DEVOTED CHOICE 007 PA (PPO)

DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC · 2027 plan year

Plan ID H6018-007-000

Local PPO★ 3 CMS Stars
MOOP (in-network)
$7,100
MOOP (combined)
$10,750
Monthly premium
$0/mo
Part C $0 + Part D $0
Prescription drugs
Included

This plan in 2026

Plan information

Contract / Plan / Segment
H6018-007-000
Medical deductible
$50
Part D premium
$0/mo (part of the monthly premium above)
Part D deductible
$650/yr
Also owed
Your Medicare Part B premium, paid separately

More DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC plans in PA

Benefits & cost sharing

Hospital

BenefitIn-network
Inpatient Hospital — Acute$430/day for days 1–6, $0 after
Inpatient Hospital — Additional Days (Acute)No charge
Inpatient Hospital — Psychiatric$350/day for days 1–6, $0 after
Worldwide Urgent Care Coverage$130

Pharmacy

BenefitIn-network
Part B DrugsSee plan details
Chemotherapy & Radiation Drugs (Part B)0%-20% coinsurance
Other Part B Drugs0%-20% coinsurance

Mental Health

BenefitIn-network
Mental Health Specialty ServicesSee plan details
Mental Health — Individual Sessions$40
Mental Health — Group Sessions$40
Supplemental Health BenefitsSee plan details

Other

BenefitIn-network
Vision — Eye ExamsSee plan details
Prosthetics & OrthoticsSee plan details
Medicare-Covered Preventive ServicesSee plan details
Vision — Eyewear UpgradesNo charge
Urgently Needed Services$0-$45
Skilled Nursing Facility (SNF)$0/day for days 1–20, $221/day for days 21–100
Cardiac & Pulmonary RehabilitationSee plan details
Cardiac Rehabilitation — Additional Sessions$40
Intensive Cardiac Rehabilitation — Additional Sessions$40
Pulmonary Rehabilitation — Additional Sessions$35
Supervised Exercise Therapy (SET)$25
Emergency Services$130
Worldwide Emergency & Urgent CoverageSee plan details
Worldwide Emergency Coverage$130
Worldwide Emergency Transportation$315 copay + 20% coinsurance
Partial Hospitalization Program$60
Intensive Outpatient Program (IOP)$60
Home Health ServicesNo charge
Primary Care Physician ServicesNo charge
Chiropractic Services$15
Occupational Therapy Services$40-$50
Physician Specialist Services$40
Podiatry Services$40
Other Health Care Professional Services$0-$40
Psychiatric ServicesSee plan details
Psychiatric Services — Individual Sessions$40
Psychiatric Services — Group Sessions$40
Physical Therapy & Speech-Language Pathology$40-$50
Additional Telehealth Services (Part B)$0-$45
Opioid Treatment Program Services$40
Diagnostic Tests & Lab ServicesSee plan details
Diagnostic Procedures & Tests$0-$95
Laboratory Services$0-$40 copay + 20% coinsurance
Radiological ServicesSee plan details
Diagnostic Radiology$25-$300
Therapeutic Radiology20% coinsurance
X-Ray Services$0-$75
Outpatient Hospital Services$0-$450
Hospital Observation Services$350/day
Ambulatory Surgical Center (ASC)$0-$350
Outpatient Substance Abuse ServicesSee plan details
Substance Abuse — Individual Sessions$40
Substance Abuse — Group Sessions$40
Outpatient Blood ServicesNo charge
Ambulance ServicesSee plan details
Ground Ambulance$0-$315
Air Ambulance20% coinsurance
Durable Medical Equipment (DME)20%-50% coinsurance
Prosthetic Devices0%-20% coinsurance
Medical Supplies0%-20% coinsurance
Diabetic Supplies & ServicesSee plan details
Diabetic SuppliesNo charge
Diabetic Therapeutic Shoes & InsertsNo charge
Diabetic Monitors0%-50% coinsurance
Dialysis Services20% coinsurance
Over-the-Counter (OTC) ItemsNo charge
Other Supplemental BenefitNo charge
Other Supplemental BenefitNo charge
Annual Physical ExamNo charge
Health EducationNo charge
Nutritional & Dietary BenefitNo charge
Fitness BenefitNo charge
Home & Bathroom Safety DevicesNo charge
Weight Management ProgramNo charge
Alternative TherapiesNo charge
Kidney Disease Education ServicesNo charge
Glaucoma ScreeningNo charge
Diabetes Self-Management TrainingNo charge
Digital Rectal ExamsNo charge
Welcome to Medicare EKGNo charge
Insulin (Part B)0%-20% coinsurance (max $35)
Dental — Medicare-Covered Services$40
Dental — PreventiveSee plan details
Dental — Oral ExamsNo charge
Vision — Eyeglass FramesNo charge
Dental — X-RaysNo charge
Dental — Prophylaxis (Cleaning)No charge
Dental — Fluoride TreatmentNo charge
Dental — ComprehensiveSee plan details
Dental — Restorative Services50% coinsurance
Dental — Endodontics (Root Canal)50% coinsurance
Dental — Periodontics (Gum Care)50% coinsurance
Dental — Removable Prosthodontics (Dentures)50% coinsurance
Dental — Implant Services50% coinsurance
Dental — Fixed Prosthodontics (Bridges)50% coinsurance
Dental — Oral & Maxillofacial Surgery50% coinsurance
Dental — Adjunctive General Services50% coinsurance
Vision — Eye Exams$0-$40
Vision — Routine Eye ExamsNo charge
Vision — EyewearNo charge
Vision — EyewearSee plan details
Vision — Contact LensesNo charge
Vision — Eyeglasses (Lenses & Frames)No charge
Vision — Eyeglass LensesNo charge
Hearing — Exams$40
Hearing — ExamsSee plan details
Hearing — Routine ExamsNo charge
Hearing — Fitting & Evaluation for Hearing AidNo charge
Hearing — Prescription Hearing AidsSee plan details
Hearing — Hearing Aids (All Types)$399-$699

Service area

  • PA: 30 counties

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