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Devoted LIBERTY CHOICE Arizona (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Devoted LIBERTY 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 LIBERTY CHOICE Arizona (PPO) in 2025, please refer to our full plan details page.
Devoted LIBERTY CHOICE Arizona (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Arizona. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Devoted LIBERTY CHOICE Arizona (PPO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Devoted LIBERTY 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 LIBERTY 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. Additionally, this plan comes with a Part B Premium reduction of $140.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $5900.00 (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 $5900.00 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
Prescription drugs are not covered by Devoted LIBERTY CHOICE Arizona (PPO).
Additional Benefits
The Devoted LIBERTY CHOICE Arizona (PPO) plan offers a range of benefits, including coverage for inpatient and outpatient hospital services, with varying copays. You'll find coverage for primary care, specialist visits, and mental health services, typically with a $45 copay. The plan also includes vision and dental coverage, with a $45 copay for eye exams and a maximum annual dental benefit of $1250. This plan provides coverage for ambulance services, emergency services, and home health services, along with hearing services, and medical equipment. While it offers services with $0 copays, it's important to note that some services require prior authorization, and certain services like cardiac rehabilitation, additional hours of care, and other services are not covered.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric care, are covered by the Devoted LIBERTY CHOICE Arizona (PPO) plan. For Inpatient Hospital-Acute, you will pay a $425 copay for days 1-4, and no copay for days 5-90; Inpatient Hospital Psychiatric has the same cost sharing.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $525, Observation Services with a $425 copay, Ambulatory Surgical Center (ASC) Services with no copay, and Outpatient Substance Abuse Services with a $45 copay for both individual and group sessions. Outpatient Blood Services are also covered, including services not usually covered by Medicare plans.
Partial Hospitalization See details
Partial Hospitalization is covered under the Devoted LIBERTY CHOICE Arizona (PPO) plan, requiring prior authorization. You will have a $70 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Devoted LIBERTY CHOICE Arizona (PPO) plan. Ground ambulance services have a copay of $0-$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 for Devoted LIBERTY CHOICE Arizona (PPO) include a $125 copay, while Urgently Needed Services have a copay between $0 and $55. Worldwide Emergency Services include Worldwide Emergency Coverage with a $125 copay, Worldwide Urgent Coverage with a $125 copay, and Worldwide Emergency Transportation with a $350 copay and 20% coinsurance.
Primary Care See details
The Devoted LIBERTY CHOICE Arizona (PPO) plan covers primary care physician services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services are partially covered, but routine chiropractic care is not covered. The plan has a copay of $45 for primary care physician services, physician specialist services, individual and group sessions for mental health and psychiatric services, and opioid treatment program services. A copay of $45-$50 applies to physical therapy and speech-language pathology services, and additional telehealth benefits have a copay of $0-$45.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams, health education, weight management programs, alternative therapies, nutritional/dietary benefits, fitness benefits, home and bathroom safety devices, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit, while in-home safety assessments, personal emergency response systems, 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 are not covered.
Hearing Services See details
Hearing Services include routine hearing exams with a $45 copay, and fitting/evaluation for hearing aids, which is unlimited. Prescription hearing aids (all types) are covered with a copay between $599 and $899 for up to 2 visits every year, but hearing aids for the inner, outer, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The Devoted LIBERTY CHOICE Arizona (PPO) plan covers vision services, including eye exams with a $45 copay. Eyewear is covered up to a combined maximum of $1250 per year for both in-network and out-of-network services, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental Services are covered, with a maximum benefit of $1250 per year. Medicare Dental Services require prior authorization and have a $45 copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, 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 by the Devoted LIBERTY CHOICE Arizona (PPO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 20% coinsurance, and Prosthetics/Medical Supplies with 20% coinsurance for Medicare-covered items, but Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered. Diabetic Equipment and Diabetic Therapeutic Shoes/Inserts are also not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by this plan, with varying costs depending on the service. Diagnostic Procedures/Tests have a copay between $0 and $95, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $300, and Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Devoted LIBERTY CHOICE Arizona (PPO) plan with no copay and no coinsurance, but require authorization. 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 LIBERTY CHOICE Arizona (PPO) plan. Although the plan covers some cardiac rehabilitation services, none of the listed sub-services are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Devoted LIBERTY CHOICE Arizona (PPO) plan, but require prior authorization. There is no copay for days 1-20, a $214 copay for days 21-60, and no copay for days 61-100; there is no coinsurance. Additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services are not covered by the Devoted LIBERTY CHOICE Arizona (PPO) plan. Some services that are not covered include acupuncture, over-the-counter items, and meal benefits.
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