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Devoted LIBERTY CHOICE Austin (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Devoted LIBERTY 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 LIBERTY CHOICE Austin (PPO) in 2025, please refer to our full plan details page.
Devoted LIBERTY 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 LIBERTY CHOICE Austin (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 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 LIBERTY 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. 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 $14000.00 (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 $14000.00 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 Austin (PPO).
Additional Benefits
The Devoted LIBERTY CHOICE Austin (PPO) plan offers a wide range of benefits, including coverage for inpatient and outpatient hospital services, with varying copays. It also covers services like primary care, hearing, vision, and dental, each with specific copays and limitations on the amount covered annually. Emergency, ambulance, and home health services are covered with copays or coinsurance. The plan includes coverage for preventive services with no copay, home infusion, and dialysis services. However, it excludes cardiac rehabilitation services and has limitations on additional services such as personal care, and other services.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both requiring prior authorization. For the first 4 days of an Inpatient Hospital-Acute or Inpatient Hospital Psychiatric stay, there is a $425 copay, and then no copay for days 5-90. Additional days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered stays and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, offered by Devoted LIBERTY CHOICE Austin (PPO), covers all outpatient hospital services, with copays ranging from $0 to $525. Observation Services have a copay of $425, while Ambulatory Surgical Center (ASC) Services have no copay. Outpatient Substance Abuse Services have a copay of $45 per session for both individual and group sessions, and Outpatient Blood Services are covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Devoted LIBERTY CHOICE Austin (PPO) plan, with a $70 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Devoted LIBERTY CHOICE Austin (PPO) plan. Ground ambulance services have a copay of $0-$350, while air ambulance services have a 20% coinsurance; however, transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by Devoted LIBERTY CHOICE Austin (PPO). Emergency Services have a $110 copay, and Urgently Needed Services have a copay between $0 and $45. Worldwide Emergency Transportation has a 20% coinsurance and a $350 copay, while Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $110 copay.
Primary Care See details
The Devoted LIBERTY CHOICE Austin (PPO) plan covers primary care physician services, occupational therapy services, physician specialist services with a $45 copay, mental health specialty services with a $45 copay for individual or group sessions, physical therapy and speech-language pathology services with a $45-50 copay, opioid treatment program services with a $45 copay, and additional telehealth benefits with a $0-45 copay. Chiropractic services are partially covered, but routine chiropractic care is not covered, and podiatry services are not covered.
Preventive Services See details
The Devoted LIBERTY CHOICE Austin (PPO) plan covers preventive services, including Medicare-covered services with no copay, annual physical exams, health education, weight management programs, alternative therapies, nutritional/dietary benefits, fitness benefits, home and bathroom safety devices and modifications, kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit. In-home safety assessment, personal emergency response systems (PERS), 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, and counseling services are not covered.
Hearing Services See details
Hearing services include routine hearing exams with a $45 copay for one visit per year, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $599 and $899 for two hearing aids per year; however, prescription hearing aids (inner ear, outer ear, and over the ear) are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for eye exams with a $45 copay, routine eye exams (1 per year), and eyewear with a combined maximum benefit of $250 per year for both in-network and out-of-network services. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The Devoted LIBERTY CHOICE Austin (PPO) plan covers a variety of dental services, including oral exams with a $45 copay, dental x-rays, and other diagnostic and preventive services. Other services are covered, but coverage is limited to $250 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, 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 these services.
Dialysis Services See details
Dialysis Services are covered by the Devoted LIBERTY CHOICE Austin (PPO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME) with an 18% coinsurance and no copay, but not for use outside of the home; Prosthetics/Medical Supplies with coinsurance for Medicare-covered devices and supplies and no copay, and Diabetic Equipment, but not for diabetic supplies or therapeutic shoes/inserts. Prosthetic Devices have between 0-20% coinsurance, and Medical Supplies have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Devoted LIBERTY CHOICE Austin (PPO) plan, with Diagnostic Procedures/Tests having a copay between $0 and $95. Lab Services have no copay, while Diagnostic Radiological Services have a copay of at most $300, and Therapeutic Radiological Services have a 20% coinsurance. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Devoted LIBERTY CHOICE Austin (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Devoted LIBERTY CHOICE Austin (PPO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization. There is no copay for days 1-20 and days 61-100, but there is a $214 copay for days 21-60.
Other Services See details
The Devoted LIBERTY CHOICE Austin (PPO) plan's "Other Services" benefit 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 include $0 preventive services.
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