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DEVOTED CHOICE 007 PA (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CHOICE 007 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 007 PA (PPO) in 2026, please refer to our full plan details page.
DEVOTED CHOICE 007 PA (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Eastern Pennsylvania. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that DEVOTED CHOICE 007 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 007 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 007 PA (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 $450.00 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 007 PA (PPO) Medicare prescription drug plan features an annual drug deductible of $450. For Tier 1 preferred generic and Tier 2 generic medications, members pay no copay for one-month, two-month, or three-month supplies filled at standard pharmacies or through standard mail order. This structure helps keep everyday generic prescription costs highly affordable for members. For brand-name and specialty medications, costs are shared through coinsurance. Tier 3 preferred brand and Tier 4 non-preferred drugs require a 25% coinsurance for one-month, two-month, and three-month supplies. Tier 5 specialty drugs require a 27% coinsurance for a one-month supply at standard pharmacies or through standard mail order.
Additional Benefits
The DEVOTED CHOICE 007 PA (PPO) plan offers comprehensive coverage featuring no copay and no coinsurance for primary care visits, preventive care, and home health services. For specialized medical needs, members pay a $40 copay with no coinsurance for specialist visits, while routine dental care is covered with no copay up to a $2,500 annual limit. Routine vision exams range from no copay to a $40 copay, and eyewear is covered with no copay up to a $200 yearly maximum. For more intensive medical care, inpatient hospital stays require a $350 daily copay for the first several days with no coinsurance, while emergency room visits carry a $130 copay. Skilled nursing facility stays feature no copay for the first 20 days, and diagnostic lab services and outpatient X-rays are also available with no copay. Additionally, the plan provides extra value with an over-the-counter item allowance of up to $75 every three months with no copay.
Inpatient Hospital See details
DEVOTED CHOICE 007 PA (PPO) offers inpatient hospital coverage with no coinsurance, requiring a $350 daily copay for days 1 to 7 of acute stays (no copay for days 8 and beyond) and a $350 daily copay for days 1 to 5 of psychiatric stays (no copay for days 6 to 90). This benefit is partially covered as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by DEVOTED CHOICE 007 PA (PPO) with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay ranging from $0 to $450, observation services carry a $350 copay per stay, and substance abuse sessions cost a $40 copay, with prior authorization required for most services.
Partial Hospitalization See details
DEVOTED CHOICE 007 PA (PPO) covers partial hospitalization services with a $60 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Ambulance services are covered by DEVOTED CHOICE 007 PA (PPO) with prior authorization, requiring a copay of no copay to $315 plus coinsurance for ground transport, and a 20% coinsurance plus a copay for air transport. Transportation services are not covered.
Emergency Services See details
DEVOTED CHOICE 007 PA (PPO) covers emergency services with a $130 copay and no coinsurance (waived if admitted to the hospital within 24 hours), and urgently needed services with a copay ranging from no copay to $45 and no coinsurance. Worldwide emergency and urgent care are covered up to a $25,000 maximum benefit with a $130 copay and no coinsurance, while worldwide emergency transportation requires a $315 copay and 20% coinsurance.
Primary Care See details
DEVOTED CHOICE 007 PA (PPO) features primary care doctor visits with no copay and no coinsurance, while specialists, mental health, psychiatric, and opioid treatment services require a $40 copay and no coinsurance. Physical, occupational, and speech therapies have a $40 to $50 copay and no coinsurance, telehealth services range from no copay to a $45 copay with no coinsurance, and chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by DEVOTED CHOICE 007 PA (PPO) with no copay and no coinsurance, which includes annual physical exams, kidney disease education, and diabetes self-management training. Additional preventive services are partially covered with no copay and no coinsurance, but do not cover in-home safety assessments, personal emergency response systems (PERS), 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 counseling, enhanced disease management, telemonitoring, remote access technologies, and counseling.
Hearing Services See details
Hearing services are partially covered under the DEVOTED CHOICE 007 PA (PPO) plan, offering routine hearing exams for a $40 copay and no coinsurance, and up to two prescription hearing aids per year for a $399 to $699 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
DEVOTED CHOICE 007 PA (PPO) covers vision services with no coinsurance, offering one routine eye exam per year with a $0 to $40 copay, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance, providing up to a $200 yearly combined maximum for contacts, eyeglasses, and upgrades.
Dental Services See details
Dental Services are partially covered by DEVOTED CHOICE 007 PA (PPO) up to a $2,500 annual limit, though maxillofacial prosthetics, implant services, and orthodontics are not covered. Preventive and some comprehensive dental care options require no copay and no coinsurance, while other comprehensive services have no copay and no coinsurance to 50% coinsurance. Medicare-covered dental services are available with a $40 copay and no coinsurance.
Home Infusion bundled Services See details
DEVOTED CHOICE 007 PA (PPO) covers home infusion bundled services with no copay, subject to prior authorization. Medicare Part B chemotherapy, radiation, and other drugs carry no coinsurance to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the DEVOTED CHOICE 007 PA (PPO) plan with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
DEVOTED CHOICE 007 PA (PPO) covers durable medical equipment with no copay and 20% to 50% coinsurance, and prosthetics with no copay and no coinsurance to 20% coinsurance. Diabetic equipment is partially covered with no copay and no coinsurance to 50% coinsurance, though diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED CHOICE 007 PA (PPO) covers diagnostic and radiological services with prior authorization required for all care. Lab services and outpatient X-rays have no copay, diagnostic procedures and tests carry a copay of $0 to $95 with no coinsurance, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by DEVOTED CHOICE 007 PA (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by DEVOTED CHOICE 007 PA (PPO) with no coinsurance and require prior authorization. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered by this plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by DEVOTED CHOICE 007 PA (PPO) with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. This partially covered benefit features no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, while additional days beyond the Medicare limit are not covered.
Other Services See details
DEVOTED CHOICE 007 PA (PPO) partially covers other services, providing over-the-counter (OTC) items (up to $75 every three months) and additional preventive services with no copay and no coinsurance. However, acupuncture, meal benefits, and dual-eligible SNP services are not covered under this plan.
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