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Devoted CHOICE PLUS Pennsylvania (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Devoted CHOICE PLUS Pennsylvania (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Devoted CHOICE PLUS Pennsylvania (PPO) in 2025, please refer to our full plan details page.
Devoted CHOICE PLUS Pennsylvania (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Philadelphia Area. The overall rating for this plan is not yet available for 2025.
It's important to know that Devoted CHOICE PLUS Pennsylvania (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 PLUS Pennsylvania (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 PLUS Pennsylvania (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $18.90. 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 $11300.00 (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 $11300.00 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 PLUS Pennsylvania (PPO) plan has an "Enhanced Alternative" drug benefit. The plan has a deductible of $590.00. After the deductible, you will pay either a copay or coinsurance depending on the drug tier and where you get your prescriptions filled. For example, you will pay $8.00 copay for preferred generic drugs at a standard pharmacy, and 25% coinsurance for standard generic drugs at a standard pharmacy. After your total drug costs reach $2000.00, you pay nothing for covered drugs.
Additional Benefits
The Devoted CHOICE PLUS Pennsylvania (PPO) plan offers a range of benefits, including inpatient hospital stays with a $275 copay for the first seven days, and no copay for days 8-90. Outpatient services have varying copays depending on the service, and the plan also covers services like primary care with no copay, vision and dental services, and home health services with no copay. The plan includes coverage for emergency services, ambulance services, and diagnostic services, with varying copays and coinsurance amounts. The plan also offers coverage for hearing aids, prescription hearing aids, and eyewear, but excludes certain services like cardiac rehabilitation and acupuncture.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $275 copay for days 1-7, and no copay for days 8-90. For Inpatient Hospital Psychiatric, you will pay a $275 copay for days 1-7, and no copay for days 8-90. Additional days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, and additional days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services with a copay between $0 and $375, observation services with a $275 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services, including individual and group sessions, have a copay of $35.00. Outpatient blood services are also covered, with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Devoted CHOICE PLUS Pennsylvania (PPO) plan. You will have a $60 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Devoted CHOICE PLUS Pennsylvania (PPO) plan. Ground ambulance services have a copay between $0 and $300, while air ambulance services have a 20% coinsurance; however, transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Devoted CHOICE PLUS Pennsylvania (PPO) plan. For Emergency Services, there is a $110 copay, and no coinsurance; for Urgently Needed Services, there is a copay between $0 and $45, and no coinsurance; and for Worldwide Emergency Transportation, there is a $300 copay and 20% coinsurance, while Worldwide Emergency Coverage and Worldwide Urgent Coverage each have a $110 copay and no coinsurance.
Primary Care See details
The Devoted CHOICE PLUS Pennsylvania (PPO) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $15 copay, Occupational Therapy Services with a $35 copay, Physician Specialist Services with a copay between $0 and $35, Mental Health Specialty Services with a $35 copay for individual and group sessions, Other Health Care Professional Services with a copay between $0 and $35, Psychiatric Services with a $35 copay for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with a copay between $35 and $50, Additional Telehealth Benefits with a copay between $0 and $35, and Opioid Treatment Program Services with a $35 copay. Routine Chiropractic Care is not covered.
Preventive Services See details
The Devoted CHOICE PLUS Pennsylvania (PPO) plan covers preventive services, including Medicare-covered preventive services, annual physical exams, health education, personal emergency response systems, weight management programs, alternative therapies, nutritional/dietary benefits, fitness benefits, home and bathroom safety devices, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs. However, in-home safety assessments, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, 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 $35 copay for 1 visit per year and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $199 and $499 for 2 visits per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and neither are OTC hearing aids.
Vision Services See details
The Devoted CHOICE PLUS Pennsylvania (PPO) plan covers vision services, including eye exams with a $35 copay. Eyewear is also covered, with a combined maximum benefit of $1250 every year for both in-network and out-of-network services, as are contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
Devoted CHOICE PLUS Pennsylvania (PPO) covers dental services, including oral exams with a $35 copay, dental x-rays, other diagnostic services, fluoride treatments, and other preventive services. Prophylaxis (cleaning) is covered with a $35 copay for 2 visits per year, while orthodontics is covered up to a maximum of $1250 per year. However, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and 20% coinsurance; other services have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Devoted CHOICE PLUS Pennsylvania (PPO) plan. There is a 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment benefits are covered by the Devoted CHOICE PLUS Pennsylvania (PPO) plan, with Durable Medical Equipment (DME) subject to 0-20% coinsurance and no copay. Prosthetic Devices have 0-20% coinsurance and no copay, while Medical Supplies have a 20% coinsurance with no copay. Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests with a copay ranging from $0 to $95, lab services with no copay, diagnostic radiological services with a copay of up to $300, therapeutic radiological services with up to 20% coinsurance, and outpatient X-ray services with no copay. Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered under the Devoted CHOICE PLUS Pennsylvania (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Devoted CHOICE PLUS Pennsylvania (PPO) plan. While the plan states that Cardiac Rehabilitation Services are covered, the plan does not cover any of the sub-services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Devoted CHOICE PLUS Pennsylvania (PPO) plan, but require prior authorization. For days 1-20 and 61-100, there is no copay, while days 21-60 have a $214 copay. Additional days beyond Medicare and non-Medicare stays are not covered.
Other Services See details
The Devoted CHOICE PLUS Pennsylvania (PPO) plan does not cover acupuncture, over-the-counter (OTC) items, or meal benefits. In addition, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are also not covered.
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