A non-government entity
Devoted CHOICE Washington (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Devoted CHOICE Washington (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Devoted CHOICE Washington (PPO) in 2025, please refer to our full plan details page.
Devoted CHOICE Washington (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Washington. The overall rating for this plan is not yet available for 2025.
It's important to know that Devoted CHOICE Washington (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 Washington (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 Washington (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 $590.00 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 $10000.00 (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 $10000.00 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 Washington (PPO) plan has an "Enhanced Alternative" drug benefit type. The plan has a deductible of $590. Once you meet your deductible, you will pay the following costs for your prescriptions. For preferred generic drugs, you will pay a $10 copay at standard and mail order pharmacies. For standard generic, preferred brand, and non-preferred drugs, you will pay 25% coinsurance at standard and mail order pharmacies. After your total drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The Devoted CHOICE Washington (PPO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, while outpatient services have copays between $0 and $525. Emergency, primary care, hearing, vision, dental, and home infusion services are covered with copays, coinsurance, or both. The plan also covers ambulance, partial hospitalization, and home health services. Many preventive services are covered, and durable medical equipment is covered with coinsurance. Some services, such as skilled nursing facility stays, have specific copays depending on the length of stay.
Inpatient Hospital See details
Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For days 1-5 of an inpatient stay, you will pay a $425 copay, and for days 6-90 there is no copay.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services with a copay between $0 and $525, and observation services with a $425 copay. Ambulatory Surgical Center (ASC) Services have no copay, and outpatient substance abuse services have a $45 copay per individual or group session. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by Devoted CHOICE Washington (PPO), with a $60 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground ambulance services have a copay between $0-$290, while air ambulance services have a 20% coinsurance; transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services are covered by Devoted CHOICE Washington (PPO), with a $125 copay, and no coinsurance. Urgently Needed Services have a copay between $0 and $45, and no coinsurance. Worldwide Emergency Services are also covered, with a $125 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a 20% coinsurance and $290 copay for Worldwide Emergency Transportation.
Primary Care See details
Primary Care services include coverage for primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits and opioid treatment program services. Chiropractic services have a $20 copay, while routine chiropractic care is not covered. Occupational therapy services, individual and group sessions for mental health and psychiatric services, and opioid treatment program services have a $45 copay. Physician specialist services have a $45 copay. Physical therapy and speech-language pathology services have a copay between $45 and $50. Additional telehealth benefits have a copay between $0 and $45. Podiatry services are not covered.
Preventive Services See details
Preventive Services, including Medicare-covered services, an annual physical exam, and additional preventive services are covered. Health education, weight management programs, alternative therapies, nutritional/dietary benefits, fitness benefits, home and bathroom safety devices, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following the Welcome Visit are also covered. In-home safety assessment, personal emergency response systems (PERS), medical nutrition therapy (MNT), 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 of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, and counseling services are not covered.
Hearing Services See details
Hearing exams are covered with a $45 copay, including routine hearing exams and fitting/evaluation for hearing aids. Prescription hearing aids are partially covered with a copay between $399 and $699 for all types, but not for inner ear, outer ear, or over-the-ear hearing aids. OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for eye exams with a $45 copay, and eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Eyewear has a combined maximum plan benefit coverage of $1000 every year for both in-network and out-of-network services.
Dental Services See details
The Devoted CHOICE Washington (PPO) plan covers a range of dental services. Medicare Dental Services have a $45 copay, while other services like oral exams, x-rays, and cleanings are covered with no copay, up to a $1,000 annual maximum. However, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Devoted CHOICE Washington (PPO) plan, with a $35 copay and 20% coinsurance for Medicare Part B Insulin Drugs, and coinsurance between 0% and 20% for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by Devoted CHOICE Washington (PPO). There is a 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetic Devices, and Medical Supplies, is covered, with a 0-20% coinsurance for DME and 0-20% coinsurance for Prosthetic Devices. Medical Supplies have a 20% coinsurance, and Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests, and lab services. Diagnostic Procedures/Tests have a copay between $0 and $95, Lab Services have no copay, and Diagnostic Radiological Services have a copay of at most $300. Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Devoted CHOICE Washington (PPO) plan with no copay and no coinsurance, but require authorization. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Devoted CHOICE Washington (PPO) plan. However, specific services such as Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, SET for PAD Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Devoted CHOICE Washington (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services are not covered by the Devoted CHOICE Washington (PPO) plan, including acupuncture, over-the-counter items, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services.
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