A non-government entity
Devoted CHOICE Illinois (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Devoted CHOICE Illinois (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Devoted CHOICE Illinois (PPO) in 2025, please refer to our full plan details page.
Devoted CHOICE Illinois (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Greater Chicago. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Devoted CHOICE Illinois (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 Illinois (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 Illinois (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 $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 $6200.00 (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 $6200.00 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 Illinois (PPO) plan has an enhanced alternative drug benefit. The plan has a deductible of $590.00. In the initial coverage phase, after the deductible, you pay a $5 copay for preferred generic drugs at standard and mail order pharmacies, and 25% coinsurance for standard generic, preferred brand, and non-preferred drugs. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Devoted CHOICE Illinois (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays will cost you a $325 copay for days 1-7, and no copay for days 8-90. Outpatient services have copays ranging from $0 to $425, and emergency services have a $140 copay. This plan also covers primary care, vision, and dental services. Primary care has a $0-$30 copay for a variety of services, and eye exams and dental oral exams have a $10 copay. You will also have access to hearing exams with a $10 copay, and a combined maximum benefit of $2000 per year for eyewear.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization. For Inpatient Hospital-Acute, you'll pay a $325 copay for days 1-7, and no copay for days 8-90; Inpatient Hospital Psychiatric has the same cost structure.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay ranging from $0 to $425, and observation services with a $325 copay. Ambulatory Surgical Center (ASC) Services have no copay, while outpatient substance abuse individual and group sessions have a copay of $30. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Devoted CHOICE Illinois (PPO) plan, but requires prior authorization. You will have a $70 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Devoted CHOICE Illinois (PPO). Ground ambulance services have a copay between $0 and $350, while air ambulance services have a 20% coinsurance; 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 Illinois (PPO) plan. Emergency Services have a $140 copay, while Urgently Needed Services have a copay between $0 and $45. Worldwide Emergency Transportation has a $350 copay and 20% coinsurance, and Worldwide Emergency Coverage and Worldwide Urgent Coverage each have a $140 copay.
Primary Care See details
The Devoted CHOICE Illinois (PPO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a copay between $0 and $30, physician specialist services with a copay between $0 and $30, mental health specialty services with a $30 copay for individual and group sessions, other health care professional services with a copay between $0 and $30, psychiatric services with a $30 copay for individual and group sessions, physical therapy and speech-language pathology services with a copay between $0 and $30, additional telehealth benefits with a copay between $0 and $30, and opioid treatment program services with a $30 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, annual physical exams, health education, Personal Emergency Response System (PERS), Weight Management Programs, Alternative Therapies, Nutritional/Dietary Benefit, Fitness Benefit, Home and Bathroom Safety Devices and Modifications, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. However, In-Home Safety Assessment, Medical Nutrition Therapy (MNT), 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 (including Web/Phone-based technologies and Nursing Hotline), and Counseling Services are not covered.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $10 copay, fitting/evaluation for hearing aids, and prescription hearing aids. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC hearing aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams with a $10 copay, and eyewear with a combined maximum benefit of $2000 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The Devoted CHOICE Illinois (PPO) plan covers dental services including oral exams for no copay, with a $2,000 maximum benefit per year, but does not cover maxillofacial prosthetics, implant services, and orthodontics. Medicare dental services have a $30 copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Devoted CHOICE Illinois (PPO) plan, including Medicare Part B Insulin Drugs with a $35 copay and 20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with up to 20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Devoted CHOICE Illinois (PPO) plan. The coinsurance for dialysis services is between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 30%, Prosthetic Devices with a coinsurance between 0% and 20%, and Medical Supplies with a 20% coinsurance, but does not cover Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts. There is no copay for any of these services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures and tests with a copay between $0 and $95, and lab services with no copay. Radiological services include coverage for diagnostic radiological services with a copay up to $250, therapeutic radiological services with a coinsurance of at least 20%, and outpatient X-ray services with no copay.
Home Health Services See details
Home Health Services are covered by the Devoted CHOICE Illinois (PPO) plan with no copay and no coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Devoted CHOICE Illinois (PPO) plan. Although the plan states that it covers Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, it does not cover any of them.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Devoted CHOICE Illinois (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
Other Services are not covered, as acupuncture, over-the-counter items, meal benefits, dual eligible SNPs with highly integrated services, 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 not covered.
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