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DEVOTED CHOICE 001 IL (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CHOICE 001 IL (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED CHOICE 001 IL (PPO) in 2026, please refer to our full plan details page.
DEVOTED CHOICE 001 IL (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 2026.
It's important to know that DEVOTED CHOICE 001 IL (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 001 IL (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 001 IL (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 has a $300.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $395.00 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 $7200.00 (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 $7200.00 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 001 IL (PPO) Medicare plan has an annual drug deductible of $395. For generic medications, this plan offers excellent savings with no copay for both Tier 1 (Preferred Generic) and Tier 2 (Generic) drugs at standard pharmacies and standard mail order. This no-copay benefit applies to one-month, two-month, and three-month supplies. For brand-name and specialty drugs, you will pay a percentage of the cost through coinsurance at standard pharmacies or mail order. Tier 3 (Preferred Brand) drugs carry a 23% coinsurance, while Tier 4 (Non-Preferred) drugs have a 25% coinsurance. Specialty Tier 5 medications are covered with a 28% coinsurance for a one-month supply.
Additional Benefits
The DEVOTED CHOICE 001 IL (PPO) plan offers robust medical coverage with no copay and no coinsurance for primary care visits and routine preventive services. For inpatient hospital stays, members pay no coinsurance, though acute stays require a $395 daily copay for the first seven days before dropping to no copay. Specialist visits, mental health services, and routine hearing exams are accessible with a $35 copay and no coinsurance. This plan also features supplemental dental coverage up to a $2,000 annual limit, with no copay for preventive care and up to 50% coinsurance for restorative services. Vision benefits include eyewear with no copay up to a $350 annual limit, while prescription hearing aids are available with copays ranging from no copay up to $299. Additionally, members enjoy no copays for home health care and a $30 quarterly allowance for over-the-counter items.
Inpatient Hospital See details
DEVOTED CHOICE 001 IL (PPO) covers inpatient hospital services with no coinsurance, though prior authorization is required. For acute stays, there is a $395 daily copay for days 1 to 7 and no copay for days 8 and beyond, while psychiatric stays require a $395 daily copay for days 1 to 5 and no copay for days 6 to 90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED CHOICE 001 IL (PPO) covers outpatient services with no coinsurance, featuring a $0 to $495 copay for outpatient hospital services and a $395 copay per stay for observation services. Ambulatory surgical center and blood services require no copay and no coinsurance, while outpatient substance abuse sessions require a $35 copay and no coinsurance.
Partial Hospitalization See details
DEVOTED CHOICE 001 IL (PPO) covers partial hospitalization services with a $70.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance services under DEVOTED CHOICE 001 IL (PPO) require prior authorization, featuring ground ambulance services with a copay ranging from no copay to $350 and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. While transportation services are technically covered, transport to plan-approved or health-related locations is not covered.
Emergency Services See details
DEVOTED CHOICE 001 IL (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services feature no copay to a $45 copay and no coinsurance, and worldwide emergency services are covered up to a $25,000 limit with copays of $130 for emergency or urgent care, and a $350 copay plus 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED CHOICE 001 IL (PPO) covers primary care physician visits with no copay and no coinsurance, while specialist, therapy, and mental health services require a $35 copay and no coinsurance. Telehealth ranges from no copay to a $45 copay with no coinsurance, chiropractic services are partially covered with a $15 copay and no coinsurance (routine and other chiropractic services are not covered), and podiatry is not covered.
Preventive Services See details
Preventive services under DEVOTED CHOICE 001 IL (PPO) are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management. Additional preventive benefits are partially covered with no copay and no coinsurance, but exclude in-home safety assessments, personal emergency response systems, medical nutrition therapy, therapeutic massage, adult day health, home-based palliative care, and in-home support services.
Hearing Services See details
Hearing Services are partially covered by DEVOTED CHOICE 001 IL (PPO), offering routine hearing exams for a $35 copay and no coinsurance, and up to two prescription hearing aids per year with no coinsurance and a copay ranging from no copay to $299. 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 001 IL (PPO) offers partially covered vision services, as other eye exam services are not covered. Covered benefits include one routine eye exam per year with a $0 to $35 copay and no coinsurance, and eyewear with no copay and no coinsurance up to a $350 combined annual limit for both in-network and out-of-network services.
Dental Services See details
Dental services under DEVOTED CHOICE 001 IL (PPO) are partially covered up to a $2,000 annual maximum for both in- and out-of-network care, with Medicare-covered dental requiring a $35 copay and no coinsurance. Most preventive and diagnostic services have no copay and no coinsurance, while restorative, endodontic, and prosthodontic services feature no copay and 0% to 50% coinsurance. Orthodontics, implant services, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
DEVOTED CHOICE 001 IL (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs carry no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the DEVOTED CHOICE 001 IL (PPO) plan with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Medical equipment is partially covered by DEVOTED CHOICE 001 IL (PPO) with no copays and prior authorization required, though diabetic therapeutic shoes and inserts are not covered. Durable medical equipment requires a 20% to 50% coinsurance, while prosthetic devices, medical supplies, and diabetic supplies feature no coinsurance to up to 20% or 50% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED CHOICE 001 IL (PPO) with no coinsurance for diagnostic services, which feature no copay for lab services and diagnostic test copays ranging from $0 to $95. Radiological services require prior authorization and include outpatient X-rays with no copay, diagnostic radiology starting at a $0 copay, and therapeutic radiology with a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by DEVOTED CHOICE 001 IL (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 001 IL (PPO) with no copay and no coinsurance, but require prior authorization. Some services are covered, but cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
DEVOTED CHOICE 001 IL (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a three-day hospital stay is not required prior to admission, additional days beyond the standard 100 days are not covered.
Other Services See details
DEVOTED CHOICE 001 IL (PPO) partially covers other services, offering over-the-counter (OTC) items up to $30 every three months and additional preventive services with no copay and no coinsurance. Acupuncture, meal benefits, and other additional services are not covered under this plan.
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