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DEVOTED C-SNP CHOICE PREMIUM 017 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 PREMIUM 017 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 PREMIUM 017 GA (PPO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP CHOICE PREMIUM 017 GA (PPO C-SNP) is a PPO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 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 C-SNP CHOICE PREMIUM 017 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 PREMIUM 017 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 PREMIUM 017 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 PREMIUM 017 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 does not have a health deductible. Your insurance coverage on covered health services will start immediately.
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 PREMIUM 017 GA (PPO C-SNP)
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Drug Coverage
The DEVOTED C-SNP CHOICE PREMIUM 017 GA (PPO C-SNP) prescription drug plan features an annual drug deductible of $615. Under this plan, Tier 6 select care drugs are covered with no copay for up to a 3-month supply at standard pharmacies and standard mail-order services. For Tier 1 preferred generics and Tier 2 generics, standard copays range from $18 to $19 for a 1-month supply, up to $54 and $57 respectively for a 3-month supply. Brand-name and specialty medications are subject to coinsurance rather than flat copayments. Standard pharmacy and standard mail-order costs require a 21% coinsurance for Tier 3 preferred brand drugs and a 33% coinsurance for Tier 4 non-preferred drugs. Specialty medications in Tier 5 carry a 25% coinsurance for a 1-month supply.
Additional Benefits
The DEVOTED C-SNP CHOICE PREMIUM 017 GA (PPO C-SNP) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. Specialist visits and Medicare-covered dental care require a $40 copay, while routine dental services feature no copay up to a $2,000 annual limit. Additionally, members can access vision eyewear with no copay up to $300 annually and prescription hearing aids with copays ranging from $399 to $699. For inpatient hospital stays, there is a $430 daily copay for the first few days and no copay thereafter, while emergency room care requires a $115 copay that is waived upon admission. Skilled nursing facility stays have no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100. Diagnostic lab tests and outpatient X-rays are provided with no copay, while dialysis services require a 20% coinsurance.
Inpatient Hospital See details
DEVOTED C-SNP CHOICE PREMIUM 017 GA (PPO C-SNP) covers inpatient hospital services with no coinsurance, requiring a $430 daily copay for days 1 through 5 for acute stays and days 1 through 4 for psychiatric stays, followed by no copay for subsequent days. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED C-SNP CHOICE PREMIUM 017 GA (PPO C-SNP) covers outpatient services with no coinsurance, though prior authorization is required. Outpatient hospital services have a copay of $0 to $530 ($430 for observation stays) and substance abuse sessions have a $40 copay, while ambulatory surgical center and blood services have no copay.
Partial Hospitalization See details
Partial hospitalization is covered by the DEVOTED C-SNP CHOICE PREMIUM 017 GA (PPO C-SNP) plan with a $70.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by DEVOTED C-SNP CHOICE PREMIUM 017 GA (PPO C-SNP), featuring ground ambulance services with a copay ranging from no copay to $350 plus coinsurance, and air ambulance services with a 20% coinsurance plus a copay. Prior authorization is required for ambulance services, and transportation services to health-related locations are not covered.
Emergency Services See details
DEVOTED C-SNP CHOICE PREMIUM 017 GA (PPO C-SNP) covers emergency services with a $115 copay and no coinsurance, with the copay waived if admitted to the hospital within 24 hours. Urgently needed services require no copay to a $40 copay and no coinsurance, while worldwide emergency services are covered up to $25,000 with a $115 copay and no coinsurance for medical care, and a $350 copay plus 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED C-SNP CHOICE PREMIUM 017 GA (PPO C-SNP) covers primary care physician services with no copay and no coinsurance, while specialist and mental health visits require a $40 copay and no coinsurance. Therapy services range from a $35 to $50 copay with no coinsurance, and chiropractic care is only partially covered since routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by DEVOTED C-SNP CHOICE PREMIUM 017 GA (PPO C-SNP) with no copay and no coinsurance for covered options like annual physicals, fitness benefits, and nutritional therapy. However, certain sub-services are not covered, including in-home safety assessments, personal emergency response systems, therapeutic massage, and counseling.
Hearing Services See details
Hearing services are partially covered by DEVOTED C-SNP CHOICE PREMIUM 017 GA (PPO C-SNP), offering one annual routine hearing exam for a $40 copay and no coinsurance, alongside unlimited fitting evaluations. Covered prescription hearing aids require a copayment between $399 and $699 with no coinsurance for up to two devices per year, while OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by DEVOTED C-SNP CHOICE PREMIUM 017 GA (PPO C-SNP), as other eye exam services are not covered. Covered routine eye exams carry a $0 to $40 copay with no coinsurance, while eyewear is available with no copay, no coinsurance, and a $300 annual maximum allowance.
Dental Services See details
Dental services are partially covered by DEVOTED C-SNP CHOICE PREMIUM 017 GA (PPO C-SNP) up to a $2,000 annual limit, featuring a $40 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered services. Sub-services not covered under this plan include other diagnostic services, other preventive services, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by DEVOTED C-SNP CHOICE PREMIUM 017 GA (PPO C-SNP) with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the DEVOTED C-SNP CHOICE PREMIUM 017 GA (PPO C-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
Medical equipment is partially covered by DEVOTED C-SNP CHOICE PREMIUM 017 GA (PPO C-SNP) with no copay and coinsurance ranging from no coinsurance to 20%, with prior authorization required. While durable medical equipment, prosthetics, and diabetic supplies are covered, diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED C-SNP CHOICE PREMIUM 017 GA (PPO C-SNP) covers diagnostic and radiological services with prior authorization required, offering lab services and outpatient X-rays with no copay. Outpatient diagnostic tests have no coinsurance and copays ranging from no copay to $95, while therapeutic radiological services carry a minimum 20% coinsurance and diagnostic radiological copays start at no copay.
Home Health Services See details
Home Health Services are covered by DEVOTED C-SNP CHOICE PREMIUM 017 GA (PPO C-SNP) with no copay and no coinsurance. Prior authorization is required for these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by DEVOTED C-SNP CHOICE PREMIUM 017 GA (PPO C-SNP) with no coinsurance, though some services are not covered. Specifically, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and require copayments ranging from $20 to $30.
Skilled Nursing Facility (SNF) See details
DEVOTED C-SNP CHOICE PREMIUM 017 GA (PPO C-SNP) covers Skilled Nursing Facility (SNF) care with no coinsurance and does not require a prior three-day inpatient hospital stay, though prior authorization is required. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with no coverage for additional days.
Other Services See details
Other services are partially covered by DEVOTED C-SNP CHOICE PREMIUM 017 GA (PPO C-SNP), offering no copay and no coinsurance for over-the-counter items up to $50 every three months, diabetic shoes not covered by Medicare, and additional preventive services. Acupuncture and meal benefits are not covered under this plan.
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