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DEVOTED CHOICE 011 TN (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CHOICE 011 TN (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED CHOICE 011 TN (PPO) in 2026, please refer to our full plan details page.
DEVOTED CHOICE 011 TN (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Memphis. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that DEVOTED CHOICE 011 TN (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 011 TN (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 011 TN (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 $9500.00 (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 $9500.00 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 011 TN (PPO) Medicare plan features an annual prescription drug deductible of $375. Beneficiaries enjoy no copay for Tier 1 preferred generic and Tier 2 generic drugs filled at standard pharmacies or through standard mail order. This cost-saving benefit applies to one-month, two-month, and three-month supplies of these common medications. For brand-name and specialty medications, the plan transitions to a coinsurance structure. You will pay a 19% coinsurance for Tier 3 preferred brand drugs and a 25% coinsurance for Tier 4 non-preferred drugs. Tier 5 specialty drugs require a 28% coinsurance for a one-month supply at standard retail pharmacies or standard mail order.
Additional Benefits
The DEVOTED CHOICE 011 TN (PPO) plan offers comprehensive coverage with no copay for primary care visits, preventive services, and home health care. For specialist visits, members pay a $30 copay, while inpatient hospital stays require a $295 daily copay for the first five days and no copay thereafter. Emergency room visits carry a $130 copay, which is waived if you are admitted to the hospital within 24 hours. This plan also features robust dental coverage up to a $3,000 annual limit with no copay for preventive care and up to 50% coinsurance for restorative services. Vision benefits include routine exams and up to $350 annually for eyewear, while hearing aid copays range from $399 to $699 per device. Additionally, members receive a $150 allowance every three months for over-the-counter items and skilled nursing facility care with no copay for the first 20 days.
Inpatient Hospital See details
DEVOTED CHOICE 011 TN (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $295 daily copay for days 1 through 5 and no copay for days 6 through 90. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, and prior authorization is required.
Outpatient Services See details
DEVOTED CHOICE 011 TN (PPO) covers outpatient services with no coinsurance, offering ambulatory surgical center and blood services with no copay. Outpatient hospital services require a copay ranging from $0 to $395, observation services carry a $295 copay per stay, and outpatient substance abuse sessions require a $30 copay.
Partial Hospitalization See details
Partial hospitalization services are covered under DEVOTED CHOICE 011 TN (PPO) with a $60 copay and no coinsurance. Prior authorization is required to receive this care.
Ambulance and Transportation Services See details
DEVOTED CHOICE 011 TN (PPO) partially covers ambulance and transportation services, as routine transportation to health-related locations is not covered. Prior authorized ground ambulance services require no copay to a $295 copay and no coinsurance, while air ambulance services require a 20% coinsurance and no copay.
Emergency Services See details
DEVOTED CHOICE 011 TN (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services range from no copay to a $45 copay with no coinsurance, and worldwide emergency services are covered up to $25,000 with copays ranging from $130 to $295 and 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED CHOICE 011 TN (PPO) covers primary care physician visits with no copay and no coinsurance, and specialist visits for a $30 copay and no coinsurance. Therapy, mental health, and telehealth services range from a $0 to $50 copay with no coinsurance, while chiropractic care is partially covered (excluding routine and other chiropractic services) and podiatry is not covered.
Preventive Services See details
DEVOTED CHOICE 011 TN (PPO) preventive services are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. Additional preventive benefits are partially covered with no copay and no coinsurance, offering fitness, weight management, and alternative therapies, while excluding services like personal emergency response systems, therapeutic massage, and in-home support.
Hearing Services See details
Hearing services are partially covered by DEVOTED CHOICE 011 TN (PPO), featuring routine hearing exams with a $30 copay and no coinsurance. Prescription hearing aids are covered with no coinsurance and a copay ranging from $399 to $699 for up to two devices per year, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
DEVOTED CHOICE 011 TN (PPO) partially covers vision services, as other eye exam services are not covered. Routine eye exams are covered once per year with a $0 to $30 copay and no coinsurance, while eyewear is covered with no copay or coinsurance up to a $350 annual maximum.
Dental Services See details
DEVOTED CHOICE 011 TN (PPO) covers dental services up to a $3,000 annual maximum for both in-network and out-of-network care. Preventive services, periodontics, and oral surgery require no copay and no coinsurance, while restorative, endodontic, and prosthodontic services have no copay and 0% to 50% coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered, and Medicare-covered dental services require a $30 copay and no coinsurance.
Home Infusion bundled Services See details
DEVOTED CHOICE 011 TN (PPO) covers Home Infusion bundled Services with no copay and no coinsurance, although prior authorization and step therapy are required. Associated Medicare Part B chemotherapy and other drugs carry a 0% to 20% coinsurance with no copay, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by DEVOTED CHOICE 011 TN (PPO) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
DEVOTED CHOICE 011 TN (PPO) partially covers medical equipment with no copays, though diabetic therapeutic shoes and inserts are not covered. Covered durable medical equipment requires a 20% coinsurance, while medical supplies, prosthetic devices, and diabetic supplies carry a coinsurance ranging from no coinsurance to 20%.
Diagnostic and Radiological Services See details
DEVOTED CHOICE 011 TN (PPO) covers diagnostic and radiological services with prior authorization required. Diagnostic services feature no coinsurance, with no copay for lab services and $0 to $95 copays for diagnostic procedures, while radiological services offer outpatient X-rays with no copay, diagnostic radiological services with copays starting at $0, and therapeutic radiological services with a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by DEVOTED CHOICE 011 TN (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 011 TN (PPO) with no copay and no coinsurance, but only some services are covered in practice. Standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
DEVOTED CHOICE 011 TN (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, and while no prior three-day inpatient hospital stay is needed, additional days beyond the standard Medicare limit are not covered.
Other Services See details
Other Services are partially covered by DEVOTED CHOICE 011 TN (PPO), which features over-the-counter (OTC) items up to $150 every three months and additional preventive services with no copay and no coinsurance. Acupuncture, meal benefits, and dual-eligible SNP services are not covered under this benefit.
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