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Devoted CHOICE South Carolina (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Devoted CHOICE South Carolina (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Devoted CHOICE South Carolina (PPO) in 2025, please refer to our full plan details page.
Devoted CHOICE South Carolina (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 2025.
It's important to know that Devoted CHOICE South Carolina (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 South Carolina (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 South Carolina (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 $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 South Carolina (PPO) plan has an enhanced alternative drug benefit. The plan has a deductible of $590. After the deductible, you will pay for your prescriptions based on the drug tier and pharmacy you use. In the initial coverage phase, you will pay a $0 copay for preferred generic drugs at a standard pharmacy or through mail order. For standard generic, preferred brand, and non-preferred drugs, you will pay 25% coinsurance at standard pharmacies and through mail order. After your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The Devoted CHOICE South Carolina (PPO) plan offers a range of benefits, including inpatient hospital stays with a $350 copay for days 1-5 and no copay for days 6-90, outpatient services with varying copays, and emergency services with a $125 copay. The plan also covers primary care visits with no copay, hearing exams with a $30 copay, and vision services including eye exams with a $30 copay. Additional benefits include dental services with a $35 copay for oral exams, home infusion bundled services, and dialysis services with coinsurance. The plan also covers home health services with no copay, skilled nursing facility stays, and medical equipment. However, the plan does not cover cardiac rehabilitation services, and has exclusions on some services like acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care, with a copay of $350 for days 1-5 and no copay for days 6-90. Additional days for acute care are covered, but non-Medicare covered stays and upgrades for both acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $450, observation services with a $350 copay, Ambulatory Surgical Center (ASC) Services with no copay, outpatient substance abuse services with a $35 copay for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Devoted CHOICE South Carolina (PPO) plan, with a $60 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services include coverage for ground ambulance services with a copay of $0-$300 and air ambulance services with 20% coinsurance; however, transportation services to health-related locations are not covered. All ambulance services require prior authorization.
Emergency Services See details
Emergency Services include coverage for emergency services, urgently needed services, and worldwide emergency services. Emergency services have a $125 copay, while urgently needed services have a copay between $0 and $45. Worldwide emergency transportation has a $300 copay and 20% coinsurance, and worldwide emergency and urgent coverage each have a $125 copay.
Primary Care See details
The Devoted CHOICE South Carolina (PPO) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay, Occupational Therapy Services with a copay between $35 and $45, Physician Specialist Services with a $35 copay, and Mental Health Specialty Services with a minimum copay of $35 for individual and group sessions. The plan also covers Other Health Care Professional services with a copay between $0 and $35, Psychiatric Services with a minimum copay of $35 for individual and group sessions, and Physical Therapy and Speech-Language Pathology Services with a copay between $35 and $50. Additionally, Additional Telehealth Benefits are covered with a copay between $0 and $35, and Opioid Treatment Program Services are covered with a minimum copay of $35.
Preventive Services See details
Preventive Services are covered, including Medicare-covered preventive services, annual physical exams, and other services not usually covered by Medicare plans. Health Education, Personal Emergency Response Systems, Weight Management Programs, Alternative Therapies, Nutritional/Dietary Benefits, Fitness Benefits, Home and Bathroom Safety Devices and Modifications, Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKGs following a Welcome Visit are covered, while In-Home Safety Assessments, 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 $30 copay, fitting/evaluation for hearing aids with no copay, and prescription hearing aids with a copay between $399 and $699. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a $30 copay, and eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Eyewear has a combined maximum benefit of $1500 per year, covering both in-network and out-of-network services.
Dental Services See details
The Devoted CHOICE South Carolina (PPO) plan covers dental services, including oral exams with a $35 copay, 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. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and 20% coinsurance. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Devoted CHOICE South Carolina (PPO) plan with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment with 0-20% coinsurance and no copay, prosthetics/medical supplies with a coinsurance, and diabetic equipment. 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, with a copay that can range from $0 to $95, and lab services with no copay. Diagnostic Radiological Services have a maximum copay of $300, and Therapeutic Radiological Services have a coinsurance of at least 20%, while Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Devoted CHOICE South Carolina (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Devoted CHOICE South Carolina (PPO) plan. While the plan mentions copays for specific services, it explicitly states that Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Devoted CHOICE South Carolina (PPO) plan does not cover acupuncture, over-the-counter items, or meal benefits, and it does not cover 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, or Self-Directed Personal Assistance Services. Other services are covered.
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