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DEVOTED CHOICE PREMIUM 002 PA (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CHOICE PREMIUM 002 PA (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED CHOICE PREMIUM 002 PA (PPO) in 2026, please refer to our full plan details page.
DEVOTED CHOICE PREMIUM 002 PA (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Philadelphia Area. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that DEVOTED CHOICE PREMIUM 002 PA (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 PREMIUM 002 PA (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 PREMIUM 002 PA (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $32.70. 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 $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 PREMIUM 002 PA (PPO) Medicare plan features an annual drug deductible of $615 before coverage begins for higher-tier medications. For generic prescriptions, you will pay no copay for Tier 1 preferred generics at standard pharmacies or through standard mail order. Tier 2 generic drugs are also highly affordable, with standard pharmacy copays starting at $3.00 for a 1-month supply and standard mail order copays maxing out at $7.50 for a 3-month supply. For brand-name and specialty medications, this plan utilizes coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 23% coinsurance for standard pharmacy and mail order fills. Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance, with specialty tier coverage limited to a 1-month supply.
Additional Benefits
The DEVOTED CHOICE PREMIUM 002 PA (PPO) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, preventive care, and home health services. Specialist visits require a copay ranging from no copay to $50, while inpatient hospital stays require a $275 daily copay for days 1 through 7 and no copay for days 8 through 90. Emergency room visits carry a $115 copay, which is waived if admitted within 24 hours, and urgent care services range from no copay to a $40 copay. Ancillary benefits include generous dental coverage up to a $4,000 annual maximum, featuring no copay for preventive care and 0% to 50% coinsurance for restorative services. Vision benefits offer routine exams for a copay ranging from no copay to $35 and up to a $350 annual allowance for eyewear, while hearing aids require a $199 to $499 copay. Additionally, members receive a $115 over-the-counter allowance every three months with no copay or coinsurance.
Inpatient Hospital See details
Inpatient hospital services are covered by DEVOTED CHOICE PREMIUM 002 PA (PPO) with no coinsurance, requiring a $275 daily copay for days 1 through 7 and no copay for days 8 through 90 per stay. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric hospital days are not covered.
Outpatient Services See details
DEVOTED CHOICE PREMIUM 002 PA (PPO) covers outpatient services with no coinsurance, though prior authorization is required for most services. There is no copay for ambulatory surgical center and blood services, while outpatient substance abuse sessions have a $35 copay, and outpatient hospital services range from a $0 to $375 copay (including $275 per stay for observation services).
Partial Hospitalization See details
DEVOTED CHOICE PREMIUM 002 PA (PPO) covers partial hospitalization services with a $60.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by DEVOTED CHOICE PREMIUM 002 PA (PPO), as transportation to plan-approved or health-related locations is not covered. Prior authorized ground ambulance services require no copay to a $315 copay and coinsurance, while air ambulance services require a 20% coinsurance and no copay.
Emergency Services See details
DEVOTED CHOICE PREMIUM 002 PA (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if admitted within 24 hours. Urgently needed services are covered with a copay ranging from no copay to $40 and no coinsurance, and worldwide emergency services are covered up to $25,000 with a $115 copay and no coinsurance for emergency or urgent care and a $315 copay and 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED CHOICE PREMIUM 002 PA (PPO) covers primary care physician services with no copay and no coinsurance, while other services like specialist visits, therapies, and mental health care require copays ranging from $0 to $50 with no coinsurance. Podiatry is not covered, and while some chiropractic services are covered, routine and other chiropractic services are not.
Preventive Services See details
Preventive services under the DEVOTED CHOICE PREMIUM 002 PA (PPO) plan are partially covered with no copay and no coinsurance for covered care, which includes annual physical exams, fitness benefits, and kidney disease education. However, several sub-services are not covered, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, extra smoking cessation, enhanced disease management, telemonitoring, remote access technologies, and counseling.
Hearing Services See details
DEVOTED CHOICE PREMIUM 002 PA (PPO) hearing services include routine exams for a $35 copay and no coinsurance, while prescription hearing aids are partially covered with a $199 to $499 copay and no coinsurance. OTC hearing aids, as well as 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 PREMIUM 002 PA (PPO) since other eye exam services are not covered. Routine eye exams carry a $0 to $35 copay and no coinsurance, while eyewear is covered with no copay or coinsurance up to a $350 annual maximum.
Dental Services See details
DEVOTED CHOICE PREMIUM 002 PA (PPO) provides partially covered dental services up to a $4,000 annual maximum, featuring no copay and no coinsurance for preventive care, cleanings, and exams. Medicare-covered dental services require a $35 copay and no coinsurance, restorative services have no copay and 0% to 50% coinsurance, and implants, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
DEVOTED CHOICE PREMIUM 002 PA (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
DEVOTED CHOICE PREMIUM 002 PA (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 PREMIUM 002 PA (PPO) covers durable medical equipment, prosthetics, and medical supplies with no copay and coinsurance ranging from no coinsurance to 20%, though prior authorization is required. Diabetic equipment is partially covered with no copay and up to 20% coinsurance (ranging from no coinsurance to 20%) for supplies, but diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED CHOICE PREMIUM 002 PA (PPO) covers diagnostic and radiological services with prior authorization, offering diagnostic services with no coinsurance, no copay for lab services, and a copay of $0 to $95 for diagnostic tests. Radiological services feature no copay for outpatient X-rays, copays starting at $0 for diagnostic radiology, and a minimum coinsurance of 20 for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by the DEVOTED CHOICE PREMIUM 002 PA (PPO) plan with no copay and no coinsurance. Prior authorization is required to access these benefits.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered under the DEVOTED CHOICE PREMIUM 002 PA (PPO) plan with no copay, no coinsurance, and prior authorization required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered in practice.
Skilled Nursing Facility (SNF) See details
DEVOTED CHOICE PREMIUM 002 PA (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by DEVOTED CHOICE PREMIUM 002 PA (PPO), offering no copay and no coinsurance for additional preventive services and over-the-counter (OTC) items with a $115 allowance every three months. Acupuncture, meal benefits, and dual-eligible SNP services are not covered under this benefit.
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