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DEVOTED CHOICE 008 IN (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CHOICE 008 IN (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED CHOICE 008 IN (PPO) in 2026, please refer to our full plan details page.
DEVOTED CHOICE 008 IN (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Southeast and Louisville-Jeffersonville Indiana. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED CHOICE 008 IN (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 008 IN (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 008 IN (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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $9550.00 (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 $9550.00 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 008 IN (PPO) plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately with no upfront deductible to meet. Under this plan, you will pay no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) medications filled at standard pharmacies or through standard mail order. This makes managing common, everyday prescription medications highly affordable for members. For higher-tier medications, cost-sharing is based on coinsurance for both standard pharmacies and standard mail order. Tier 3 (Preferred Brand) drugs require a 20% coinsurance, while Tier 4 (Non-Preferred Drug) medications have a 25% coinsurance. Specialty medications in Tier 5 carry a 31% coinsurance and are limited to a 1-month supply.
Additional Benefits
The DEVOTED CHOICE 008 IN (PPO) plan offers robust medical coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay a $390 daily copay for days 1 through 5 and no copay for days 6 through 90, with no coinsurance. Emergency room visits require a $130 copay, which is waived if admitted, while specialist visits and outpatient therapies have copays ranging from $0 to $50. This plan also features dental coverage up to a $3,000 annual maximum with no copay and 0% to 50% coinsurance for most services. Vision care includes no copay for eyewear up to a $300 annual limit, while prescription hearing aids require a copay of $399 to $699. Additionally, members benefit from a $100 over-the-counter allowance every three months with no copay, and skilled nursing facility stays have no copay for the first 20 days.
Inpatient Hospital See details
DEVOTED CHOICE 008 IN (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $390 daily copay for days 1 to 5 and no copay for days 6 to 90. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED CHOICE 008 IN (PPO) covers outpatient services with no coinsurance, including no copay for ambulatory surgical center and blood services. Outpatient hospital copays range from $0 to $490, observation services cost a $390 copay per stay, and outpatient substance abuse sessions require a $40 copay, all with no coinsurance.
Partial Hospitalization See details
DEVOTED CHOICE 008 IN (PPO) covers partial hospitalization services with a $60.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance services under DEVOTED CHOICE 008 IN (PPO) require prior authorization, featuring ground ambulance services with no coinsurance and a copay ranging from no copay to $315, and air ambulance services with a 20% coinsurance and no copay. Transportation services to plan-approved or health-related locations are not covered.
Emergency Services See details
DEVOTED CHOICE 008 IN (PPO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if admitted to the hospital within 24 hours. Urgently needed services range from no copay to a $45 copay with no coinsurance, while worldwide emergency services are covered up to $25,000, featuring a $130 copay for emergency or urgent care and a $315 copay plus 20% coinsurance for transportation.
Primary Care See details
DEVOTED CHOICE 008 IN (PPO) offers primary care physician services with no copay and no coinsurance, while other services like specialists, therapies, mental health, and telehealth have copays ranging from $0 to $50 and no coinsurance. Some chiropractic services are covered with a $15 copay and no coinsurance, but routine and other chiropractic services are not covered, and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by DEVOTED CHOICE 008 IN (PPO) with no copay and no coinsurance for annual exams, kidney disease education, and fitness benefits. However, this benefit is partially covered, as it excludes in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, chemotherapy wigs, therapeutic massage, adult day health, palliative care, in-home support, caregiver support, additional tobacco cessation, disease management, telemonitoring, remote access technologies, and counseling.
Hearing Services See details
Hearing services are partially covered by DEVOTED CHOICE 008 IN (PPO), featuring routine hearing exams with a $40 copay and no coinsurance, and prescription hearing aids with a copay of $399 to $699 and no coinsurance. There is no deductible, but 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 008 IN (PPO) offers partially covered vision services, featuring one routine eye exam per year 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, offering up to a $300 annual maximum benefit for contacts, frames, lenses, and upgrades.
Dental Services See details
DEVOTED CHOICE 008 IN (PPO) provides partially covered dental services up to a $3,000 annual maximum for both in- and out-of-network care. Medicare-covered dental services require a $40 copay and no coinsurance, while other covered dental benefits feature no copay and 0% to 50% coinsurance; however, orthodontics, implant services, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
DEVOTED CHOICE 008 IN (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs carry no coinsurance to 20% coinsurance, while insulin drugs have a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
DEVOTED CHOICE 008 IN (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Medical Equipment See details
DEVOTED CHOICE 008 IN (PPO) covers medical equipment with no copay, though prior authorization is required and a 20% coinsurance applies to durable medical equipment. Prosthetic devices, medical supplies, and diabetic supplies carry a coinsurance ranging from no coinsurance to 20%, but diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED CHOICE 008 IN (PPO) with prior authorization required. Diagnostic services feature no coinsurance, with no copay for lab services and a copay of $0 to $95 for diagnostic procedures, while radiological services include no-copay X-rays and therapeutic services with a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by DEVOTED CHOICE 008 IN (PPO) with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered under DEVOTED CHOICE 008 IN (PPO) with no coinsurance, though prior authorization is required. While some services are covered, standard cardiac rehabilitation (with a $40 copay), intensive cardiac rehabilitation ($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
Skilled Nursing Facility (SNF) services are covered by DEVOTED CHOICE 008 IN (PPO) with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior 3-day hospital stay is not needed, and additional days beyond the standard 100-day limit are not covered.
Other Services See details
DEVOTED CHOICE 008 IN (PPO) partially covers other services, offering additional preventive services and over-the-counter (OTC) items with no copay and no coinsurance, including a $100 allowance every three months. Acupuncture, meal benefits, and dual-eligible SNP services are not covered.
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