A non-government entity
DEVOTED CHOICE 015 TN (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CHOICE 015 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 015 TN (PPO) in 2026, please refer to our full plan details page.
DEVOTED CHOICE 015 TN (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Nashville. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that DEVOTED CHOICE 015 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 015 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 015 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 $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 015 TN (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The DEVOTED CHOICE 015 TN (PPO) Medicare plan features an annual drug deductible of $375. For Tier 1 preferred generic drugs, members pay no copay for one-month, two-month, or three-month supplies filled at standard pharmacies or through standard mail order. Tier 2 generic medications require a copay starting at $5.00 for a one-month supply, up to $15.00 for a three-month supply at standard pharmacies, or $12.50 for a three-month supply via standard mail order. Higher-tier prescription drugs are covered under a coinsurance structure at standard pharmacies and standard mail order. Members pay 24% coinsurance for Tier 3 preferred brand drugs and 25% coinsurance for Tier 4 non-preferred drugs. Tier 5 specialty drugs require a 28% coinsurance and are limited to a one-month supply.
Additional Benefits
The DEVOTED CHOICE 015 TN (PPO) plan offers comprehensive medical coverage with no copays or coinsurance for primary care visits and preventive services, while specialist visits require a $30 copay. For hospital care, inpatient stays require a $325 daily copay for the first five days followed by no copay for days 6 through 90, and emergency room visits carry a $130 copay. Outpatient hospital services range from no copay up to a $425 copay, with no coinsurance required. This plan also includes valuable supplemental benefits, featuring no copays for preventive dental care and routine eyewear up to a $350 annual allowance. Routine hearing exams carry a $30 copay, and prescription hearing aids require copays between $399 and $699 with no coinsurance. Additionally, members receive a $100 quarterly over-the-counter allowance and enjoy no copays for home health services or the first 20 days of skilled nursing facility care.
Inpatient Hospital See details
DEVOTED CHOICE 015 TN (PPO) inpatient hospital care is partially covered, requiring no coinsurance and a copay of $325 per day for days 1 through 5, with no copay for days 6 through 90. 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 015 TN (PPO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay ranging from no copay to $425, while observation services have a $325 copay per stay and outpatient substance abuse sessions require a $30 copay.
Partial Hospitalization See details
DEVOTED CHOICE 015 TN (PPO) covers partial hospitalization services with a $60 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
DEVOTED CHOICE 015 TN (PPO) covers ambulance services with prior authorization, requiring a copay ranging from no copay up to $315 with no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. Transportation services are not covered under this plan.
Emergency Services See details
Emergency services under DEVOTED CHOICE 015 TN (PPO) are covered with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, and urgently needed services range from no copay to a $45 copay with no coinsurance. Worldwide emergency and urgent care are covered up to a $25,000 maximum benefit with a $130 copay and no coinsurance, while worldwide emergency transportation requires a $315 copay and 20% coinsurance.
Primary Care See details
DEVOTED CHOICE 015 TN (PPO) provides primary care physician services with no copay and no coinsurance, and specialist visits with a $30.00 copay and no coinsurance. Mental health, psychiatric, and therapy services require copays ranging from $30.00 to $50.00 with no coinsurance, while podiatry is not covered, and for chiropractic care, some services are covered but routine and other chiropractic services are not.
Preventive Services See details
Preventive services under DEVOTED CHOICE 015 TN (PPO) are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, and fitness benefits. This benefit is partially covered, as sub-services such as in-home support, personal emergency response systems, and therapeutic massages are not covered.
Hearing Services See details
DEVOTED CHOICE 015 TN (PPO) covers hearing services, featuring a $30 copay and no coinsurance for one routine hearing exam per year and unlimited fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $399 to $699 for up to two aids yearly, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
DEVOTED CHOICE 015 TN (PPO) vision services are partially covered, featuring one routine eye exam per year with a $0 to $30 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $350 combined annual maximum for contacts, eyeglasses, lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by DEVOTED CHOICE 015 TN (PPO), offering preventive care with no copay and no coinsurance, and Medicare-covered dental services with a $30 copay and no coinsurance. Covered comprehensive services have no copay and 0% to 50% coinsurance up to a $3,500 annual maximum benefit, though maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by DEVOTED CHOICE 015 TN (PPO) with no copay and no coinsurance, though prior authorization is required. Associated Medicare Part B chemotherapy and other Part B drugs have no copay and no coinsurance to 20% coinsurance, while covered Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under DEVOTED CHOICE 015 TN (PPO) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
DEVOTED CHOICE 015 TN (PPO) covers medical equipment with no copays, though diabetic equipment is only partially covered because diabetic therapeutic shoes and inserts are not covered. Prior authorization is required, with coinsurance ranging from 20% to 50% for durable medical equipment, no coinsurance to 20% for prosthetics and medical supplies, and no coinsurance to 50% for diabetic supplies.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED CHOICE 015 TN (PPO) with no coinsurance for diagnostic services, no copay for lab services or outpatient X-rays, and prior authorization required. Diagnostic procedures and tests carry a copay of $0 to $95, diagnostic radiological services start at a $0 copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the DEVOTED CHOICE 015 TN (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
DEVOTED CHOICE 015 TN (PPO) covers some cardiac rehabilitation services with no coinsurance, though prior authorization is required. However, standard cardiac, intensive cardiac, and pulmonary rehabilitation services (each requiring a $30 copay), as well as supervised exercise therapy for peripheral artery disease (requiring a $25 copay), are not covered.
Skilled Nursing Facility (SNF) See details
DEVOTED CHOICE 015 TN (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
DEVOTED CHOICE 015 TN (PPO) offers partial coverage for other services, featuring no copay and no coinsurance for additional preventive services and over-the-counter (OTC) items, which include a $100 allowance every three months. Acupuncture and meal benefits are not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved