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DEVOTED CHOICE 015 FL (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CHOICE 015 FL (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 FL (PPO) in 2026, please refer to our full plan details page.
DEVOTED CHOICE 015 FL (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Escambia, Santa Rosa Counties. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that DEVOTED CHOICE 015 FL (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 FL (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 FL (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 $595.00 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 $10000.00 (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 $10000.00 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 015 FL (PPO) Medicare plan features an annual prescription drug deductible of $595. Under this plan, there is no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) medications filled at standard pharmacies or through standard mail order for up to a three-month supply. For higher-tier prescriptions, standard pharmacy and mail-order fills require a 24% coinsurance for Tier 3 (Preferred Brand) drugs and a 25% coinsurance for Tier 4 (Non-Preferred Drug) medications. Tier 5 (Specialty Tier) drugs are covered with a 25% coinsurance for a one-month supply at standard pharmacies or through standard mail order.
Additional Benefits
The DEVOTED CHOICE 015 FL (PPO) plan offers robust coverage for essential medical needs, featuring no copays or coinsurance for primary care visits, preventive services, and home health care. For specialist visits, patients can expect copays ranging from $45 to $50, while inpatient hospital stays require a $295 daily copay for the first six days and no copay thereafter. Emergency room visits carry a $130 copay, which is waived if you are admitted within 24 hours. Ancillary benefits include partially covered dental services up to a $1,500 annual limit, featuring no copay for preventive care and up to 50% coinsurance for restorative services. Vision benefits provide routine exams with a copay up to $45 and a $200 annual allowance for eyewear with no copay, while hearing aids require a copay between $399 and $699. Additionally, members receive a $50 allowance every three months for over-the-counter items with no copay.
Inpatient Hospital See details
DEVOTED CHOICE 015 FL (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $295 daily copay for days 1 through 6 and no copay for days 7 through 90 for both acute and psychiatric stays. Unlimited additional acute care days are covered, but upgrades, non-Medicare-covered stays, and additional psychiatric hospital days are not covered.
Outpatient Services See details
DEVOTED CHOICE 015 FL (PPO) covers outpatient services with no coinsurance, featuring a $0 to $395 copay for outpatient hospital services and a $295 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are available with no copay and no coinsurance, while outpatient substance abuse sessions require a $45 copay.
Partial Hospitalization See details
DEVOTED CHOICE 015 FL (PPO) covers partial hospitalization services with a $60.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
DEVOTED CHOICE 015 FL (PPO) covers ambulance services with prior authorization, but transportation services are not covered. Ground ambulance services have a copay ranging from no copay to $295 with no coinsurance, while air ambulance services require a 20% coinsurance and no copay.
Emergency Services See details
DEVOTED CHOICE 015 FL (PPO) covers emergency services with a $130 copay (waived if admitted within 24 hours) and no coinsurance, and urgent care with no copay to a $45 copay and no coinsurance. Worldwide emergency and urgent services are covered up to a $25,000 lifetime maximum with a $130 copay and no coinsurance, while worldwide emergency transportation requires a $295 copay and 20% coinsurance.
Primary Care See details
DEVOTED CHOICE 015 FL (PPO) offers primary care physician services with no copay and no coinsurance, while specialist, mental health, and physical therapy services require copays ranging from $45.00 to $50.00 and no coinsurance. Chiropractic and podiatry services are not covered under this plan.
Preventive Services See details
Preventive services under DEVOTED CHOICE 015 FL (PPO) are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management. While select supplemental benefits like fitness programs and alternative therapies are included, this benefit is partially covered as services such as in-home support, therapeutic massage, and personal emergency response systems are not covered.
Hearing Services See details
DEVOTED CHOICE 015 FL (PPO) partially covers hearing services, offering routine hearing exams for a $45 copay and no coinsurance, plus unlimited fitting evaluations. Covered prescription hearing aids have no coinsurance and a copay ranging from $399 to $699 (limited to two per year), though over-the-counter (OTC) hearing aids and inner-ear, outer-ear, and over-the-ear prescription models are not covered.
Vision Services See details
DEVOTED CHOICE 015 FL (PPO) covers vision services, featuring one routine eye exam per year with a $0 to $45 copay and no coinsurance, though other eye exam services are not covered. Covered eyewear, including contacts and eyeglasses, is available with no copay, no coinsurance, and no deductible, up to a $200 combined annual limit.
Dental Services See details
DEVOTED CHOICE 015 FL (PPO) dental services are partially covered up to a $1,500 yearly maximum for both in- and out-of-network care, offering no copay and no coinsurance for preventive, diagnostic, periodontic, and oral surgery services. Restorative, endodontic, and prosthodontic services require no copay and 0% to 50% coinsurance, while Medicare-covered dental has a $45 copay and no coinsurance; implant services, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
DEVOTED CHOICE 015 FL (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy and other Part B drugs have a coinsurance ranging from no coinsurance to 20%, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the DEVOTED CHOICE 015 FL (PPO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is partially covered by DEVOTED CHOICE 015 FL (PPO) with no copays, though prior authorization is required. Durable medical equipment carries a 20% to 50% coinsurance, while prosthetics, medical supplies, and diabetic supplies range from no coinsurance up to 20% or 50% coinsurance. Diabetic therapeutic shoes and inserts are not covered under this plan.
Diagnostic and Radiological Services See details
DEVOTED CHOICE 015 FL (PPO) covers diagnostic services with no coinsurance, featuring no copay for lab services and a $0 to $95 copay for diagnostic procedures and tests. Radiological services are also covered, offering diagnostic radiological services and outpatient X-rays with no copay, while therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by DEVOTED CHOICE 015 FL (PPO) with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
DEVOTED CHOICE 015 FL (PPO) covers some cardiac and pulmonary rehabilitation services with no coinsurance, but standard cardiac rehabilitation ($40 copay), intensive cardiac rehabilitation ($40 copay), pulmonary rehabilitation ($35 copay), and supervised exercise therapy for peripheral artery disease ($25 copay) are not covered. Prior authorization is required for covered services.
Skilled Nursing Facility (SNF) See details
DEVOTED CHOICE 015 FL (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not needed, and additional days beyond the standard 100 Medicare-covered days are not covered.
Other Services See details
DEVOTED CHOICE 015 FL (PPO) partially covers other services, offering over-the-counter (OTC) items up to $50 every three months and additional preventive services with no copay and no coinsurance. Acupuncture and meal benefits are not covered under this plan.
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