A non-government entity
Devoted CHOICE Tennessee (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Devoted CHOICE Tennessee (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Devoted CHOICE Tennessee (PPO) in 2025, please refer to our full plan details page.
Devoted CHOICE Tennessee (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Tri-Cities. The overall rating for this plan is not yet available for 2025.
It's important to know that Devoted CHOICE Tennessee (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 Tennessee (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 Tennessee (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 $8950.00 (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 $8950.00 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:
Sign up for Devoted CHOICE Tennessee (PPO)
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Drug Coverage
The Devoted CHOICE Tennessee (PPO) plan has an enhanced alternative drug benefit. The plan has a $590 deductible for prescription drugs. In the initial coverage phase, after you meet your deductible, you will pay either a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, you will pay a $5 copay for preferred generic drugs at a standard or mail-order pharmacy. You will pay 25% coinsurance for standard generic, preferred brand, and non-preferred drugs. After your total drug costs reach $2000, you will enter the catastrophic coverage phase and pay nothing for your drugs.
Additional Benefits
The Devoted CHOICE Tennessee (PPO) plan offers comprehensive coverage with a variety of benefits. This plan covers inpatient hospital stays with a $295 copay for days 1-5, and no copay for days 6-90. Outpatient services, primary care, preventive services, hearing, vision, dental, home health, and skilled nursing facility services are also covered, with varying copays and coinsurance amounts.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered, with a copay of $295 for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered stays and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $395, and observation services with a $295 copay. Ambulatory Surgical Center (ASC) Services have no copay, and outpatient substance abuse services have a $40 copay for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial hospitalization is covered by the Devoted CHOICE Tennessee (PPO) plan, with a copay of $85.00. 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 and $300, while air ambulance services have a 20% coinsurance; however, transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $125 copay, Urgently Needed Services have a copay between $0 and $45, and Worldwide Emergency Transportation has a $300 copay and 20% coinsurance, while the other Worldwide Emergency Services have a $125 copay.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services and Chiropractic Services, with a $20 copay for Chiropractic Services. Occupational Therapy Services have a copay between $40 and $45, while Physician Specialist Services and Additional Telehealth Benefits have a copay between $0 and $40. Mental Health Specialty Services and Psychiatric Services both have a $40 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a copay between $40 and $50. Opioid Treatment Program Services have a $40 copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive services include Medicare-covered services and additional services not usually covered by Medicare, such as an annual physical exam, health education, personal emergency response system, weight management programs, alternative therapies, nutritional/dietary benefits, fitness benefits, home and bathroom safety devices and modifications, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs, while in-home safety assessment, 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 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 services include routine hearing exams with a $40 copay for 1 visit per year, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $399 and $699 for 2 visits per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Devoted CHOICE Tennessee (PPO) plan covers vision services, including eye exams with a $40 copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, and eyeglass frames, are also covered, with a combined maximum benefit of $1000 every year.
Dental Services See details
Devoted CHOICE Tennessee (PPO) covers a variety of dental services, including oral exams with a $40 copay, dental x-rays with a $40 copay, other diagnostic dental services with a $40 copay, prophylaxis (cleaning) with a $40 copay, and fluoride treatment with a $40 copay. This plan also includes a $1,000 annual maximum for dental services, and the plan does not cover maxillofacial prosthetics, implant services, or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 20% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Devoted CHOICE Tennessee (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, but does not cover DME for use outside the home. Prosthetics/Medical Supplies have a coinsurance, and Medical Supplies have a 20% coinsurance. Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $95, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $300, and Therapeutic Radiological Services have 20% coinsurance, while Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Devoted CHOICE Tennessee (PPO) plan with no copay and no coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Devoted CHOICE Tennessee (PPO). However, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization required. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
Other Services are not covered by the Devoted CHOICE Tennessee (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. Some Other Services benefits, such as $0 Preventive Services, are covered.
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