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DEVOTED CHOICE 010 IL (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CHOICE 010 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 010 IL (PPO) in 2026, please refer to our full plan details page.
DEVOTED CHOICE 010 IL (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2026 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 010 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 010 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 010 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 $250.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $355.00 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 $4900.00 (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 $4900.00 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 IL (PPO) prescription drug plan features an annual drug deductible of $355. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 2 generic medications filled at standard pharmacies or through standard mail order. This coverage applies to one-month, two-month, and three-month supplies of these generic drugs. For brand-name and specialty medications, your costs are determined by coinsurance percentages at standard pharmacies and mail order. You will pay a 19% coinsurance for Tier 3 preferred brand drugs and a 25% coinsurance for Tier 4 non-preferred drugs. Tier 5 specialty drugs require a 28% coinsurance for a one-month supply.
Additional Benefits
The DEVOTED CHOICE 010 IL (PPO) plan offers comprehensive medical coverage with no copay or coinsurance for primary care visits and routine preventive services. Specialist visits, physical therapy, and mental health services require a $40 copay with no coinsurance, while emergency room visits carry a $130 copay. For inpatient hospital stays, members pay a daily copay of $425 for the first seven days of acute stays, after which there is no copay for the remainder of the stay. Supplemental benefits include preventive dental care with no copay up to a $3,000 annual limit and a $400 annual allowance for eyewear with no copay. Routine eye exams feature a copay ranging from no copay to $40, while prescription hearing aids require a copay of $399 to $699. Additionally, members receive a $75 quarterly allowance for over-the-counter items and pay no copay for the first 20 days of a skilled nursing facility stay.
Inpatient Hospital See details
DEVOTED CHOICE 010 IL (PPO) covers inpatient hospital stays with no coinsurance, requiring a daily copay of $425 for days 1-7 of acute stays and days 1-5 of psychiatric stays, with no copay for remaining covered days. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED CHOICE 010 IL (PPO) covers outpatient services with no coinsurance, featuring a $0 to $525 copay for outpatient hospital services and a $425 copay per stay for observation services. Ambulatory surgical center and blood services are available with no copay and no coinsurance, while outpatient substance abuse sessions require a $40 copay and no coinsurance.
Partial Hospitalization See details
DEVOTED CHOICE 010 IL (PPO) covers partial hospitalization with a $70.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance services are covered by DEVOTED CHOICE 010 IL (PPO) with prior authorization, requiring a $0 to $350 copay for ground transport and a 20% coinsurance with no copay for air transport. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
DEVOTED CHOICE 010 IL (PPO) emergency services are covered with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services feature a copay ranging from no copay to $45 with no coinsurance. Worldwide emergency services are covered up to $25,000, with a $130 copay and no coinsurance for emergency or urgent care, and a $350 copay with 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED CHOICE 010 IL (PPO) provides primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, occupational therapy, and mental health services feature a $40 copay and no coinsurance. Telehealth services are available with a $0 to $45 copay and no coinsurance, but podiatry and routine chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by DEVOTED CHOICE 010 IL (PPO) with no copay and no coinsurance for covered services like annual physical exams, kidney disease education, and fitness benefits. The plan does not cover in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, remote access technologies, and counseling services.
Hearing Services See details
DEVOTED CHOICE 010 IL (PPO) partially covers hearing services, offering hearing exams for a $40 copay and no coinsurance. Prescription hearing aids are covered with a copay of $399 to $699 and no coinsurance, but OTC hearing aids and inner ear, outer ear, and over the ear prescription aids are not covered.
Vision Services See details
Vision services are partially covered by DEVOTED CHOICE 010 IL (PPO) because other eye exam services are not covered, though members receive one routine eye exam per year with a $0 to $40 copay, no coinsurance, and no deductible. Eyewear is also covered with no copay, no coinsurance, and no deductible, featuring a $400 annual maximum benefit for contacts, eyeglasses, lenses, frames, and upgrades.
Dental Services See details
DEVOTED CHOICE 010 IL (PPO) dental services are partially covered, with maxillofacial prosthetics, implant services, and orthodontics excluded from coverage. Preventive services feature no copay and no coinsurance under a $3,000 annual limit for both in- and out-of-network care, while other covered services have no copay and 0% to 50% coinsurance, and Medicare-covered dental requires a $40 copay and no coinsurance.
Home Infusion bundled Services See details
DEVOTED CHOICE 010 IL (PPO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs carry a coinsurance ranging from no coinsurance to 20%, while Medicare Part B insulin drugs require a $35 copay and coinsurance from no coinsurance up to 20%.
Dialysis Services See details
Dialysis services are covered by DEVOTED CHOICE 010 IL (PPO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
DEVOTED CHOICE 010 IL (PPO) partially covers medical equipment with no copays, though prior authorization is required. Covered durable medical equipment carries a 20% to 50% coinsurance, while prosthetics, medical supplies, and diabetic supplies range from no coinsurance up to 20% or 50% coinsurance. Diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED CHOICE 010 IL (PPO) covers diagnostic services with no coinsurance, offering lab services with no copay and diagnostic procedures with a copay ranging from $0 to $95. Radiological services require prior authorization and feature outpatient X-rays with no copay, diagnostic radiological services with a $0 minimum copay, and therapeutic radiological services with a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the DEVOTED CHOICE 010 IL (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
DEVOTED CHOICE 010 IL (PPO) covers some Cardiac Rehabilitation Services with no coinsurance and required prior authorization, although cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered in practice. These specific rehabilitation services carry copays ranging from $25 to $40.
Skilled Nursing Facility (SNF) See details
DEVOTED CHOICE 010 IL (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance and requires prior authorization, but does not require a prior 3-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 100 days are not covered.
Other Services See details
DEVOTED CHOICE 010 IL (PPO) partially covers other services, offering over-the-counter (OTC) items with a $75 allowance 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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