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DEVOTED CHOICE 001 SC (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CHOICE 001 SC (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED CHOICE 001 SC (PPO) in 2026, please refer to our full plan details page.
DEVOTED CHOICE 001 SC (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in South Carolina. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that DEVOTED CHOICE 001 SC (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 001 SC (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 001 SC (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 $370.00 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 $10000.00 (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 $10000.00 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 001 SC (PPO) Medicare prescription drug plan features an annual drug deductible of $370. Under this plan, members pay no copay for Tier 1 preferred generic and Tier 2 generic medications filled at standard pharmacies or through standard mail-order services. For higher-tier medications, costs are determined by coinsurance during the initial coverage phase. Tier 3 preferred brand drugs require 24% coinsurance, Tier 4 non-preferred drugs require 43% coinsurance, and Tier 5 specialty drugs require 28% coinsurance for a one-month supply.
Additional Benefits
The DEVOTED CHOICE 001 SC (PPO) plan offers robust coverage with no copay for primary care visits and no coinsurance for inpatient hospital stays, which require a $395 daily copay for the first five days and no copay thereafter. Emergency services are covered with a $130 copay, which is waived if you are admitted, while outpatient hospital services feature copays ranging from no copay up to $495. Specialist visits and routine outpatient mental health sessions generally require a copay between $40 and $50 with no coinsurance. For ancillary care, the plan provides preventive and comprehensive dental services with no copay up to a $1,500 annual limit, alongside a $250 annual allowance for eyewear with no copay. Skilled nursing facility stays feature no copay for the first 20 days and a $218 daily copay for days 21 through 100. Additionally, members benefit from home health services with no copay, though durable medical equipment and dialysis services require a 20% to 50% coinsurance.
Inpatient Hospital See details
Inpatient hospital care is covered by DEVOTED CHOICE 001 SC (PPO) with no coinsurance, requiring a $395 daily copay for days 1 through 5 and no copay for days 6 through 90. Prior authorization is required for both acute and psychiatric stays, and certain services like room upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by DEVOTED CHOICE 001 SC (PPO) with no coinsurance, featuring no copay or deductible for blood services, no copay for ambulatory surgical center services, and a $40 copay for substance abuse sessions. Outpatient hospital services require a copay of $0 to $495, including a $395 copay per stay for observation services, with prior authorization required for most care.
Partial Hospitalization See details
Partial hospitalization services are covered by DEVOTED CHOICE 001 SC (PPO) with a $60.00 copay and no coinsurance. Prior authorization is required for these benefits.
Ambulance and Transportation Services See details
DEVOTED CHOICE 001 SC (PPO) covers ambulance services with prior authorization, featuring a copay ranging from no copay to $315 and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. Routine transportation services are not covered under this plan.
Emergency Services See details
DEVOTED CHOICE 001 SC (PPO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require no copay to a $45 copay and no coinsurance, while worldwide emergency services are covered up to $25,000 with a $130 copay and no coinsurance for emergency or urgent care, and a $315 copay with 20% coinsurance for transportation.
Primary Care See details
DEVOTED CHOICE 001 SC (PPO) covers primary care physician services with no copay and no coinsurance, while specialist, therapy, psychiatric, and mental health services require copays ranging from $40 to $50 and no coinsurance. Podiatry and chiropractic services are not covered, but telehealth benefits are available with a copay ranging from no copay to $45 and no coinsurance.
Preventive Services See details
DEVOTED CHOICE 001 SC (PPO) offers partially covered preventive services with no copay and no coinsurance, which includes annual physical exams, fitness benefits, and nutritional counseling. However, several sub-services are not covered, such as personal emergency response systems (PERS), therapeutic massage, in-home support services, and caregiver support.
Hearing Services See details
DEVOTED CHOICE 001 SC (PPO) partially covers hearing services, offering annual routine hearing exams for a $40 copay and no coinsurance, with no deductible required. Prescription hearing aids are covered with no coinsurance and copayments ranging from $399 to $699 for up to two devices per year, though OTC hearing aids as well as inner-ear, outer-ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by DEVOTED CHOICE 001 SC (PPO), featuring one annual routine eye exam with a $0 to $40 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $250 annual maximum for contacts, lenses, frames, and upgrades.
Dental Services See details
DEVOTED CHOICE 001 SC (PPO) partially covers dental services with a $40.00 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other preventive and comprehensive services up to a $1,500 annual limit. Maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Home infusion bundled services are covered by DEVOTED CHOICE 001 SC (PPO) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs have no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
DEVOTED CHOICE 001 SC (PPO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Medical Equipment See details
DEVOTED CHOICE 001 SC (PPO) covers medical equipment with no copay, though prior authorization is required. Durable medical equipment has a 20% to 50% coinsurance, while prosthetic devices, medical supplies, and diabetic supplies range from no coinsurance to 20% or 50% coinsurance. This benefit is partially covered because diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED CHOICE 001 SC (PPO) with prior authorization required, offering no copay for lab services and outpatient X-rays. Diagnostic procedures feature no coinsurance and a copay of $0 to $95, while diagnostic radiological services start at no copay and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by DEVOTED CHOICE 001 SC (PPO) with no copay and no coinsurance, although prior authorization is required for these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under DEVOTED CHOICE 001 SC (PPO) require prior authorization and have no coinsurance, though only some services are covered. Standard cardiac and intensive cardiac rehabilitation (each with a $40 copay), pulmonary rehabilitation ($35 copay), and supervised exercise therapy for peripheral artery disease ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
DEVOTED CHOICE 001 SC (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance and does not require a prior three-day hospital stay, although prior authorization is required. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by DEVOTED CHOICE 001 SC (PPO), which offers over-the-counter (OTC) items and additional preventive services with no copay and no coinsurance. Acupuncture, meal benefits, and dual-eligible SNP services are not covered under this plan.
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