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DEVOTED CHOICE 001 IL (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CHOICE 001 IL (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED CHOICE 001 IL (PPO) in 2026, please refer to our full plan details page.
DEVOTED CHOICE 001 IL (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Central Illinois. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED CHOICE 001 IL (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 001 IL (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 001 IL (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 $385.00 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 $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 001 IL (PPO) Medicare prescription drug plan features an annual drug deductible of $385. Under this plan, members enjoy no copay for Tier 1 preferred generic and Tier 2 generic medications for 1-month, 2-month, or 3-month supplies at standard pharmacies and standard mail order. This makes essential generic prescriptions highly affordable and accessible. For brand-name and specialty medications, costs are structured as coinsurance rather than flat copays. You will pay a 19% coinsurance for Tier 3 preferred brand drugs and a 25% coinsurance for Tier 4 non-preferred drugs for 1-month, 2-month, or 3-month supplies. Tier 5 specialty drugs require a 27% coinsurance for a 1-month supply at standard pharmacies and standard mail order.
Additional Benefits
The DEVOTED CHOICE 001 IL (PPO) plan offers robust coverage for essential medical needs, featuring no copay and no coinsurance for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay a $330 daily copay for days 1 through 5, with no copay for days 6 through 90. Outpatient services and emergency care are also covered with no coinsurance, requiring a $130 copay for emergency room visits and outpatient hospital copays ranging from no copay to $430. Specialist visits and mental health services require a $35 copay with no coinsurance, while diagnostic lab work and X-rays are available with no copay. The plan also includes supplemental dental care with no copay and up to a $3,500 annual limit, as well as a $400 annual allowance for eyewear with no copay or deductible. Prescription hearing aids are covered with copays ranging from $399 to $699, and over-the-counter items are provided with no copay and no coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by DEVOTED CHOICE 001 IL (PPO) with no coinsurance, requiring a $330 daily copay for days 1 through 5 and no copay for days 6 through 90 per stay. While unlimited additional acute care days are covered, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED CHOICE 001 IL (PPO) covers outpatient services with no coinsurance, featuring a $0 to $430 copay for outpatient hospital services, a $330 copay per stay for observation services, and a $35 copay for outpatient substance abuse sessions. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
DEVOTED CHOICE 001 IL (PPO) covers partial hospitalization services with a $60.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered under DEVOTED CHOICE 001 IL (PPO), as routine transportation services to health-related locations are not covered. Prior-authorized ground ambulance services require a copay ranging from no copay to $315 along with coinsurance, while air ambulance services require a 20% coinsurance and a copay.
Emergency Services See details
Emergency services are covered by DEVOTED CHOICE 001 IL (PPO) with a $130 copay and no coinsurance (waived if admitted within 24 hours), and urgently needed services range from no copay to a $45 copay with no coinsurance. Worldwide emergency services are covered up to a $25,000 maximum, featuring a $130 copay and no coinsurance for emergency and urgent care, and a $315 copay with 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED CHOICE 001 IL (PPO) provides primary care physician services with no copay and no coinsurance, while specialist visits, mental health, psychiatric, and opioid treatment services require a $35 copay and no coinsurance. Physical, occupational, and speech therapy carry a $35 to $50 copay and no coinsurance, telehealth services range from a $0 to $45 copay with no coinsurance, and podiatry along with routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by DEVOTED CHOICE 001 IL (PPO) with no copay and no coinsurance, including annual physical exams, kidney disease education, and select screenings. Additional preventive services are partially covered, but in-home safety assessments, personal emergency response systems, 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, additional smoking and tobacco cessation counseling, enhanced disease management, telemonitoring, remote access technologies, and counseling services are not covered.
Hearing Services See details
Hearing services are partially covered by DEVOTED CHOICE 001 IL (PPO), featuring routine exams for a $35 copay and no coinsurance, and prescription hearing aids with a copay ranging from $399 to $699 and no coinsurance. OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Vision services are covered by DEVOTED CHOICE 001 IL (PPO), offering one annual routine eye exam with a copay ranging from $0 to $35, no coinsurance, and no deductible, though other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible up to a combined maximum benefit of $400 per year for contacts, frames, lenses, and upgrades.
Dental Services See details
DEVOTED CHOICE 001 IL (PPO) partially covers dental services up to a $3,500 annual maximum, featuring preventive care with no copay and no coinsurance, and comprehensive care with no copay and 0% to 50% coinsurance. Medicare-covered dental has a $35 copay and no coinsurance, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED CHOICE 001 IL (PPO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization and step therapy are required. Covered Medicare Part B chemotherapy, radiation, and other Part B drugs have no copay and 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
DEVOTED CHOICE 001 IL (PPO) covers Dialysis Services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
DEVOTED CHOICE 001 IL (PPO) partially covers medical equipment with no copay, though diabetic therapeutic shoes and inserts are not covered. Covered items like durable medical equipment, prosthetics, medical supplies, and diabetic supplies require prior authorization and carry coinsurance ranging from no coinsurance up to 20% (flat 20% coinsurance for durable medical equipment).
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED CHOICE 001 IL (PPO), with prior authorization required. Outpatient lab services and X-rays have no copay, diagnostic procedures and tests have no coinsurance and a copay of $0 to $95, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered under DEVOTED CHOICE 001 IL (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are provided by DEVOTED CHOICE 001 IL (PPO) with no coinsurance, though prior authorization is required. While some services are covered, Cardiac, Intensive Cardiac, Pulmonary Rehabilitation, and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) services are not covered in practice and require copays of $35 ($25 for SET for PAD).
Skilled Nursing Facility (SNF) See details
DEVOTED CHOICE 001 IL (PPO) covers Skilled Nursing Facility (SNF) services 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 three-day inpatient hospital stay is not required, and additional days beyond the standard 100-day benefit period are not covered.
Other Services See details
DEVOTED CHOICE 001 IL (PPO) partially covers other services, offering additional preventive services and over-the-counter (OTC) items with no copay and no coinsurance. However, acupuncture and meal benefits are not covered under this plan.
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