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Devoted CHOICE Austin (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Devoted CHOICE Austin (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Devoted CHOICE Austin (PPO) in 2025, please refer to our full plan details page.
Devoted CHOICE Austin (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Austin. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Devoted CHOICE Austin (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 Austin (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 Austin (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 Austin (PPO) plan has an "Enhanced Alternative" drug benefit. The plan has a $590 deductible for prescription drugs. Once you meet your deductible, you will pay either a 25% coinsurance or no copay depending on the tier and the pharmacy you use. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for your Part D covered drugs.
Additional Benefits
The Devoted CHOICE Austin (PPO) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying copays depending on the specific service. Emergency and primary care services are covered, with copays ranging from $0 to $125 for emergency services, and $20 to $40 for primary care, depending on the service. Preventive, hearing, vision, and dental services are also included, with copays for routine exams and services, and an annual maximum benefit of $1,100 for both vision and dental. Additional benefits include coverage for ambulance, home infusion, and dialysis services with copays or coinsurance. The plan also covers medical equipment, and diagnostic and radiological services, with copays and coinsurance applying. Skilled nursing facility services and home health services are covered. However, this plan does not cover certain services, such as acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a prior authorization requirement. For Inpatient Hospital-Acute, you pay a $325 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you pay a $325 copay for days 1-4, and no copay for days 5-90. Additional days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services, including all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital services have a copay between $0 and $425, observation services have a $325 copay, individual and group outpatient substance abuse sessions have a $40 copay, and ASC services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $60 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Devoted CHOICE Austin (PPO) plan. Ground ambulance services have a copay between $0 and $285, while air ambulance services have a 20% coinsurance, and transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services are covered with a $125 copay, and Urgently Needed Services are covered with a copay between $0 and $45. Worldwide Emergency Services, including Worldwide Emergency Coverage and Worldwide Urgent Coverage, have a $125 copay, while Worldwide Emergency Transportation has a $285 copay and 20% coinsurance.
Primary Care See details
The Devoted CHOICE Austin (PPO) plan covers primary care physician services, chiropractic services, occupational therapy, 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 have a $20 copay, physician specialist services have a $40 copay, and individual and group sessions for mental health and psychiatric services have a $40 copay. Occupational therapy has a copay between $0 and $45, other health care professional services have a copay between $0 and $40, and physical therapy and speech-language pathology services have a copay between $0 and $50. Additional telehealth benefits have a copay between $0 and $40, and opioid treatment program services have a $40 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Devoted CHOICE Austin (PPO) plan covers preventive services, including Medicare-covered services, annual physical exams, and additional preventive services such as health education, Personal Emergency Response System (PERS), Weight Management Programs, Alternative Therapies, Nutritional/Dietary Benefit, Fitness Benefit, Home and Bathroom Safety Devices and Modifications, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. However, In-Home Safety Assessment, Medical Nutrition Therapy (MNT), 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 (including Web/Phone-based technologies and Nursing Hotline), and Counseling Services are not covered.
Hearing Services See details
Hearing Services includes routine hearing exams with a $40 copay, and fitting/evaluation for hearing aids. Prescription hearing aids are covered with a copay between $199 and $499, but inner ear, outer ear, and over the ear hearing aids are not covered, and OTC hearing aids are also not covered.
Vision Services See details
The Devoted CHOICE Austin (PPO) plan covers vision services, including routine eye exams with a $40 copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, and eyeglass frames, are covered, with a combined maximum benefit of $1,100 every year.
Dental Services See details
The Devoted CHOICE Austin (PPO) plan offers dental services with a $1,100 maximum benefit per year, and a $40 copay for Medicare dental services. The plan covers 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. The plan does not cover maxillofacial prosthetics, implant services, or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and 20% coinsurance; for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Devoted CHOICE Austin (PPO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment coverage includes Durable Medical Equipment (DME) with a coinsurance between 0% and 25% and no copay, Prosthetic Devices with a coinsurance between 0% and 20% and no copay, and Medical Supplies with a 20% coinsurance and no copay, while 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, diagnostic procedures/tests with a copay between $0 and $95, and lab services with no copay. Radiological services are covered with a copay up to $300 for diagnostic services, a coinsurance of 20% for therapeutic services, and no copay for outpatient X-ray services.
Home Health Services See details
Home Health Services are covered by the Devoted CHOICE Austin (PPO) plan with no copay or 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 covered by the Devoted CHOICE Austin (PPO) plan, but are not covered in practice. The plan mentions that copays apply.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Devoted CHOICE Austin (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
The Devoted CHOICE Austin (PPO) plan does not cover 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. Other Services and Other 2 benefits are covered, but no cost information is provided.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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