A non-government entity
DEVOTED CHOICE 005 LA (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CHOICE 005 LA (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED CHOICE 005 LA (PPO) in 2026, please refer to our full plan details page.
DEVOTED CHOICE 005 LA (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Greater New Orleans. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED CHOICE 005 LA (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 005 LA (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 005 LA (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 $375.00 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 $6300.00 (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 $6300.00 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 005 LA (PPO) prescription drug plan features an annual drug deductible of $375. 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. This coverage provides a highly affordable option for those managing everyday generic prescriptions. For brand-name and specialty medications, costs are structured as coinsurance percentages. Tier 3 preferred brand drugs require a 19% coinsurance, while Tier 4 non-preferred drugs have a 25% coinsurance. Tier 5 specialty drugs require a 28% coinsurance for a one-month supply through standard retail or mail-order pharmacies.
Additional Benefits
The DEVOTED CHOICE 005 LA (PPO) plan offers comprehensive medical coverage featuring no copay for primary care doctor visits and a $30 copay for specialists. Inpatient hospital stays require a $175 daily copay for days one through seven and no copay for days eight through ninety, while outpatient hospital services range from no copay up to a $275 copay. Emergency room visits have a $150 copay, which is waived if you are admitted to the hospital within 24 hours. For extra wellness benefits, the plan provides up to $4,000 in dental coverage with no copay for most preventive services, alongside a $350 annual eyewear allowance with no copay. Routine hearing exams require a $30 copay, and prescription hearing aids are covered with copays ranging from $399 to $699. Additionally, members receive a $100 over-the-counter item allowance every three months and home health services with no copay.
Inpatient Hospital See details
DEVOTED CHOICE 005 LA (PPO) offers partially covered inpatient hospital services with no coinsurance, requiring a $175 daily copay for days 1 through 7 and no copay for days 8 through 90. Hospital upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered under this benefit.
Outpatient Services See details
DEVOTED CHOICE 005 LA (PPO) covers outpatient services with no coinsurance, including ambulatory surgical center and outpatient blood services which also feature no copay. Medicare-covered outpatient hospital services require a copay ranging from $0 to $275, outpatient observation services cost a $175 copay per stay, and outpatient substance abuse sessions have a $30 copay.
Partial Hospitalization See details
Partial hospitalization is covered under the DEVOTED CHOICE 005 LA (PPO) plan with a $105.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
DEVOTED CHOICE 005 LA (PPO) covers ambulance services with prior authorization, featuring ground ambulance services with no copay to a $315 copay and air ambulance services with a 20% coinsurance. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
DEVOTED CHOICE 005 LA (PPO) covers emergency services with a $150 copay and no coinsurance, which is 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 $150 copay and no coinsurance for emergency or urgent care, and a $315 copay plus 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED CHOICE 005 LA (PPO) offers primary care physician services with no copay and no coinsurance, and specialist, mental health, psychiatric, and opioid treatment services for a $30 copay and no coinsurance. Physical, occupational, and speech therapy services require a $30 to $50 copay and no coinsurance, telehealth has a $0 to $45 copay and no coinsurance, and chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by DEVOTED CHOICE 005 LA (PPO) with no copay and no coinsurance for covered benefits like annual physical exams, fitness benefits, and kidney disease education. However, several sub-services are not covered, including in-home support, personal emergency response systems (PERS), medical nutrition therapy, counseling, and therapeutic massage.
Hearing Services See details
Hearing services are partially covered by DEVOTED CHOICE 005 LA (PPO), featuring a $30 copay and no coinsurance or deductible for routine hearing exams. Prescription hearing aids are covered up to two per year with no coinsurance and a copay between $399 and $699, though OTC hearing aids and inner-ear, outer-ear, or over-the-ear prescription models are not covered.
Vision Services See details
DEVOTED CHOICE 005 LA (PPO) vision services are partially covered, featuring one routine eye exam every year with a copay ranging from $0 to $30 and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a combined maximum benefit of $350 per year for contacts, eyeglasses, and upgrades.
Dental Services See details
Dental services are partially covered by DEVOTED CHOICE 005 LA (PPO), offering up to a $4,000 annual maximum benefit for combined in-network and out-of-network care. Most preventive, diagnostic, and surgical services feature no copay and no coinsurance, while restorative, endodontic, and prosthodontic services have no copay and 0% to 50% coinsurance. Medicare-covered dental requires a $30 copay with no coinsurance, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED CHOICE 005 LA (PPO) covers home infusion bundled services with no copay, subject to prior authorization. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and a 0% to 20% coinsurance, while Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under DEVOTED CHOICE 005 LA (PPO) with no copay and a 20% coinsurance, and prior authorization is required.
Medical Equipment See details
DEVOTED CHOICE 005 LA (PPO) covers medical equipment with no copays and prior authorization requirements, featuring coinsurance ranging from 20% to 35% for durable medical equipment, no coinsurance to 20% for prosthetics, and no coinsurance to 40% for diabetic supplies. This benefit is partially covered by the plan, as diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED CHOICE 005 LA (PPO) covers diagnostic and radiological services, with prior authorization required for all services. Lab services feature no copay and no coinsurance, diagnostic procedures have a copay ranging from $0 to $95 with no coinsurance, and therapeutic radiology requires a minimum 20% coinsurance along with a copay.
Home Health Services See details
Home Health Services are covered by DEVOTED CHOICE 005 LA (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
DEVOTED CHOICE 005 LA (PPO) covers some cardiac rehabilitation services with prior authorization, no copay, and no coinsurance, but standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
DEVOTED CHOICE 005 LA (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 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare limit are not covered.
Other Services See details
Other services are partially covered by DEVOTED CHOICE 005 LA (PPO), as acupuncture and meal benefits are not covered. Covered benefits include additional preventive services and over-the-counter (OTC) items with no copay and no coinsurance, featuring a $100 maximum benefit limit every three months for OTC items.
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