. For chiropractic services, some services are covered but routine and other chiropractic care are not covered.
Preventive Services See details
Preventive services are partially covered by DEVOTED C-SNP CHOICE PLUS 016 GA (PPO C-SNP) with no copay and no coinsurance for covered options such as annual physical exams, fitness benefits, and kidney disease education. However, certain sub-services are not covered, including personal emergency response systems (PERS), in-home support, therapeutic massage, and counseling services.
Hearing Services See details
Hearing services covered by DEVOTED C-SNP CHOICE PLUS 016 GA (PPO C-SNP) include hearing exams with no copay, though routine annual exams require prior authorization and a 50% coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $399 to $699 for up to two devices per year, but inner ear, outer ear, over the ear, and over-the-counter hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by DEVOTED C-SNP CHOICE PLUS 016 GA (PPO C-SNP), featuring one routine eye exam per year with no copay and 0% to 50% coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $300 annual maximum benefit for contacts, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered by DEVOTED C-SNP CHOICE PLUS 016 GA (PPO C-SNP), featuring a $4,000 annual maximum benefit with no copay and no coinsurance for most preventive and comprehensive care. However, Medicare-covered dental services require a 30% coinsurance and no copay, while other diagnostic, other preventive, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED C-SNP CHOICE PLUS 016 GA (PPO C-SNP) covers home infusion bundled services with no copay and no coinsurance, subject to prior authorization. Associated Medicare Part B drugs, including chemotherapy and other drugs, have no copay and range from no coinsurance to 20% coinsurance, while insulin requires a $35.00 copay.
Dialysis Services See details
Dialysis services are covered under the DEVOTED C-SNP CHOICE PLUS 016 GA (PPO C-SNP) plan with no copay and a 20% coinsurance, and prior authorization is required.
Medical Equipment See details
Medical equipment is covered by DEVOTED C-SNP CHOICE PLUS 016 GA (PPO C-SNP) with no copay and coinsurance ranging from no coinsurance to 20%, with prior authorization required. This benefit is partially covered, as durable medical equipment, prosthetics, and diabetic supplies are included, but diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED C-SNP CHOICE PLUS 016 GA (PPO C-SNP) with no copays, though prior authorization is required. Diagnostic procedures and tests have no coinsurance, while there is a 50% coinsurance for lab services, 20% coinsurance for therapeutic radiological services, and 45% coinsurance for both diagnostic radiological and outpatient X-ray services.
Home Health Services See details
Home Health Services are covered by DEVOTED C-SNP CHOICE PLUS 016 GA (PPO C-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by DEVOTED C-SNP CHOICE PLUS 016 GA (PPO C-SNP) with no copay, subject to prior authorization. However, some sub-services, including intensive cardiac, pulmonary, and SET for PAD rehabilitation, are not covered and require a 30% coinsurance.
Skilled Nursing Facility (SNF) See details
DEVOTED C-SNP CHOICE PLUS 016 GA (PPO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and allowing admission without a prior 3-day hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
DEVOTED C-SNP CHOICE PLUS 016 GA (PPO C-SNP) provides partial coverage for other services with no copay and no coinsurance, including diabetic shoes, additional preventive services, and a $50 quarterly over-the-counter item allowance. Acupuncture and meal benefits are not covered under this plan.
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