- find a plan
- Fulton, OH
Plans in Your Area
Do you have Medicaid? View Dual HMO Plan
Want help enrolling? Give us a call.
Devoted CHOICE Ohio (PPO)Summary of Benefits (PDF)Updated August 30, 2023 | Devoted GIVEBACK Ohio (HMO)Summary of Benefits (PDF)Updated August 30, 2023 | Devoted CORE Ohio (HMO)Summary of Benefits (PDF)Updated August 30, 2023 | Devoted PRIME Ohio (HMO)Summary of Benefits (PDF)Updated August 30, 2023 | |
---|---|---|---|---|
2024 CMS Plan RatingEvery year, Medicare evaluates plans based on a 5-star rating system. | CMS Rating not applicable | ⭐⭐⭐⭐⭐ | ⭐⭐⭐⭐⭐ | ⭐⭐⭐⭐⭐ |
Monthly Premium | $0 You must continue to pay your part B premium. | $0 Also, your Part B premium is reduced by up to $164.90 per month. | $0 You must continue to pay your part B premium. | $14 You must continue to pay your part B premium. If you receive "Extra Help" from Medicare to help pay for your Medicare prescription drug plan costs, your monthly plan premium may be reduced to $0. |
Part B GivebackThis amount goes back into your Social Security check each month. | None | Up to $164.90 per month | None | None |
Annual Out-of-Pocket MaximumThis is the most you'll pay in a year for Medicare covered medical services. Your out-of-pocket Part D drug costs don't count toward this amount. | In-network:
In- and Out-of-network:
| $5,900 | $3,800 | $3,900 |
Primary Care Provider (PCP) Visits | In-network:
Out-of-network:
| $0 copay* | $0 copay* | $0 copay* |
Specialist Visits | In-network:
Out-of-network:
| $40 copay* | $25 copay* | $25 copay* |
Inpatient Hospital Stays | In-network:
Out-of-network:
| Days 1 - 5 | Days 1 - 6 | Days 1 - 6 |
Outpatient SurgeryAmbulatory surgery centers are different from hospitals and focus just on outpatient surgery. | In-network:
Out-of-network:
|
|
|
|
Emergency Room VisitIf admitted to the hospital within 24 hours, you won't have a copay for emergency care. | $120 copay per stay | $120 copay per stay | $135 copay per stay | $120 copay per stay |
Urgent Care Center VisitTo treat a non-emergency illness, injury, or condition that requires immediate medical care. | $45 copay | $50 copay | $35 copay | $25 copay |
LabsIf the lab is part of a hospital system, you might pay the higher copay. Call us to find out. | In-network:
Out-of-network:
| $0 copay* | $0 copay* | $0 copay* |
X-rays and UltrasoundsIf the provider is part of a hospital system, you might pay the higher copay. Call us to find out. | In-network:
Out-of-network:
|
|
|
|
Diagnostic Tests and ProceduresIf the provider is part of a hospital system, you might pay the higher copay. Call us to find out. | In-network:
Out-of-network:
| $50 copay* | $25 copay* | $15 copay* |
Pharmacy (Part D) Deductible | $150 for Tiers 3-5 only | $545 for Tiers 3-5 only | This plan does not have a deductible. | This plan does not have a deductible. |
30-Day Supply Retail PharmacyIf you get Extra Help from Medicare, your costs may be lower. |
|
|
|
|
100-Day Supply Mail-Order PharmacyIf you get Extra Help from Medicare, your costs may be lower. |
|
|
|
|
Erectile Dysfunction DrugsSildenafil (Viagra) and tadalfil (Cialis) are covered medications for up to 6 pills a month. | $0 per prescription* | $10 per prescription* | $0 per prescription* | $0 per prescription* |
Dental |
This plan also includes out-of-network dental coverage. | $1,000 a year for all covered dental services |
|
|
Food & Home CardPre-loaded card for purchase of groceries, utilities, mortgage, or rent | Not covered | Not covered | $55 per month The Food & Home Card is available to members with eligible chronic health conditions. | Not covered |
Over-the-Counter CreditFor items like toothpaste, vitamins, blood pressure cuffs, and more | $100 per quarter (every 3 months) | $55 per quarter (every 3 months) | $55 per quarter (every 3 months) | $170 per quarter (every 3 months) |
Medical Alert DeviceCall for emergency help with the press of a button. | Free device and free monthly monitoring* | Free device and free monthly monitoring* | Free device and free monthly monitoring* | Free device and free monthly monitoring* |
Hearing AidsPlan covers 2 hearing aids a year, plus free batteries. |
|
|
|
|
Vision | In-network:
Out-of-network:
$400 per year toward glasses or contacts |
|
|
|
Fitness |
|
|
|
|
*When you use an in-network provider or pharmacy.
Next Steps
Now that you know what our plans are all about, you can:
- See if your doctors are in our network
- Make sure we cover your medications
And if you have any questions, call us at (1-800-990-0723) (TTY 711) You can also see and compare more plan options at www.Medicare.gov.