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DEVOTED CHOICE 003 KY (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CHOICE 003 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 003 KY (PPO) in 2026, please refer to our full plan details page.
DEVOTED CHOICE 003 KY (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 2026.
It's important to know that DEVOTED CHOICE 003 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 003 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 003 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 $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 003 KY (PPO) Medicare plan features an annual prescription drug deductible of $375. For generic medications, this plan offers savings with no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) drugs filled at standard pharmacies or through standard mail order. This cost-free coverage applies to one-month, two-month, and three-month prescriptions. For brand-name and specialty medications, costs are based on coinsurance rather than flat copays. You will pay a 19% coinsurance for Tier 3 (Preferred Brand) drugs and a 25% coinsurance for Tier 4 (Non-Preferred) drugs. Tier 5 (Specialty) drugs require a 28% coinsurance for a one-month supply at standard pharmacies and standard mail order.
Additional Benefits
The DEVOTED CHOICE 003 KY (PPO) plan offers comprehensive medical coverage with no copay for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay a $325 daily copay for the first 7 days and no copay for days 8 through 90, while specialist visits require a $40 copay. Emergency room visits carry a $130 copay, which is waived if admitted, and urgent care ranges from no copay to a $45 copay. This plan also features valuable supplemental benefits, including up to $3,500 annually for dental care with no copay for preventive services and a $350 annual allowance for eyewear with no copay. Additionally, members benefit from hearing aid coverage with copays between $399 and $699, alongside a $100 allowance every three months for over-the-counter items. Most covered services under this plan feature no coinsurance, helping to keep your health care costs predictable.
Inpatient Hospital See details
DEVOTED CHOICE 003 KY (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $325 daily copay for days 1 through 7 and no copay for days 8 through 90 per stay. Unlimited additional days are covered for acute care, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
DEVOTED CHOICE 003 KY (PPO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services which carry no copays. Outpatient hospital services have a $0 to $425 copay (or a $325 copay per stay for observation services) with no coinsurance, while outpatient substance abuse sessions require a $40 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by DEVOTED CHOICE 003 KY (PPO) with a $60.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
DEVOTED CHOICE 003 KY (PPO) covers ambulance services with prior authorization, offering ground ambulance services with a copay ranging from no copay to $315 and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered by DEVOTED CHOICE 003 KY (PPO) with a $130 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours. Urgently needed services require no copay to a $45 copay and no coinsurance, while worldwide emergency services are covered up to $25,000 with a $130 copay (no coinsurance) for care and a $315 copay with 20% coinsurance for transportation.
Primary Care See details
DEVOTED CHOICE 003 KY (PPO) provides primary care physician services with no copay and no coinsurance, and specialist visits for a $40 copay with no coinsurance. Therapy services require a $40 to $50 copay with no coinsurance, telehealth ranges from a $0 to $45 copay with no coinsurance, podiatry is not covered, and some chiropractic services are covered but routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by DEVOTED CHOICE 003 KY (PPO) with no copay and no coinsurance, including annual physical exams, kidney disease education, and select wellness programs. This benefit is partially covered, as several sub-services such as in-home support, personal emergency response systems (PERS), and telemonitoring are not covered.
Hearing Services See details
DEVOTED CHOICE 003 KY (PPO) covers hearing services with no deductible and no coinsurance, featuring a $40 copay for an annual routine hearing exam and coverage for unlimited fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $399.00 to $699.00 for up to two devices per year, though inner ear, outer ear, over the ear, and over-the-counter hearing aids are not covered.
Vision Services See details
DEVOTED CHOICE 003 KY (PPO) vision services are partially covered, offering one routine eye exam per year with a $0 to $40 copay and no coinsurance, while other eye exam services are not covered. Eyewear, including contacts and eyeglasses, is covered with no copay and no coinsurance up to a $350 combined annual maximum.
Dental Services See details
DEVOTED CHOICE 003 KY (PPO) offers partially covered dental services with up to a $3,500 annual maximum for both in- and out-of-network care, featuring no copay and no coinsurance for preventive care. While comprehensive services have no copay and 0% to 50% coinsurance, implants, orthodontics, and maxillofacial prosthetics are not covered, and Medicare-covered dental requires a $40 copay and no coinsurance.
Home Infusion bundled Services See details
Home infusion bundled services are covered by DEVOTED CHOICE 003 KY (PPO) with no copay, though prior authorization and step therapy may apply. Covered Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while Part B insulin drugs have a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by DEVOTED CHOICE 003 KY (PPO) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
DEVOTED CHOICE 003 KY (PPO) partially covers medical equipment with no copay, charging a 20% coinsurance for durable medical equipment and no coinsurance to 20% coinsurance for prosthetics, medical supplies, and diabetic supplies. Diabetic therapeutic shoes and inserts are not covered, and prior authorization is required for covered equipment.
Diagnostic and Radiological Services See details
DEVOTED CHOICE 003 KY (PPO) covers diagnostic and radiological services with prior authorization, offering no copay for lab and outpatient X-ray services and no coinsurance for diagnostic tests. Diagnostic procedures and tests have a copay ranging from $0 to $95, while therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
DEVOTED CHOICE 003 KY (PPO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered in practice under DEVOTED CHOICE 003 KY (PPO), despite having no coinsurance. Individual services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
DEVOTED CHOICE 003 KY (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not necessary, and additional days beyond the standard Medicare limit are not covered.
Other Services See details
DEVOTED CHOICE 003 KY (PPO) provides partial coverage for other services, which includes over-the-counter (OTC) items (up to $100 every three months) and additional preventive services with no copay and no coinsurance. Acupuncture, meal benefits, and dual-eligible SNP services are not covered.
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