A non-government entity
DEVOTED CHOICE MA ONLY 007 NC (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CHOICE MA ONLY 007 NC (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED CHOICE MA ONLY 007 NC (PPO) in 2026, please refer to our full plan details page.
DEVOTED CHOICE MA ONLY 007 NC (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in North Carolina. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED CHOICE MA ONLY 007 NC (PPO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about DEVOTED CHOICE MA ONLY 007 NC (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 MA ONLY 007 NC (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. Additionally, this plan comes with a Part B Premium reduction of $184.70. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $13900.00 (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 $13900.00 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 MA ONLY 007 NC (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
Prescription drugs are not covered by DEVOTED CHOICE MA ONLY 007 NC (PPO).
Additional Benefits
The DEVOTED CHOICE MA ONLY 007 NC (PPO) plan offers robust coverage for essential medical services, featuring no copay or coinsurance for primary care visits and preventive care. If you require specialist visits or emergency care, you will face predictable copays of $45 and $115 respectively, with no coinsurance. For hospital stays, inpatient care requires a daily copay of $425 for the first four days followed by no copay, while home health services are fully covered with no copay or coinsurance. Supplemental benefits include an annual dental allowance of up to $1,000 with no copay for many preventive services, alongside a $400 annual limit for eyewear with no copay or coinsurance. Routine hearing exams carry a $45 copay, while prescription hearing aids require copays between $599 and $899. For durable medical equipment and dialysis services, you can expect to pay no copay and a 20% coinsurance.
Inpatient Hospital See details
DEVOTED CHOICE MA ONLY 007 NC (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance and a daily copay of $425 for days 1 through 4, followed by no copay for days 5 through 90. Prior authorization is required, and some services such as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED CHOICE MA ONLY 007 NC (PPO) covers outpatient services with no coinsurance, featuring a copay ranging from no copay to $525 for outpatient hospital services and $425 per stay for observation services. Outpatient substance abuse sessions require a $45 copay, while ambulatory surgical center and outpatient blood services are offered with no copay.
Partial Hospitalization See details
Partial hospitalization is covered by DEVOTED CHOICE MA ONLY 007 NC (PPO) with a $70.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by DEVOTED CHOICE MA ONLY 007 NC (PPO), with ground ambulance services requiring a $0 to $350 copay and no coinsurance, and air ambulance services requiring 20% coinsurance and no copay. Prior authorization is required for ambulance services, and these costs are not waived if you are admitted to the hospital. While some transportation services are covered, trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
DEVOTED CHOICE MA ONLY 007 NC (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require no copay to a $40 copay with no coinsurance, and worldwide emergency services are covered up to a $25,000 limit with a $115 copay for emergency/urgent care and a $350 copay plus 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED CHOICE MA ONLY 007 NC (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $45 copay and no coinsurance. Therapy and mental health services are covered with copays ranging from $35 to $50 and no coinsurance, though podiatry is not covered. For chiropractic care, some services are covered but routine and other chiropractic services are not covered.
Preventive Services See details
DEVOTED CHOICE MA ONLY 007 NC (PPO) preventive services are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes training. Additional preventive benefits are partially covered; fitness benefits, alternative therapies, and nutrition counseling are included, but services like in-home support, personal emergency response systems, counseling, and therapeutic massage are not covered.
Hearing Services See details
Hearing services are partially covered by DEVOTED CHOICE MA ONLY 007 NC (PPO), which features a $45 copay and no coinsurance for routine hearing exams, and copays between $599 and $899 with no coinsurance for up to two prescription hearing aids per year. OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Vision services are partially covered under DEVOTED CHOICE MA ONLY 007 NC (PPO), which features routine eye exams with a $0 to $45 copay and no coinsurance, while other eye exam services are not covered. Covered eyewear, including contacts, lenses, and frames, has no copay or coinsurance up to a combined annual limit of $400.
Dental Services See details
DEVOTED CHOICE MA ONLY 007 NC (PPO) offers partially covered dental services with an annual maximum benefit of $1,000 for both in-network and out-of-network care. Medicare-covered dental has a $45 copay and no coinsurance, while other covered preventive and comprehensive services have no copay and 0% to 50% coinsurance, excluding maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by DEVOTED CHOICE MA ONLY 007 NC (PPO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have a coinsurance ranging from no coinsurance to 20%, while Part B insulin drugs require a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
DEVOTED CHOICE MA ONLY 007 NC (PPO) covers Dialysis Services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by DEVOTED CHOICE MA ONLY 007 NC (PPO) with no copays, featuring a 20% coinsurance for durable medical equipment and no coinsurance to 20% coinsurance for prosthetics, medical supplies, and diabetic supplies. Diabetic equipment is partially covered, as diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED CHOICE MA ONLY 007 NC (PPO) with prior authorization required for all services. Diagnostic tests feature no coinsurance and a copay ranging from $0 to $95, lab services and outpatient X-rays have no copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the DEVOTED CHOICE MA ONLY 007 NC (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
DEVOTED CHOICE MA ONLY 007 NC (PPO) covers some Cardiac Rehabilitation Services with no copay and no coinsurance. However, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD rehabilitation services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
DEVOTED CHOICE MA ONLY 007 NC (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. Patients pay no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered under the DEVOTED CHOICE MA ONLY 007 NC (PPO) plan, which provides additional preventive services not covered by Medicare with no copay and no coinsurance. However, acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
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