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DEVOTED CHOICE 001 WA (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CHOICE 001 WA (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 WA (PPO) in 2026, please refer to our full plan details page.
DEVOTED CHOICE 001 WA (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 2026.
It's important to know that DEVOTED CHOICE 001 WA (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 WA (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 WA (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 $370.00 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 001 WA (PPO) Medicare plan features an annual prescription drug deductible of $370. Enrollees benefit from no copay for Tier 1 preferred generic and Tier 2 generic drugs when using standard pharmacies or standard mail order. This no-copay coverage applies to 1-month, 2-month, and 3-month supplies, providing affordable access to essential everyday medications. For brand-name and specialty medications, the plan utilizes coinsurance rather than set copayments. Tier 3 preferred brand drugs require a 19% coinsurance, while Tier 4 non-preferred drugs carry a 25% coinsurance for all supply durations. Tier 5 specialty drugs require a 28% coinsurance for a 1-month supply filled through standard pharmacies or standard mail order.
Additional Benefits
The DEVOTED CHOICE 001 WA (PPO) Medicare plan offers comprehensive coverage with no copay for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay a $425 copay for days one through five and no copay for days six through ninety per stay. Outpatient, diagnostic, and emergency services are also covered, typically requiring fixed copays and no coinsurance, though some specialized treatments like dialysis and durable medical equipment require a twenty percent coinsurance. This plan also features valuable supplemental benefits, including dental coverage up to a $2,000 annual limit with no copay for preventive care and no copay with zero to fifty percent coinsurance for comprehensive services. Vision benefits cover routine eye exams and up to $400 annually for eyewear with no copay, while hearing benefits cover an annual exam and up to two prescription hearing aids. Additionally, members can take advantage of an over-the-counter benefit providing up to $75 every three months with no copay.
Inpatient Hospital See details
DEVOTED CHOICE 001 WA (PPO) inpatient hospital benefits are partially covered with no coinsurance, requiring a $425 copay for days 1 through 5 and no copay for days 6 through 90 per stay. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED CHOICE 001 WA (PPO) covers outpatient services with no coinsurance, though prior authorization is required. There is no copay for ambulatory surgical center and blood services, a $45 copay for outpatient substance abuse sessions, a $425 copay per stay for observation services, and a $0 to $525 copay for outpatient hospital services.
Partial Hospitalization See details
Partial hospitalization services are covered by DEVOTED CHOICE 001 WA (PPO) with a $60.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
DEVOTED CHOICE 001 WA (PPO) covers ambulance services with prior authorization, featuring ground ambulance services with a copay ranging from no copay to $290 and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
DEVOTED CHOICE 001 WA (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a copay ranging from no copay to $45 and no coinsurance. Worldwide emergency services are covered up to a $25,000 lifetime maximum, with a $130 copay and no coinsurance for emergency and urgent care, and a $290 copay with 20% coinsurance for emergency transportation.
Primary Care See details
Primary care benefits under DEVOTED CHOICE 001 WA (PPO) include primary care physician services with no copay and no coinsurance, while specialist, mental health, and therapy services feature copays ranging from $0 to $50 and no coinsurance. Podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive Services under DEVOTED CHOICE 001 WA (PPO) are partially covered, featuring an annual physical, kidney disease education, and Medicare-covered preventive services with no copay and no coinsurance. Supplemental benefits like fitness and alternative therapies are covered with coinsurance ranging from 0% to 50%, but services such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, and home-based palliative care are not covered.
Hearing Services See details
Hearing services covered by DEVOTED CHOICE 001 WA (PPO) include one routine hearing exam annually for a $45 copay and no coinsurance, alongside up to two prescription hearing aids per year with copays ranging from $399 to $699 and no coinsurance. OTC hearing aids and specific prescription aid types, including inner ear, outer ear, and over-the-ear models, are not covered under this plan.
Vision Services See details
DEVOTED CHOICE 001 WA (PPO) partially covers vision services, as other eye exam services are not covered. Routine eye exams are covered with no deductible, no coinsurance, and a copay ranging from no copay to $45, while eyewear is covered with no copay, no coinsurance, and a $400 annual maximum benefit for contacts, frames, lenses, and upgrades.
Dental Services See details
Dental services are covered by DEVOTED CHOICE 001 WA (PPO) up to a $2,000 annual limit for both in- and out-of-network care, with no copay and no coinsurance for preventive care, and no copay with 0% to 50% coinsurance for most comprehensive services. Medicare-covered dental services require a $45 copay and no coinsurance, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered under DEVOTED CHOICE 001 WA (PPO) with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and radiation, require no coinsurance to 20% coinsurance, while Part B insulin is subject to a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the DEVOTED CHOICE 001 WA (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
DEVOTED CHOICE 001 WA (PPO) partially covers medical equipment with no copay, requiring a 20% coinsurance for durable medical equipment and a coinsurance ranging from no coinsurance to 20% for prosthetics, medical supplies, and diabetic supplies. Prior authorization is required for these benefits, and diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED CHOICE 001 WA (PPO) covers diagnostic and radiological services with prior authorization, offering lab services with no copay or coinsurance and diagnostic tests with a $0 to $95 copay and no coinsurance. Outpatient X-rays feature no copay, diagnostic radiological services have copays starting at $0, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by DEVOTED CHOICE 001 WA (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by DEVOTED CHOICE 001 WA (PPO) with no coinsurance, though prior authorization is required. However, some services are not covered in practice, including standard cardiac rehabilitation (which carries a $40 copay), intensive cardiac rehabilitation ($40 copay), pulmonary rehabilitation ($35 copay), and supervised exercise therapy for peripheral artery disease ($25 copay).
Skilled Nursing Facility (SNF) See details
DEVOTED CHOICE 001 WA (PPO) covers skilled nursing facility (SNF) care 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 hospital stay is not required, and additional days beyond the standard 100 days are not covered.
Other Services See details
DEVOTED CHOICE 001 WA (PPO) partially covers other services, which include acupuncture with no copay and 50% coinsurance, and additional preventive services with no copay and no coinsurance. Over-the-counter (OTC) items are also covered with no copay and no coinsurance up to $75 every three months, while meal benefits are not covered.
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