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Devoted CHOICE North Carolina (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Devoted CHOICE North Carolina (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Devoted CHOICE North Carolina (PPO) in 2025, please refer to our full plan details page.
Devoted CHOICE North Carolina (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in North Carolina Triad. The overall rating for this plan is not yet available for 2025.
It's important to know that Devoted CHOICE North Carolina (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 North Carolina (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 North Carolina (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 $5900.00 (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 $5900.00 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 North Carolina (PPO) plan has an "Enhanced Alternative" drug benefit. The plan has a $590 deductible for prescription drugs. Once you meet your deductible, you will pay a copay or coinsurance for your prescriptions. For example, you will pay a $5 copay for preferred generic drugs at a standard pharmacy, and 25% coinsurance for standard generic, preferred brand, and non-preferred drugs.
Additional Benefits
The Devoted CHOICE North Carolina (PPO) plan offers a range of benefits, including inpatient and outpatient hospital services with varying copays and coinsurance. You'll find coverage for primary care, preventive services, hearing, vision, and dental services, each with specific copays or cost-sharing arrangements. Additional benefits include ambulance, emergency, and home health services. This plan also covers home infusion, dialysis, medical equipment, and diagnostic services, with associated copays or coinsurance. However, certain services such as cardiac rehabilitation, private duty nursing, and other "other services" are not covered.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric services, with a copay of $325 for days 1-6 and no copay for days 7-90. Additional days for Inpatient Hospital-Acute are covered, while non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services are covered. Outpatient hospital services have a copay between $0 and $425, and observation services have a copay of $325, while ambulatory surgical center services have no copay. Individual and group sessions for outpatient substance abuse have a copay of $25. Outpatient blood services include a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered with a $60 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Devoted CHOICE North Carolina (PPO). Ground ambulance services have a copay between $0 and $275, while air ambulance services have a 20% coinsurance, and transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services for the Devoted CHOICE North Carolina (PPO) plan include a $125 copay, and no coinsurance. Urgently Needed Services have a copay between $0 and $45, and no coinsurance. Worldwide Emergency Services have varying cost sharing, including a $125 copay for Worldwide Emergency and Urgent Coverage, a $275 copay and 20% coinsurance for Worldwide Emergency Transportation.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay, Occupational Therapy Services with a copay between $25 and $45, Physician Specialist Services with a $25 copay, Mental Health Specialty Services with a $25 copay for individual and group sessions, Other Health Care Professional with a copay between $0 and $25, Psychiatric Services with a $25 copay for individual and group sessions, and Physical Therapy and Speech-Language Pathology Services with a $25 to $50 copay. Additional Telehealth benefits are covered with a copay between $0 and $25, and Opioid Treatment Program Services are covered with a $25 copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
The Devoted CHOICE North Carolina (PPO) plan covers preventive services, including annual physical exams, 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 a welcome visit. However, in-home safety assessments, personal emergency response systems, 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 hearing exams with a $25 copay, and routine hearing exams are covered once per year. Prescription hearing aids are partially covered, with a copay between $399 and $699 per year for all types of hearing aids, but inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a $25 copay, and eyewear with a combined maximum benefit of $1000 per year for both in-network and out-of-network services. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Devoted CHOICE North Carolina (PPO) covers dental services, including oral exams, dental x-rays, and other diagnostic services, with no copay. Medicare dental services have a $25 copay. Other services such as Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered. The plan has a maximum benefit of $1,000 per year for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay with 20% coinsurance. 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 North Carolina (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment, including Durable Medical Equipment (DME), Prosthetic Devices, and Medical Supplies, is covered. DME has a coinsurance of 0-20%, while Prosthetic Devices have a coinsurance of 0-20%, and Medical Supplies have a 20% coinsurance. Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered, and Durable Medical Equipment for use outside the home is also not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, with copays ranging from $0 to $95, and lab services with no copay. Diagnostic Radiological Services have a copay of at most $300, while Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Devoted CHOICE North Carolina (PPO) plan with no copay and no coinsurance; however, additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Devoted CHOICE North Carolina (PPO) plan. While the plan covers Cardiac Rehabilitation Services, the sub-services of 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 by the Devoted CHOICE North Carolina (PPO) plan, but require prior authorization. For days 1-20 and 61-100, there is no copay, and for days 21-60, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services are not covered, 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. Other 2 includes $0 preventive services.
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