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Devoted CHOICE Arizona (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Devoted CHOICE Arizona (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Devoted CHOICE Arizona (PPO) in 2025, please refer to our full plan details page.
Devoted CHOICE Arizona (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Rural Arizona. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Devoted CHOICE Arizona (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 Arizona (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 Arizona (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 $8950.00 (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 $8950.00 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 Arizona (PPO) plan has an "Enhanced Alternative" drug benefit. The plan has a deductible of $590.00. Once the deductible is met, you will pay a $4 copay for preferred generic drugs at standard and mail order pharmacies. For standard generic, preferred brand, and non-preferred drugs, you pay 25% coinsurance. 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 Arizona (PPO) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays. Emergency services have a $125 copay, and primary care visits have no copay, while specialist visits have a $40 copay. The plan also provides coverage for hearing and vision services, with copays for exams and allowances for eyewear. Additional benefits include dental coverage with a $40 copay, home health services with no copay, and coverage for medical equipment and diagnostic services, with varying coinsurance or copays. The plan also covers skilled nursing facility stays with a $0 copay for the first 20 days and a $214 copay for days 21-100, and offers coverage for home infusion bundled services and dialysis services. However, certain services like acupuncture and private duty nursing are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered under the Devoted CHOICE Arizona (PPO) plan. For Inpatient Hospital-Acute, you will pay a $335 copay for days 1-7, and no copay for days 8-90; for Inpatient Hospital Psychiatric, you will pay a $335 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute is covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0-$435, Observation Services with a $335 copay, Ambulatory Surgical Center (ASC) Services with no copay, Individual and Group Sessions for Outpatient Substance Abuse with a $40 copay, and Outpatient Blood Services.
Partial Hospitalization See details
Partial Hospitalization is covered with a $70 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Devoted CHOICE Arizona (PPO) plan. Ground ambulance services have a copay between $0 and $350, while air ambulance services have a 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the Devoted CHOICE Arizona (PPO) plan with a $125 copay and no coinsurance. Urgently Needed Services have a copay between $0 and $45 with no coinsurance, and Worldwide Emergency Services are covered with a $125 copay for Worldwide Emergency and Urgent Coverage, and a $350 copay and 20% coinsurance for Worldwide Emergency Transportation.
Primary Care See details
Primary Care benefits cover primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy with a copay between $40 and $45, physician specialist services with a $40 copay, mental health specialty services with a $40 copay for individual and group sessions, other health care professionals with a copay between $0 and $40, psychiatric services with a $40 copay for individual and group sessions, physical therapy and speech-language pathology services with a copay between $40 and $65, additional telehealth benefits with a copay between $0 and $40, and opioid treatment program services with a $40 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services are covered, including Medicare-covered services with no copay. Some additional preventive services are not covered, including in-home safety assessments, medical nutrition therapy, 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, and counseling services.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $40 copay, as well as Routine Hearing Exams and Fitting/Evaluation for Hearing Aids. Prescription Hearing Aids (all types) are covered with a copay between $399 and $699, but Prescription Hearing Aids for Inner Ear, Outer Ear, and Over the Ear are not covered, and OTC Hearing Aids are not covered.
Vision Services See details
Vision services include eye exams with a $40 copay, and eyewear with a combined maximum benefit of $1500 per year, covering contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Routine eye exams are covered once per year.
Dental Services See details
Devoted CHOICE Arizona (PPO) covers Medicare Dental Services with a $40 copay. Other Dental Services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery. Orthodontic services are covered under diagnostic and preventive dental, and there is a $1,500 maximum benefit per year for both in-network and out-of-network services. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Devoted CHOICE Arizona (PPO) plan, including Medicare Part B Insulin Drugs with a $35 copay and 20% coinsurance, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered under the Devoted CHOICE Arizona (PPO) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical equipment benefits include Durable Medical Equipment (DME) with 0-30% coinsurance and no copay, Prosthetic Devices with 0-20% coinsurance, and Medical Supplies with 20% coinsurance. However, Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services with a copay ranging from $0 to $95, and lab services with no copay. Radiological services have a copay of up to $300 for diagnostic services, and a coinsurance of at least 20% for therapeutic services, while outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered by the Devoted CHOICE Arizona (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 technically covered, but none of the listed services are covered. No copay or coinsurance information is available.
Skilled Nursing Facility (SNF) See details
The Devoted CHOICE Arizona (PPO) plan covers Skilled Nursing Facility (SNF) services, with a $0 copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services are generally not covered under the Devoted CHOICE Arizona (PPO) plan. Specifically, 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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