Devoted CHOICE Alabama (PPO)

Inpatient Hospital See details

Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a copay of $275 for days 1-7, and no copay for days 8-90. Additional days for Inpatient Hospital-Acute are covered, but 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 all outpatient hospital services, are covered by the Devoted CHOICE Alabama (PPO) plan. Outpatient hospital services have a copay between $0 and $375, observation services have a $275 copay, and ambulatory surgical center services have no copay.

Outpatient substance abuse services have a $30 copay for both individual and group sessions. Outpatient Blood Services are covered, with a waived three-pint deductible.

Partial Hospitalization See details

Partial Hospitalization is covered by Devoted CHOICE Alabama (PPO) with a $70 copay. Prior authorization is required for this benefit.

Ambulance and Transportation Services See details

Ambulance and Transportation Services are covered by Devoted CHOICE Alabama (PPO), with prior authorization required for all ambulance services. Medicare-covered ground ambulance services have a copay of $0 - $315, while air ambulance services have a 20% coinsurance. Transportation services to any health-related location are not covered.

Emergency Services See details

Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Devoted CHOICE Alabama (PPO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a copay between $0 and $45; Worldwide Emergency Coverage, Worldwide Urgent Coverage have a $125 copay, and Worldwide Emergency Transportation has a $315 copay and 20% coinsurance.

Primary Care See details

The Devoted CHOICE Alabama (PPO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $0-$45 copay, physician specialist services with a $30 copay, mental health specialty services with a $30 copay for individual and group sessions, other health care professional services with a $0-$30 copay, psychiatric services with a $30 copay for individual and group sessions, physical therapy and speech-language pathology services with a $0-$50 copay, additional telehealth benefits with a $0-$30 copay, and opioid treatment program services with a $30 copay. Routine chiropractic care and podiatry services are not covered.

Preventive Services See details

The Devoted CHOICE Alabama (PPO) plan covers preventive services, including Medicare-covered services, annual physical exams, health education, personal emergency response systems, 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 EKGs following a welcome visit. However, the plan does not cover in-home safety assessments, 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.

Hearing Services See details

Hearing Services includes hearing exams with a $25 copay, and prescription hearing aids with a copay between $399 and $699, per year. Routine hearing exams are covered once per year, and fitting/evaluation for hearing aids is covered with no limit. Prescription hearing aids (all types) are covered up to two per year, while prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.

Vision Services See details

Vision services include coverage for 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, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Routine eye exams are covered once per year.

Dental Services See details

Devoted CHOICE Alabama (PPO) covers Medicare Dental Services with a $30 copay, and other dental services including oral exams, dental x-rays, and more with a $1,000 maximum benefit per year. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.

Home Infusion bundled Services See details

Home Infusion bundled Services are covered, with prior authorization required. Insulin has a $35 copay and 20% coinsurance, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.

Dialysis Services See details

Dialysis Services are covered by the Devoted CHOICE Alabama (PPO) plan. You will pay 20% coinsurance for this benefit.

Medical Equipment See details

Medical Equipment benefits include coverage for Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a coinsurance between 0% and 40%, while Prosthetic Devices have a coinsurance between 0% and 20%, and Medical Supplies have a 20% coinsurance. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are 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 for diagnostic procedures and tests, and no copay for lab services. Outpatient X-Ray Services have no copay, while Diagnostic Radiological Services have a maximum copay of $300, and Therapeutic Radiological Services have a 20% coinsurance.

Home Health Services See details

Home Health Services are covered by the Devoted CHOICE Alabama (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.

Cardiac Rehabilitation Services See details

Cardiac Rehabilitation Services are technically covered, but the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. There is a copay for some services, but the specific amount is not provided.

Skilled Nursing Facility (SNF) See details

Skilled Nursing Facility (SNF) services are covered by the Devoted CHOICE Alabama (PPO) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.

Other Services See details

Other Services are not covered by the Devoted CHOICE Alabama (PPO) plan. The plan does not cover 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.