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DEVOTED CHOICE 010 PA (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CHOICE 010 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 010 PA (PPO) in 2026, please refer to our full plan details page.
DEVOTED CHOICE 010 PA (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Western Pennsylvania Area. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that DEVOTED CHOICE 010 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 010 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 010 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 $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 $10100.00 (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 $10100.00 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 010 PA (PPO) Medicare plan features an annual prescription drug deductible of $375. For Tier 1 (Preferred Generic) and Tier 2 (Generic) medications, you will pay no copay for 1-month, 2-month, or 3-month supplies filled at standard pharmacies or through standard mail order. This benefit offers significant savings for members who rely on common generic prescriptions. For higher-tier medications, your costs are based on coinsurance percentages 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 Drug) prescriptions at standard pharmacies and standard mail order. Tier 5 (Specialty Tier) medications require a 28% coinsurance for a 1-month supply.
Additional Benefits
The DEVOTED CHOICE 010 PA (PPO) Medicare plan offers robust medical coverage with predictable costs, featuring no copay and no coinsurance for primary care visits and home health services. For hospital care, inpatient stays require a $295 daily copay for the first five days and no copay for days six through 90, while outpatient hospital services range from no copay up to a $395 copay. Emergency room visits have a $130 copay, which is waived if you are admitted, and urgent care services feature a copay ranging from no copay up to $45. This plan also includes valuable supplemental benefits, such as preventive dental care with no copay and comprehensive dental coverage up to a $3,000 annual limit. Additionally, members benefit from eyewear coverage up to a $350 annual allowance with no copay, routine hearing exams for a $30 copay, and an over-the-counter benefit of $100 every three months. Specialist visits and outpatient mental health services are also highly affordable, requiring just a $30 copay and no coinsurance.
Inpatient Hospital See details
DEVOTED CHOICE 010 PA (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $295 daily copay for days 1 through 5 and no copay for days 6 through 90. Unlimited additional days are covered for acute care, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED CHOICE 010 PA (PPO) covers outpatient services with no coinsurance, featuring a $0 to $395 copay for outpatient hospital services and a $295 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while individual and group outpatient substance abuse sessions require a $30 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization benefits are covered by DEVOTED CHOICE 010 PA (PPO) with a $60.00 copayment and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
DEVOTED CHOICE 010 PA (PPO) covers ambulance services with prior authorization, featuring ground ambulance services with a copay ranging from no copay to $375 plus coinsurance, and air ambulance services with a 20% coinsurance and a copay. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
DEVOTED CHOICE 010 PA (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are 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 with a $130 copay and no coinsurance, while worldwide emergency transportation requires a $375 copay and 20% coinsurance.
Primary Care See details
DEVOTED CHOICE 010 PA (PPO) provides primary care physician services with no copay and no coinsurance, while specialist, mental health, psychiatric, and opioid treatment services require a $30 copay and no coinsurance. Physical, occupational, and speech therapies have a $30 to $50 copay with no coinsurance, telehealth is offered with a $0 to $45 copay and no coinsurance, and chiropractic and podiatry services are not covered.
Preventive Services See details
DEVOTED CHOICE 010 PA (PPO) offers partially covered preventive services with no copay and no coinsurance for covered care such as annual physicals, fitness benefits, and diabetes training. Excluded sub-services include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, therapeutic massage, adult day health, palliative care, in-home support, caregiver support, tobacco cessation counseling, disease management, telemonitoring, remote access technologies, and counseling services.
Hearing Services See details
DEVOTED CHOICE 010 PA (PPO) covers routine hearing exams for a $30 copay and no coinsurance, with no deductible required. Prescription hearing aids are partially covered with a copay ranging from $399 to $699 and no coinsurance for up to two devices per year, but OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
DEVOTED CHOICE 010 PA (PPO) offers partially covered vision services, including one routine eye exam per year with a $0 to $30 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay or coinsurance, providing up to a $350 annual combined maximum benefit for contacts, lenses, frames, and upgrades.
Dental Services See details
DEVOTED CHOICE 010 PA (PPO) covers dental services up to a $3,000 annual maximum, offering preventive care with no copay and no coinsurance. Restorative, endodontic, and prosthodontic services require no copay and 0% to 50% coinsurance, while Medicare-covered dental has a $30 copay and no coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by DEVOTED CHOICE 010 PA (PPO) with no copay, though prior authorization is required. Covered Medicare Part B insulin drugs require a $35 copay and 0% (no coinsurance) to 20% coinsurance, while chemotherapy and other Part B drugs have no copay and 0% (no coinsurance) to 20% coinsurance.
Dialysis Services See details
DEVOTED CHOICE 010 PA (PPO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Medical equipment benefits under DEVOTED CHOICE 010 PA (PPO) feature no copay and coinsurance ranging from 0% to 20%, with prior authorization required. Durable medical equipment, medical supplies, and prosthetics are covered, while diabetic equipment is partially covered as diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED CHOICE 010 PA (PPO) covers diagnostic services with no coinsurance, offering no copay for lab services and a $0 to $95 copay for diagnostic procedures and tests. Radiological services are also covered with no copay for outpatient X-rays, copays starting at $0 for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology, with prior authorization required for both.
Home Health Services See details
Home Health Services are covered under DEVOTED CHOICE 010 PA (PPO) with no copay and no coinsurance, though prior authorization is required for these services.
Cardiac Rehabilitation Services See details
DEVOTED CHOICE 010 PA (PPO) partially covers Cardiac Rehabilitation Services with no coinsurance, though prior authorization is required. While some services are covered, standard Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, and Pulmonary Rehabilitation are not covered (each with a $30 copay), and Supervised Exercise Therapy (SET) for symptomatic PAD is also not covered (with a $25 copay).
Skilled Nursing Facility (SNF) See details
DEVOTED CHOICE 010 PA (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance and requires no prior 3-day inpatient hospital stay, though prior authorization is required. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, while additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by DEVOTED CHOICE 010 PA (PPO), which provides over-the-counter (OTC) items up to $100 every three months and additional preventive services with no copay and no coinsurance. Acupuncture and meal benefits are not covered under this plan.
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