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Devoted CHOICE Kentucky (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Devoted CHOICE Kentucky (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Devoted CHOICE Kentucky (PPO) in 2025, please refer to our full plan details page.
Devoted CHOICE Kentucky (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Northern Kentucky-Greater Cincinnati. The overall rating for this plan is not yet available for 2025.
It's important to know that Devoted CHOICE Kentucky (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 Kentucky (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 Kentucky (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 $9250.00 (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 $9250.00 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 Kentucky (PPO) plan has an enhanced alternative drug benefit. The plan has a deductible of $590.00. After the deductible, you'll pay 25% coinsurance for most drugs. However, there is no copay for preferred generic drugs purchased through a standard or mail-order pharmacy. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Devoted CHOICE Kentucky (PPO) plan offers a range of healthcare benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services, including substance abuse treatment, have copays ranging from $0 to $425. Emergency and urgent care services are covered, with copays, and ambulance services require prior authorization and have either a copay or coinsurance. The plan covers primary care, preventive services, hearing, vision, dental, and other specialized services, each with its own cost structure. For example, primary care visits and specialist visits have copays, and hearing aids, vision exams, and dental services also have copays. Additionally, the plan covers home health services and skilled nursing facility stays with specific copayments, and also covers medical equipment, home infusion services, and dialysis services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered, with a copay of $325 for days 1-7 and no copay for days 8-90. Additional days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay ranging from $0 to $425, and observation services with a $325 copay. Ambulatory Surgical Center (ASC) Services have no copay, and outpatient substance abuse services have a $40 copay for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered with a $60 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Devoted CHOICE Kentucky (PPO) plan, with prior authorization required for all ambulance services. Ground Ambulance Services have a copay between $0 and $285, 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. Emergency Services have a $125 copay, and the copay is waived if admitted to the hospital within 24 hours. Urgently Needed Services have a copay between $0 and $45. Worldwide Emergency Transportation has a 20% coinsurance and a $285 copay, while Worldwide Emergency Coverage and Worldwide Urgent Coverage each have a $125 copay.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services, Chiropractic Services, Occupational Therapy, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Chiropractic Services have a $20 copay, and routine chiropractic care is not covered. Occupational Therapy has a minimum copay of $40 and a maximum copay of $45. Physician Specialist Services have a $40 copay. Individual and Group Sessions for Mental Health and Psychiatric Services have a $40 copay. Physical Therapy and Speech-Language Pathology Services have a copay between $40 and $50. Additional Telehealth Benefits have a copay between $0 and $40, while Opioid Treatment Program Services have a $40 copay.
Preventive Services See details
The Devoted CHOICE Kentucky (PPO) plan covers preventive services, including annual physical exams, health education, weight management programs, alternative therapies, nutritional/dietary benefits, fitness benefits, home and bathroom safety devices and modifications, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit. However, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission prevention, wigs for chemotherapy-related hair loss, 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.
Hearing Services See details
Hearing Services include routine hearing exams with a $40 copay, and fitting/evaluation for hearing aids. Prescription hearing aids are covered, with a copay between $399 and $699, depending on the type, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, nor are OTC hearing aids.
Vision Services See details
Vision services include eye exams with a $40 copay. Eyewear has a combined maximum benefit of $1000 per year for both in-network and out-of-network services.
Dental Services See details
The Devoted CHOICE Kentucky (PPO) plan covers dental services, including oral exams, dental x-rays, and other diagnostic and preventive services with no copay. Medicare dental services have a $40 copay and require prior authorization, and other services are covered up to a maximum of $1000 per year. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but prior authorization is required. For Medicare Part B Insulin Drugs, you will pay a $35 copay and 20% coinsurance; for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, you will pay between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Devoted CHOICE Kentucky (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Devoted CHOICE Kentucky (PPO) plan, including Durable Medical Equipment (DME) with 0% to 19% coinsurance, and Prosthetics/Medical Supplies with 0% to 20% coinsurance for specific services, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered. Durable Medical Equipment for use outside the home is also not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic and radiological services, diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services are covered. Diagnostic Procedures/Tests have a copay between $0 and $95, while Lab Services and Outpatient X-Ray Services have no copay. Diagnostic Radiological Services have a copay up to $300, and Therapeutic Radiological Services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the Devoted CHOICE Kentucky (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 covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. The plan has a copay for some Cardiac Rehabilitation Services, but the specific amount is not detailed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Devoted CHOICE Kentucky (PPO), but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Devoted CHOICE Kentucky (PPO) plan does not cover acupuncture, over-the-counter items, or meal benefits. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and Case Management are also not covered.
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