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DEVOTED CHOICE 001 NE (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CHOICE 001 NE (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED CHOICE 001 NE (PPO) in 2026, please refer to our full plan details page.
DEVOTED CHOICE 001 NE (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Nebraska. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED CHOICE 001 NE (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 001 NE (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 001 NE (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 $230.00 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 $6400.00 (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 $6400.00 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 001 NE (PPO) Medicare plan features an annual drug deductible of $230. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 2 generic prescription drugs filled for up to a three-month supply through standard pharmacies or standard mail order. This makes managing everyday medications highly affordable and convenient. For brand-name and specialty medications, costs are structured as a percentage of the drug cost. You will pay a 19% coinsurance for Tier 3 preferred brand drugs and a 25% coinsurance for Tier 4 non-preferred drugs through standard pharmacy and mail order channels. Specialty medications in Tier 5 carry a 28% coinsurance for a one-month supply.
Additional Benefits
The DEVOTED CHOICE 001 NE (PPO) plan offers comprehensive medical coverage featuring no copay for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay a $395 daily copay for the first several days and no copay for subsequent days, with no coinsurance required. Emergency room visits carry a $130 copay, which is waived if admitted within 24 hours, while specialist visits require a $40 copay. This plan also features valuable supplemental benefits, including dental coverage up to a $3,000 annual limit with no copay for preventive services and 0% to 50% coinsurance for comprehensive care. Vision benefits include no copay for eyewear up to a $350 yearly limit, and routine hearing exams are available with a $40 copay. Additionally, members receive a $100 allowance every three months for over-the-counter items with no copay or coinsurance.
Inpatient Hospital See details
DEVOTED CHOICE 001 NE (PPO) covers inpatient hospital services with no coinsurance, requiring a $395 daily copay for days 1 through 6 of acute stays and days 1 through 5 of psychiatric stays, with no copay for subsequent days. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED CHOICE 001 NE (PPO) outpatient services are covered with no coinsurance, though prior authorization is required for most services. Beneficiaries will pay no copay for ambulatory surgical center and blood services, a $40 copay for outpatient substance abuse sessions, a $395 copay per stay for observation services, and between $0 and $495 for outpatient hospital services.
Partial Hospitalization See details
Partial hospitalization is covered by the DEVOTED CHOICE 001 NE (PPO) plan with a $105.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance services are covered under DEVOTED CHOICE 001 NE (PPO) with prior authorization, featuring ground ambulance services with a copay ranging from no copay to $350 and applicable coinsurance, and air ambulance services with a 20% coinsurance and applicable copay. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
DEVOTED CHOICE 001 NE (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if admitted within 24 hours, and urgently needed services with no copay to a $45 copay and no coinsurance. Worldwide emergency services are covered up to $25,000, requiring a $130 copay and no coinsurance for emergency or urgent care, and a $350 copay with 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED CHOICE 001 NE (PPO) provides primary care physician services with no copay and no coinsurance, and specialist visits with a $40 copay and no coinsurance. Other covered services, such as physical, occupational, and mental health therapies, require copays ranging from $0 to $50 and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
DEVOTED CHOICE 001 NE (PPO) provides preventive services, including annual physical exams, kidney disease education, and diabetes screenings, with no copay and no coinsurance. Additional preventive benefits are partially covered with no copay and no coinsurance, excluding services such as in-home support, therapeutic massage, personal emergency response systems (PERS), and home-based palliative care.
Hearing Services See details
Hearing services are partially covered by DEVOTED CHOICE 001 NE (PPO), offering annual routine hearing exams with a $40 copay, no coinsurance, and no deductible. Covered prescription hearing aids require a copay between $399 and $699 with no coinsurance, while OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
DEVOTED CHOICE 001 NE (PPO) offers vision benefits with no deductibles, including partially covered eye exams with a copay of no copay to $40 and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $350 annual combined maximum for contacts, lenses, frames, and upgrades.
Dental Services See details
DEVOTED CHOICE 001 NE (PPO) offers partially covered dental services with an annual maximum benefit of $3,000, featuring no copay and no coinsurance for preventive care, and no copay with 0% to 50% coinsurance for most comprehensive services. Medicare-covered dental services require a $40 copay and no coinsurance, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED CHOICE 001 NE (PPO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Associated Medicare Part B chemotherapy, radiation, and other drugs have no copay and a 0% to 20% coinsurance, while Medicare 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 001 NE (PPO) with no copay and a 20% coinsurance, and prior authorization is required.
Medical Equipment See details
DEVOTED CHOICE 001 NE (PPO) partially covers medical equipment with no copays, though prior authorization is required. Durable medical equipment carries a 20% to 25% coinsurance, while prosthetic devices, medical supplies, and diabetic supplies range from no coinsurance to 20% or 25% coinsurance. Diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED CHOICE 001 NE (PPO), with prior authorization required. Lab services and outpatient X-rays have no copay, diagnostic procedures and tests require a $0 to $95 copay with no coinsurance, and therapeutic radiological services carry a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by DEVOTED CHOICE 001 NE (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under DEVOTED CHOICE 001 NE (PPO) with no copay and no coinsurance, although prior authorization is required. While some services are covered, cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
DEVOTED CHOICE 001 NE (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is 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
DEVOTED CHOICE 001 NE (PPO) partially covers other services, offering over-the-counter items and additional preventive services with no copay and no coinsurance. Acupuncture and meal benefits are not covered, but the plan features a maximum benefit of $100 every three months for over-the-counter purchases.
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