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DEVOTED CHOICE PREMIUM 002 OR (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CHOICE PREMIUM 002 OR (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED CHOICE PREMIUM 002 OR (PPO) in 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
DEVOTED CHOICE PREMIUM 002 OR (PPO) is a PPO plan offered by Devoted Health Plan of Oregon available for the 2026 plan year to people living in Portland. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that DEVOTED CHOICE PREMIUM 002 OR (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 PREMIUM 002 OR (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 PREMIUM 002 OR (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $29.00. 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 $595.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $5900.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $5900.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $9550.00 (in-network and out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $9550.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
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 PREMIUM 002 OR (PPO) Medicare plan features an annual drug deductible of $595. Under this plan, Tier 1 preferred generic drugs are highly affordable, requiring no copay for one-, two-, or three-month supplies at standard pharmacies and through standard mail order. For Tier 2 generic medications, copayments start at just $3.00 for a one-month supply, with standard mail order offering a cost-saving $7.50 copay for a three-month supply. Higher-tier medications under this plan are subject to coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs require a 25% coinsurance for standard pharmacy and mail-order fills. Tier 5 specialty drugs also carry a 25% coinsurance and are limited to a one-month supply.
Additional Benefits
The DEVOTED CHOICE PREMIUM 002 OR (PPO) plan offers robust medical coverage with no copay for primary care visits, home health services, and annual preventive exams. Inpatient hospital stays require a $325 daily copay for the first five days, followed by no copay for days six through 90. Emergency room visits have a $130 copay, which is waived upon admission, while specialist visits require a $40 to $50 copay. Essential ancillary benefits are also covered, including dental care up to a $2,000 annual limit with no copay for preventive services. For vision and hearing, members enjoy a $200 annual eyewear allowance with no copay and routine hearing exams for a $40 copay. Additionally, the plan features a $30 quarterly allowance for over-the-counter items with no copay.
Inpatient Hospital See details
Inpatient hospital services are partially covered by DEVOTED CHOICE PREMIUM 002 OR (PPO) with no coinsurance, requiring a $325 daily copay for days 1 through 5 and no copay for days 6 through 90 for acute and psychiatric stays. While unlimited additional days for acute stays are covered, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient Services under DEVOTED CHOICE PREMIUM 002 OR (PPO) are covered with no coinsurance, offering no copays for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay of $0 to $425 ($325 per stay for observation services), while individual and group outpatient substance abuse sessions have a $40 copay.
Partial Hospitalization See details
DEVOTED CHOICE PREMIUM 002 OR (PPO) covers partial hospitalization services with a $70.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
DEVOTED CHOICE PREMIUM 002 OR (PPO) covers ambulance services with prior authorization, featuring a range of no copay to a $325 copay plus coinsurance for ground transport, and a 20% coinsurance plus a copay for air transport. While transportation benefits are technically covered, some services are not covered, specifically transportation to plan-approved or any other health-related locations.
Emergency Services See details
DEVOTED CHOICE PREMIUM 002 OR (PPO) emergency services are covered with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services feature no copay to a $45 copay with no coinsurance, and worldwide emergency services are covered up to $25,000 with a $130 copay for care and a $325 copay plus 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED CHOICE PREMIUM 002 OR (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, and mental health services require copays ranging from $40 to $50 and no coinsurance. Chiropractic care is partially covered with a $15 copay and no coinsurance for routine visits (other chiropractic services are not covered), whereas podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by DEVOTED CHOICE PREMIUM 002 OR (PPO) with no copay and no coinsurance for annual exams and kidney disease education, while alternative therapies and therapeutic massage carry up to 50% coinsurance. Sub-services not covered under this plan include in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, adult day health, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access technologies, and counseling.
Hearing Services See details
Hearing services are partially covered by DEVOTED CHOICE PREMIUM 002 OR (PPO), featuring routine hearing exams for a $40 copay and no coinsurance, and up to two prescription hearing aids per year for a $199 to $499 copay and no coinsurance. While fitting and evaluation services are covered, OTC hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
DEVOTED CHOICE PREMIUM 002 OR (PPO) provides partially covered vision services, including one annual routine eye exam with a $0 to $40 copay and no coinsurance, though other eye exam services are not covered. Covered eyewear, including contacts, lenses, frames, and upgrades, has no copay, no coinsurance, and no deductible, up to a combined annual limit of $200.
Dental Services See details
Dental services are partially covered by DEVOTED CHOICE PREMIUM 002 OR (PPO) with an annual maximum benefit of $2,000, offering preventive care and select comprehensive services with no copay and no coinsurance, though some services require 0% to 50% coinsurance. Medicare-covered dental services require a $40 copay and no coinsurance, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED CHOICE PREMIUM 002 OR (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the DEVOTED CHOICE PREMIUM 002 OR (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
DEVOTED CHOICE PREMIUM 002 OR (PPO) partially covers medical equipment with no copays, though prior authorization is required. Durable medical equipment has a 20% to 40% 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
DEVOTED CHOICE PREMIUM 002 OR (PPO) covers diagnostic and radiological services with prior authorization required. Diagnostic procedures and tests feature no coinsurance and copays ranging from $0 to $95, while lab services and outpatient X-rays are offered with no copay. Diagnostic radiological services have a $0 minimum copay, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
DEVOTED CHOICE PREMIUM 002 OR (PPO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by DEVOTED CHOICE PREMIUM 002 OR (PPO) with no copay and no coinsurance, subject to prior authorization. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
DEVOTED CHOICE PREMIUM 002 OR (PPO) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by DEVOTED CHOICE PREMIUM 002 OR (PPO), including acupuncture with no copay and 50% coinsurance, and additional preventive services with no copay and no coinsurance. Over-the-counter (OTC) items are also covered with no copay and no coinsurance up to $30 every three months, but meal benefits are not covered.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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