DEVOTED DUAL CHOICE 004 MS (PPO D-SNP)
Mississippi Medicare-Medicaid Dual Eligible D-SNP Plan (2026 Plan)
Additional Coverage
HearingVisionDental
Overall Government Star Rating
(coming soon)
Plan Name
DEVOTED DUAL CHOICE 004 MS (PPO D-SNP)
Plan Type
Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP)
DEVOTED DUAL CHOICE 004 MS (PPO D-SNP) is a Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP), which is available in Mississippi and offered by the health insurance company Devoted Health. This plan’s network type is PPO which determines in-network doctors who accept the health plan and whether a referral is needed.
Primary doctor visit
$0 copay
Specialist visit
$35 copay
DEVOTED DUAL CHOICE 004 MS (PPO D-SNP) has a monthly premium cost of $24 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $8,950 In and Out-of-network
$5,400 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for DEVOTED DUAL CHOICE 004 MS (PPO D-SNP) are defined below.
Yes
Part D Prescription Drug Coverage
DEVOTED DUAL CHOICE 004 MS (PPO D-SNP) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. DEVOTED DUAL CHOICE 004 MS (PPO D-SNP) includes coverage for hearing, vision, dental.
Medicare Advantage health plans can offer even more additional benefits. DEVOTED DUAL CHOICE 004 MS (PPO D-SNP) includes coverage for the following additional benefits:
Other benefits
Over the counter drug benefits
Home and bathroom safety devices
Health Portion of Premium
Health Plan Max Out-of-Pocket
$8,950 In and Out-of-network
$5,400 In-network
Nationwide Coverage included
Hearing Coverage included
Doctor Services
Primary doctor visit
In-network: $0 copay
Out-of-network: $0 copay
Specialist visit
In-network: $35 copay
Out-of-network: $35 copay
Tests, labs, & imaging
Diagnostic tests & procedures
In-network: $0-$95 copay
Out-of-network: $0-$95 copay
Lab services
In-network: $0-$20 copay
Out-of-network: $0-$20 copay
Diagnostic radiology services (like MRI)
In-network: $0-$300 copay
Out-of-network: $0-$300 copay
Outpatient x-rays
In-network: $0-$75 copay
Out-of-network: $0-$75 copay
Emergency care
In-network: No Data
Out-of-network: No Data
Urgent care
In-network: No Data
Out-of-network: No Data
Hospital Services
Inpatient hospital coverage
In-network: No Data
Out-of-network: No Data
Outpatient hospital coverage
In-network: $0-$375 copay
Out-of-network: $0-$375 copay
Skilled nursing facility
Skilled nursing facility
In-network: No Data
Out-of-network: No Data
Preventive services
Preventive services
In-network: $0 copay
Out-of-network: $0 copay
Ambulance
Ground ambulance
In-network: $0-$315 copay
Out-of-network: $0-$315 copay
Therapy services
Occupational therapy visit
In-network: $35-$50 copay
Out-of-network: $35-$50 copay
Physical therapy & speech & language therapy visit
In-network: $35-$50 copay
Out-of-network: $35-$50 copay
Mental health services
Outpatient group therapy with a psychiatrist
In-network: $35 copay
Out-of-network: $35 copay
Outpatient individual therapy with a psychiatrist
In-network: $35 copay
Out-of-network: $35 copay
Outpatient group therapy visit
In-network: $35 copay
Out-of-network: $35 copay
Outpatient individual therapy visit
In-network: $35 copay
Out-of-network: $35 copay
Opioid treatment services
Opioid treatment services
Other services
Durable medical equipment (like wheelchairs & oxygen)
In-network: 20%-30% coinsurance
Out-of-network: 20%-30% coinsurance
Prosthetics (like braces, artificial limbs)
In-network: 0%-20% coinsurance
Out-of-network: 0%-40% coinsurance
Diabetes supplies
In-network: 0%-30% coinsurance
Out-of-network: 0%-30% coinsurance
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
| Tiers | Initial coverage phase | Catastrophic coverage phase |
|---|
| Preferred Generic | 25% coinsurance | $0 copay |
| Generic | 25% coinsurance | $0 copay |
| Preferred Brand | 25% coinsurance | $0 copay |
| Non-Preferred Drug | 25% coinsurance | $0 copay |
| Specialty Tier | 25% coinsurance | $0 copay |
Part B Drugs
Chemotherapy drugs
In-network: 0%-20% coinsurance
Out-of-network: 20% coinsurance
Other Part B drugs
In-network: 0%-20% coinsurance
Out-of-network: 0%-20% coinsurance
Hearing
Hearing exam
In-network: $0 copay
Out-of-network: $0 copay
Fitting/evaluation
In-network: $0 copay
Out-of-network: $0 copay
Hearing aids - prescription
In-network: $399-$699 copay
Out-of-network: $399-$699 copay
Hearing aids - over the counter
Preventive Dental
Oral exam
In-network: $0 copay
Out-of-network: $0 copay
Cleaning
In-network: $0 copay
Out-of-network: $0 copay
Fluoride treatment
In-network: $0 copay
Out-of-network: $0 copay
Dental x-rays
In-network: $0 copay
Out-of-network: $0 copay
Comprehensive dental
Restorative services
In-network: $0 copay
Out-of-network: $0 copay
Endodontics
In-network: $0 copay
Out-of-network: $0 copay
Periodontics
In-network: $0 copay
Out-of-network: $0 copay
Prosthodontics, removable
In-network: $0 copay
Out-of-network: $0 copay
Prosthodontics, fixed
In-network: $0 copay
Out-of-network: $0 copay
Maxillofacial prosthetics
Oral and maxillofacial surgery
In-network: $0 copay
Out-of-network: $0 copay
Adjunctive general services
In-network: $0 copay
Out-of-network: $0 copay
Vision
Routine eye exam
In-network: $0 copay
Out-of-network: $0 copay
Contact lenses
In-network: $0 copay
Out-of-network: $0 copay
Eyeglasses (frames & lenses)
In-network: $0 copay
Out-of-network: $0 copay
Eyeglass frames (only)
In-network: $0 copay
Out-of-network: $0 copay
Eyeglass lenses (only)
In-network: $0 copay
Out-of-network: $0 copay
Upgrades
In-network: $0 copay
Out-of-network: $0 copay
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