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DEVOTED CHOICE 001 KY (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CHOICE 001 KY (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED CHOICE 001 KY (PPO) in 2026, please refer to our full plan details page.
DEVOTED CHOICE 001 KY (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Kentucky. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED CHOICE 001 KY (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 001 KY (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 001 KY (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 $375.00 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 $9650.00 (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 $9650.00 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 001 KY (PPO) Medicare plan features an annual drug deductible of $375. For prescription drugs in Tier 1 (Preferred Generic) and Tier 2 (Generic), members enjoy no copay for one-month, two-month, or three-month supplies filled at standard pharmacies or through standard mail order. This ensures that essential generic medications remain highly affordable under this plan. For higher-tier medications, cost-sharing transitions to coinsurance. Tier 3 (Preferred Brand) drugs require a 19% coinsurance, while Tier 4 (Non-Preferred Drug) medications carry a 25% coinsurance for standard pharmacy and mail-order fills. Specialty drugs in Tier 5 are subject to a 28% coinsurance for a one-month supply.
Additional Benefits
The DEVOTED CHOICE 001 KY (PPO) plan offers comprehensive medical coverage with no copay for primary care visits, while specialist visits require a $40 copay. For hospital stays, members pay a $345 daily copay for the first several days of inpatient care and no copay for longer stays, alongside a $130 copay for emergency room visits. Outpatient services feature no coinsurance, with copays ranging from no copay for ambulatory surgery to up to $445 for outpatient hospital services. This plan also includes dental, vision, and hearing benefits, featuring a $3,500 annual maximum for dental care with no copay for preventive services, and a $350 annual allowance for eyewear. Members also benefit from a $100 quarterly allowance for over-the-counter items with no copay or coinsurance, though medical equipment and dialysis require a 20% to 25% coinsurance. Skilled nursing facility stays are covered with no copay for the first 20 days, followed by a $218 daily copay up to day 100.
Inpatient Hospital See details
DEVOTED CHOICE 001 KY (PPO) covers inpatient hospital services with no coinsurance, though upgrades and non-Medicare-covered stays are not covered. For acute stays, you pay a $345 daily copay for days 1 through 7 and no copay for days 8 and beyond, while psychiatric stays require a $345 daily copay for days 1 through 6 and no copay for days 7 through 90.
Outpatient Services See details
DEVOTED CHOICE 001 KY (PPO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copay. Outpatient hospital services have a copay of $0 to $445, observation services require a $345 copay per stay, and outpatient substance abuse sessions require a $40 copay.
Partial Hospitalization See details
DEVOTED CHOICE 001 KY (PPO) covers partial hospitalization services with a $60.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services under DEVOTED CHOICE 001 KY (PPO) cover ground ambulance services with no coinsurance and a copay of up to $315, and air ambulance services with a 20% coinsurance and no copay. Prior authorization is required for all ambulance services, and transportation services are not covered.
Emergency Services See details
DEVOTED CHOICE 001 KY (PPO) covers emergency services with a $130 copay (waived if admitted within 24 hours) and no coinsurance, and urgent care with no copay to a $45 copay and no coinsurance. Worldwide emergency and urgent services are covered up to a $25,000 maximum with a $130 copay and no coinsurance, while worldwide emergency transportation requires a $315 copay and 20% coinsurance.
Primary Care See details
DEVOTED CHOICE 001 KY (PPO) covers primary care physician services with no copay and telehealth services with a $0 to $45 copay, both featuring no coinsurance. Specialist visits, mental health, and psychiatric services require a $40 copay and no coinsurance, while physical, occupational, and speech therapies have a $40 to $50 copay and no coinsurance. Chiropractic and podiatry services are not covered under this plan.
Preventive Services See details
DEVOTED CHOICE 001 KY (PPO) offers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive benefits are partially covered with no copay and no coinsurance, excluding services such as in-home support, counseling, therapeutic massage, and personal emergency response systems.
Hearing Services See details
Hearing services are partially covered by DEVOTED CHOICE 001 KY (PPO), offering routine hearing exams for a $40 copay and prescription hearing aids with a copay of $399 to $699, both with no coinsurance. While fitting evaluations are covered, OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by DEVOTED CHOICE 001 KY (PPO), offering one routine eye exam per year with a $0 to $40 copay, no coinsurance, and no deductible, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and a $350 annual combined maximum benefit for contacts, frames, lenses, and upgrades.
Dental Services See details
DEVOTED CHOICE 001 KY (PPO) offers partially covered dental services with a $3,500 yearly maximum, featuring no copay and no coinsurance for preventive care, and a $40 copay with no coinsurance for Medicare-covered dental. Comprehensive services generally have no copay and 0% to 50% coinsurance, though maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED CHOICE 001 KY (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy and other drugs require coinsurance ranging from no coinsurance up to 20%, while Part B insulin is covered with a $35 copay and up to 20% coinsurance.
Dialysis Services See details
DEVOTED CHOICE 001 KY (PPO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
DEVOTED CHOICE 001 KY (PPO) covers medical equipment with no copays, though prior authorization is required. Durable medical equipment carries a 20% to 25% coinsurance, prosthetics and medical supplies range from no coinsurance to 20% coinsurance, and diabetic equipment is partially covered with no coinsurance to 25% coinsurance for supplies, while diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED CHOICE 001 KY (PPO) covers diagnostic and radiological services with prior authorization, offering no copay for lab services, outpatient X-rays, and diagnostic radiology. Diagnostic procedures and tests have a copay ranging from $0 to $95 with no coinsurance, while therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by DEVOTED CHOICE 001 KY (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by DEVOTED CHOICE 001 KY (PPO) with no coinsurance, though prior authorization is required. While some services are covered, cardiac rehabilitation ($40 copay), intensive cardiac rehabilitation ($40 copay), pulmonary rehabilitation ($35 copay), and supervised exercise therapy for PAD ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
DEVOTED CHOICE 001 KY (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the standard 100-day Medicare benefit are not covered.
Other Services See details
Other services are partially covered by DEVOTED CHOICE 001 KY (PPO), including over-the-counter items with a $100 quarterly allowance and additional preventive services, both of which have no copay and no coinsurance. Acupuncture, meal benefits, and other select services are not covered under this benefit.
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