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DEVOTED CHOICE 003 AZ (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CHOICE 003 AZ (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED CHOICE 003 AZ (PPO) in 2026, please refer to our full plan details page.
DEVOTED CHOICE 003 AZ (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Pima County. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that DEVOTED CHOICE 003 AZ (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 003 AZ (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 003 AZ (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 $595.00 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 003 AZ (PPO) Medicare plan features an annual prescription drug deductible of $595.00 before initial coverage benefits begin. During the initial coverage phase, Tier 1 preferred generic drugs have no copay at standard pharmacies and standard mail. For other tiers, you will pay a 24% coinsurance for Tier 2 standard generics and a 25% coinsurance for Tier 3 preferred brand and Tier 4 non-preferred drugs. These initial coverage rates apply until your total drug costs reach $2,100.00, at which point you transition to the next phase. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs.
Additional Benefits
The DEVOTED CHOICE 003 AZ (PPO) plan offers comprehensive medical coverage with predictable costs, featuring no coinsurance for inpatient hospital stays and a $335 daily copay for the first several days. Outpatient services are available with no coinsurance and copays ranging from no copay up to $435, while emergency room visits require a $130 copay that is waived upon admission. Primary care visits and routine preventive services are highly accessible, often requiring no copay and no coinsurance. This plan also includes valuable supplemental benefits, such as dental coverage up to a $2,500 annual limit with no copay for preventive care and up to 50% coinsurance for comprehensive services. Vision benefits feature a $300 annual eyewear allowance and routine exams with no copay, while hearing care offers prescription hearing aid coverage with copays between $399 and $699. Additionally, members can benefit from a $40 quarterly over-the-counter allowance and no copay for diagnostic lab services.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by DEVOTED CHOICE 003 AZ (PPO) with no coinsurance, requiring a $335 daily copay for days 1 through 7 of acute stays (no copay for days 8 through 90) and days 1 through 6 of psychiatric stays (no copay for days 7 through 90). Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED CHOICE 003 AZ (PPO) covers outpatient services with no coinsurance, featuring a $0 to $435 copay for outpatient hospital services and a $335 copay per stay for observation services. Outpatient substance abuse sessions require a $40 copay, while ambulatory surgical center services are available with no copay.
Partial Hospitalization See details
DEVOTED CHOICE 003 AZ (PPO) covers partial hospitalization benefits with a $70.00 copay and no coinsurance. Prior authorization is required for this service.
Ambulance and Transportation Services See details
DEVOTED CHOICE 003 AZ (PPO) covers ambulance services with prior authorization, offering 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. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency services are covered by DEVOTED CHOICE 003 AZ (PPO) with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services range from no copay to a $45 copay with no coinsurance, and worldwide emergency services are covered up to a $25,000 maximum limit.
Primary Care See details
DEVOTED CHOICE 003 AZ (PPO) covers primary care and professional services with no coinsurance and copays ranging from no copay up to $65, though podiatry is not covered and chiropractic services are only partially covered because routine chiropractic care is excluded. Many of these benefits, including specialist visits, physical therapy, and mental health services, require prior authorization.
Preventive Services See details
DEVOTED CHOICE 003 AZ (PPO) partially covers preventive services, offering zero-dollar Medicare-covered preventive services, annual physical exams, and fitness benefits with no copay. However, several supplemental services are not covered, including in-home safety assessments, therapeutic massage, personal emergency response systems, and caregiver support.
Hearing Services See details
DEVOTED CHOICE 003 AZ (PPO) partially covers hearing services, featuring a $40 copay and no coinsurance for routine hearing exams, and a $399 to $699 copay with no coinsurance for up to two prescription hearing aids per year. 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 003 AZ (PPO) covers vision services, including annual routine eye exams with a copay ranging from no copay to $40 and no coinsurance. The plan also provides a $300 annual maximum allowance for eyewear, including lenses, frames, and contacts, with no copay or coinsurance.
Dental Services See details
Dental services are partially covered by DEVOTED CHOICE 003 AZ (PPO) up to a $2,500 annual limit, with Medicare-covered dental requiring a $40 copay and no coinsurance, and preventive services requiring no copay and no coinsurance. Covered comprehensive services require no copay and between no coinsurance and 50% coinsurance, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by DEVOTED CHOICE 003 AZ (PPO) with prior authorization required. Medicare Part B insulin drugs require a $35 copay and no coinsurance up to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and no coinsurance up to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by DEVOTED CHOICE 003 AZ (PPO) with a 20% coinsurance and no copay. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical Equipment is partially covered by DEVOTED CHOICE 003 AZ (PPO) with no copays, though coinsurance ranges from no coinsurance up to 50% depending on the item and prior authorization is required. Durable medical equipment, prosthetics, and diabetic supplies are covered, while diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED CHOICE 003 AZ (PPO) covers diagnostic and radiological services with prior authorization required. Lab services and outpatient X-rays have no copay and no coinsurance, while diagnostic procedures and tests require a copay of $0 to $95 with no coinsurance. Diagnostic radiological services have a copay of $0 to $300 with no coinsurance, and therapeutic radiological services carry a 20% coinsurance with no copay.
Home Health Services See details
Home health services are covered under the DEVOTED CHOICE 003 AZ (PPO) plan, though prior authorization is required to access these benefits. Refer to the plan details for specific copayment and coinsurance cost-sharing amounts.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the DEVOTED CHOICE 003 AZ (PPO) plan, as all sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are excluded from coverage. Consequently, there are no copays or coinsurance costs associated with these services.
Skilled Nursing Facility (SNF) See details
DEVOTED CHOICE 003 AZ (PPO) partially covers Skilled Nursing Facility (SNF) services, requiring prior authorization and offering no copay and no coinsurance for days 1 through 20. For days 21 through 100, there is a $218 daily copay and no coinsurance, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by DEVOTED CHOICE 003 AZ (PPO), featuring a $40 quarterly allowance for over-the-counter (OTC) items and coverage for additional preventive services, with no copay or coinsurance details specified. Acupuncture, meal benefits, and highly integrated SNP services are not covered.
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