Devoted CHOICE Oregon (PPO)
Oregon Medicare Advantage Plan (2024 Plan)
Additional Coverage
HearingVisionDental
Overall Government Star Rating
No Rating (new plan)
Plan Name
Devoted CHOICE Oregon (PPO)
Plan Type
Medicare Advantage Plan With Part D Prescription Drug Coverage
Devoted CHOICE Oregon (PPO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in Oregon 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
$30 copay per visit
ER visit
$120 copay per visit (always covered)
Devoted CHOICE Oregon (PPO) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $8,950 In and Out-of-network
$5,900 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 CHOICE Oregon (PPO) are defined below.
Yes
Part D Prescription Drug Coverage
Devoted CHOICE Oregon (PPO) 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 CHOICE Oregon (PPO) includes coverage for hearing, vision, dental.
Medicare Advantage health plans can offer even more additional benefits. Devoted CHOICE Oregon (PPO) 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
$5,900 In-network
Nationwide Coverage included
Hearing Coverage included
Doctor Services
Primary doctor visit
In-network: $0 copay
Out-of-network: $20 copay per visit
Specialist visit
In-network: $30 copay per visit
Out-of-network: $30 copay per visit
Tests, labs, & imaging
Diagnostic tests & procedures
In-network: $0-30 copay
Out-of-network: $0-30 copay
Lab services
In-network: $0 copay
Out-of-network: $0 copay
Diagnostic radiology services (like MRI)
In-network: $0-110 copay
Out-of-network: $0-110 copay
Outpatient x-rays
In-network: $0-15 copay
Out-of-network: $0-15 copay
Emergency care
$120 copay per visit (always covered)
Urgent care
$0-45 copay per visit (always covered)
Hospital Services
Inpatient hospital coverage
In-network: $375 per day for days 1 through 4
$0 per day for days 5 through 90
Out-of-network: $375 per day for days 1 through 4
$0 per day for days 5 through 90
Outpatient hospital coverage
In-network: $0-350 copay per visit
Out-of-network: $0-350 copay per visit
Skilled nursing facility
Skilled nursing facility
In-network: $0 per day for days 1 through 20
$203 per day for days 21 through 50
$0 per day for days 51 through 100
Out-of-network: 40% per stay
Preventive services
Preventive services
In-network: $0 copay
Out-of-network: $0 copay
Ambulance
Ground ambulance
In-network: $285 copay
Out-of-network: $285 copay
Therapy services
Occupational therapy visit
In-network: $30 copay
Out-of-network: $30 copay
Physical therapy & speech & language therapy visit
In-network: $30 copay
Out-of-network: $30 copay
Mental health services
Outpatient group therapy with a psychiatrist
In-network: $30 copay
Out-of-network: $30 copay
Outpatient individual therapy with a psychiatrist
In-network: $30 copay
Out-of-network: $30 copay
Outpatient group therapy visit
In-network: $30 copay
Out-of-network: $30 copay
Outpatient individual therapy visit
In-network: $30 copay
Out-of-network: $30 copay
Opioid treatment services
Opioid treatment services
Other services
Durable medical equipment (like wheelchairs & oxygen)
In-network: 0-20% coinsurance per item
Out-of-network: 0-30% coinsurance per item
Prosthetics (like braces, artificial limbs)
In-network: 0-20% coinsurance per item
Out-of-network: 30% coinsurance per item
Diabetes supplies
In-network: $0 copay
Out-of-network: 30% coinsurance per item
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
Tiers | Initial coverage phase | Gap coverage phase1 | Catastrophic coverage phase |
---|
Preferred Generic | $0.00 copay | $0.00 copay | $0 copay |
Generic | $0.00 copay | $0.00 copay | $0 copay |
Preferred Brand | $47.00 copay | | $0 copay |
Non-Preferred Drug | $100.00 copay | | $0 copay |
Specialty Tier | 29% | | $0 copay |
1 * The above cost-sharing only applies to some drugs on this tier. For all other drugs, you pay 25% for generic drugs and 25% for brand-name drugs. |
Part B Drugs
Chemotherapy drugs
In-network: 0-20% coinsurance
Out-of-network: 30% coinsurance
Other Part B drugs
In-network: 0-20% coinsurance
Out-of-network: 30% coinsurance
Hearing
Hearing exam
In-network: $30 copay
Out-of-network: $30 copay
Fitting/evaluation
In-network: $0 copay
Out-of-network: $0 copay
Hearing aids - All types
In-network: $199-499 copay
Out-of-network: $199-499 copay
Preventive Dental
Oral exam
In-network: $0 copay
Out-of-network: 0-50% coinsurance
Cleaning
In-network: $0 copay
Out-of-network: 0-50% coinsurance
Fluoride treatment
In-network: $0 copay
Out-of-network: 0-50% coinsurance
Dental x-rays
In-network: $0 copay
Out-of-network: 0-50% coinsurance
Comprehensive dental
Non-routine services
In-network: $0 copay
Out-of-network: 0-50% coinsurance
Diagnostic services
In-network: $0 copay
Out-of-network: 0-50% coinsurance
Restorative services
In-network: $0 copay
Out-of-network: 0-50% coinsurance
Endodontics
In-network: $0 copay
Out-of-network: 0-50% coinsurance
Periodontics
In-network: $0 copay
Out-of-network: 0-50% coinsurance
Extractions
In-network: $0 copay
Out-of-network: 0-50% coinsurance
Prosthodontics, other oral/maxillofacial surgery, other services
In-network: $0 copay
Out-of-network: 0-50% coinsurance
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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