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DEVOTED DUAL CHOICE 004 LA (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED DUAL CHOICE 004 LA (PPO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED DUAL CHOICE 004 LA (PPO D-SNP) in 2026, please refer to our full plan details page.
DEVOTED DUAL CHOICE 004 LA (PPO D-SNP) is a PPO D-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Greater Baton Rouge. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED DUAL CHOICE 004 LA (PPO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
DEVOTED DUAL CHOICE 004 LA (PPO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about DEVOTED DUAL CHOICE 004 LA (PPO D-SNP).
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 DUAL CHOICE 004 LA (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $32.90. 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 $615.00 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 $6900.00 (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 $6900.00 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 DUAL CHOICE 004 LA (PPO D-SNP) Medicare plan has an annual prescription drug deductible of $615. For prescription drug coverage, standard pharmacies and standard mail-order options require a 25% coinsurance for Tier 1 preferred generics, Tier 2 generics, Tier 3 preferred brands, and Tier 4 non-preferred drugs. Tier 5 specialty drugs also carry a 25% coinsurance for a one-month supply through standard pharmacy and standard mail-order channels. Additionally, this plan offers no copay for Tier 6 select care drugs for one-, two-, or three-month supplies filled at standard pharmacies or through standard mail order. This plan provides clear cost structures to help Louisiana residents manage their prescription medication expenses.
Additional Benefits
The DEVOTED DUAL CHOICE 004 LA (PPO D-SNP) plan offers comprehensive medical coverage, including primary care physician visits and home health services with no copay and no coinsurance. Specialist visits and Medicare-covered dental services require a $35 copay, while inpatient hospital stays have a $300 daily copay for the first six days followed by no copay for days 7 through 90. Outpatient services feature no coinsurance and copays ranging from $0 to $400 depending on the care received. This plan also provides valuable supplemental benefits, such as a $2,000 yearly limit on select dental services and a $400 annual eyewear allowance, both with no copay and no coinsurance. Additionally, members can access routine hearing exams for a $35 copay, prescription hearing aids with copays starting at $399, and a $50 quarterly over-the-counter allowance. Skilled nursing facility care is also covered with no copay for the first 20 days and a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
DEVOTED DUAL CHOICE 004 LA (PPO D-SNP) covers inpatient acute and psychiatric hospital services with no coinsurance, requiring prior authorization and a $300 daily copay for days 1 through 6, followed by no copay for days 7 through 90. This benefit is partially covered, as upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
DEVOTED DUAL CHOICE 004 LA (PPO D-SNP) covers outpatient services with no coinsurance, featuring a $0 to $400 copay for outpatient hospital services and a $300 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are available with no copay and no coinsurance, while outpatient substance abuse sessions require a $35 copay.
Partial Hospitalization See details
DEVOTED DUAL CHOICE 004 LA (PPO D-SNP) covers partial hospitalization services with a $105.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by DEVOTED DUAL CHOICE 004 LA (PPO D-SNP), with ground ambulance services requiring a coinsurance and a copay ranging from no copay to $290, and air ambulance services requiring a 20% coinsurance and a copay. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Emergency services are covered by DEVOTED DUAL CHOICE 004 LA (PPO D-SNP) with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services have 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 $290 copay plus 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED DUAL CHOICE 004 LA (PPO D-SNP) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $35 copay and no coinsurance. Physical, occupational, and speech therapy services require a $35 to $50 copay and no coinsurance, while podiatry is not covered, and some chiropractic services are covered but routine and other chiropractic services are not.
Preventive Services See details
Preventive services are partially covered by DEVOTED DUAL CHOICE 004 LA (PPO D-SNP) with no copay and no coinsurance for covered benefits like annual exams and fitness programs. However, services that are not covered include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access, and counseling.
Hearing Services See details
Hearing services are partially covered by DEVOTED DUAL CHOICE 004 LA (PPO D-SNP), which includes one routine hearing exam per year for a $35 copay and no coinsurance, and unlimited fitting evaluations with no copay and no coinsurance. Up to two prescription hearing aids are covered annually with copays ranging from $399 to $699 and no coinsurance, but OTC hearing aids and 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 DUAL CHOICE 004 LA (PPO D-SNP), offering one annual routine eye exam with a $0 to $35 copay, no coinsurance, and no deductible, though other eye exam services are not covered. Additionally, the plan provides a $400 annual limit for eyewear, including contacts and eyeglasses, with no copay, no coinsurance, and no deductible.
Dental Services See details
DEVOTED DUAL CHOICE 004 LA (PPO D-SNP) partially covers dental services, offering Medicare-covered dental for a $35 copay and no coinsurance, and other dental services with no copay and no coinsurance up to a $2,000 yearly limit. Excluded from coverage are other diagnostic and preventive dental services, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
DEVOTED DUAL CHOICE 004 LA (PPO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs have no copay and 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 DUAL CHOICE 004 LA (PPO D-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
DEVOTED DUAL CHOICE 004 LA (PPO D-SNP) partially covers medical equipment with no copays, though prior authorization is required for these services. Durable medical equipment carries a 20% to 30% coinsurance, prosthetics and medical supplies have no coinsurance to 20% coinsurance, and diabetic supplies range from no coinsurance to 30% coinsurance, while diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED DUAL CHOICE 004 LA (PPO D-SNP) with prior authorization required. Lab services feature no copay and no coinsurance, diagnostic tests range from a $0 to $95 copay with no coinsurance, and radiological services require varying copays and coinsurance, including a minimum 20% coinsurance for therapeutic services.
Home Health Services See details
Home health services are covered by DEVOTED DUAL CHOICE 004 LA (PPO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by DEVOTED DUAL CHOICE 004 LA (PPO D-SNP) with no copay and no coinsurance, meaning some services are covered. However, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for PAD services are not covered in practice under this plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by DEVOTED DUAL CHOICE 004 LA (PPO D-SNP) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required and a prior three-day hospital stay is not needed, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
DEVOTED DUAL CHOICE 004 LA (PPO D-SNP) provides partial coverage for other services, featuring additional preventive services and a $50 quarterly over-the-counter (OTC) allowance with no copay and no coinsurance. Acupuncture and meal benefits are not covered by this plan.
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