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DEVOTED CHOICE MA ONLY 005 AZ (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CHOICE MA ONLY 005 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 MA ONLY 005 AZ (PPO) in 2026, please refer to our full plan details page.
DEVOTED CHOICE MA ONLY 005 AZ (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 2026.
It's important to know that DEVOTED CHOICE MA ONLY 005 AZ (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 CHOICE MA ONLY 005 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 MA ONLY 005 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. Additionally, this plan comes with a Part B Premium reduction of $184.70. 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 $7900.00 (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 $7900.00 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 CHOICE MA ONLY 005 AZ (PPO).
Additional Benefits
The DEVOTED CHOICE MA ONLY 005 AZ (PPO) plan provides comprehensive healthcare coverage with manageable out-of-pocket costs, often featuring no copays or coinsurance for essential services. For inpatient hospital stays, members pay a $425 copay for days one through four, followed by no copay for days five through 90. Preventive services, routine dental care, and primary care visits are highly accessible, with many of these services requiring no copay. Additional perks include a $400 annual vision allowance with no deductible, a $1,000 yearly dental limit, and a $100 quarterly over-the-counter allowance. For specialized care, emergency services require a $130 copay, while dialysis and durable medical equipment require a 20% to 50% coinsurance. Diagnostic services, skilled nursing facilities, and home infusions are also covered, though several specialized benefits require prior authorization.
Inpatient Hospital See details
DEVOTED CHOICE MA ONLY 005 AZ (PPO) covers inpatient hospital acute and psychiatric stays with a $425 copay for days 1 to 4, no copay for days 5 to 90, and no coinsurance, though prior authorization is required. This benefit is partially covered as upgrades for acute stays, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED CHOICE MA ONLY 005 AZ (PPO) covers outpatient services with no coinsurance, including ambulatory surgical center services with no copay and substance abuse sessions for a $45 copay. Outpatient hospital services range from no copay to a $525 copay, while observation services require a $425 copay per stay.
Partial Hospitalization See details
Partial hospitalization benefits are covered by DEVOTED CHOICE MA ONLY 005 AZ (PPO) with a $70 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
DEVOTED CHOICE MA ONLY 005 AZ (PPO) partially covers Ambulance and Transportation Services, as transportation services to health-related locations are not covered. Covered ground ambulance services require a copay ranging from no copay to $350 and no coinsurance, while air ambulance services require a 20% coinsurance and no copay.
Emergency Services See details
Emergency services are covered by DEVOTED CHOICE MA ONLY 005 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, while worldwide emergency services are covered up to a $25,000 limit with a $130 copay (no coinsurance) for emergency or urgent care and a $350 copay plus 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED CHOICE MA ONLY 005 AZ (PPO) offers partially covered primary care benefits with no coinsurance and copays ranging from no copay up to $50. Podiatry services and routine chiropractic care are not covered, and prior authorization is required for several services including specialist visits, physical therapy, and psychiatric sessions.
Preventive Services See details
DEVOTED CHOICE MA ONLY 005 AZ (PPO) partially covers preventive services with no copay or coinsurance for covered benefits such as annual physical exams, fitness programs, and health education. Uncovered sub-services include In-Home Safety Assessments, PERS, Medical Nutrition Therapy, post-discharge medication reconciliation, readmission prevention, wigs for chemotherapy-related hair loss, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, additional tobacco cessation counseling, enhanced disease management, telemonitoring, remote access technologies, and counseling.
Hearing Services See details
DEVOTED CHOICE MA ONLY 005 AZ (PPO) provides partially covered hearing services, which include routine hearing exams for a $45 copay and no coinsurance, and hearing aid fittings with no coinsurance. Prescription hearing aids (all types) are covered up to two per year with a copay ranging from $599 to $899 and no coinsurance, while OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by DEVOTED CHOICE MA ONLY 005 AZ (PPO), which includes one annual routine eye exam with a copay ranging from no copay to $45 and no coinsurance. The plan also provides up to a $400 annual allowance for eyewear—including contacts, eyeglasses, lenses, frames, and upgrades—with no deductible and no coinsurance.
Dental Services See details
DEVOTED CHOICE MA ONLY 005 AZ (PPO) offers partially covered dental services with an annual maximum benefit of $1,000 for both in-network and out-of-network care, excluding maxillofacial prosthetics, implant services, and orthodontics. Medicare-covered dental services require a $45 copay and no coinsurance, while preventive care has no copay or coinsurance, and restorative, endodontic, and prosthodontic services feature no copay and 0% to 50% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by DEVOTED CHOICE MA ONLY 005 AZ (PPO) with prior authorization, offering chemotherapy, radiation, and other Part B drugs with no copay and no coinsurance to 20% coinsurance. Covered Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance, with no deductible applying to these services.
Dialysis Services See details
DEVOTED CHOICE MA ONLY 005 AZ (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Medical Equipment See details
Medical equipment benefits are partially covered by DEVOTED CHOICE MA ONLY 005 AZ (PPO) with no copays, though prior authorization is required. Durable medical equipment requires 20% to 50% coinsurance, prosthetics and medical supplies range from no coinsurance to 20% coinsurance, and diabetic supplies range from no coinsurance to 50% coinsurance, while diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the DEVOTED CHOICE MA ONLY 005 AZ (PPO) plan, with prior authorization required. There is no copay or coinsurance for lab and outpatient X-rays, copays ranging from $0 to $95 for diagnostic tests and up to $300 for diagnostic radiology, and a 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered under the DEVOTED CHOICE MA ONLY 005 AZ (PPO) plan, but prior authorization is required. Specific copay and coinsurance information is not detailed in the plan benefits.
Cardiac Rehabilitation Services See details
DEVOTED CHOICE MA ONLY 005 AZ (PPO) does not cover Cardiac Rehabilitation Services, as none of the sub-services—including Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD—are covered. Consequently, there are no copays or coinsurance benefits available for these services under this plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by DEVOTED CHOICE MA ONLY 005 AZ (PPO), requiring prior authorization with no coinsurance, no copay for days 1 to 20, and a $218 copay for days 21 to 100. Additional days beyond those covered by Medicare are not covered.
Other Services See details
Other Services are partially covered by DEVOTED CHOICE MA ONLY 005 AZ (PPO), which offers a $100 quarterly over-the-counter allowance and additional preventive services with no copay or coinsurance. Acupuncture, meal benefits, and highly integrated dual eligible SNP services are not covered under this plan.
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