DEVOTED CHOICE MA ONLY 005 AZ (PPO) Medicare Advantage Plan H6586-005 • 2026 • Coconino County, AZ

DEVOTED CHOICE MA ONLY 005 AZ Overview

Plan Overview for DEVOTED CHOICE MA ONLY 005 AZ

This Medicare Advantage PPO plan covers Medicare Part A and Part B services and allows access to Medicare-approved providers. The monthly premium is $0.00, with lower costs when using in-network providers.

Primary care visits have a $0 copay | Out-of-network: $25 copay, specialist visits come with a $45 copay | Out-of-network: $45 copay, urgent care services carry a $0-$45 copay, and ambulance transportation is $0-$350 copay | Out-of-network: $0-$350 copay. These costs apply toward the plan’s annual maximum out-of-pocket (MOOP) limit of $5900.00. After this limit is reached, in-network services are fully covered for the remainder of the year.

This plan is listed by CMS under Plan ID H6586-005. Cost-sharing details for key services are provided below.

Cost-Sharing Overview

DEVOTED CHOICE MA ONLY 005 AZ includes cost-sharing, which refers to out-of-pocket expenses for covered healthcare services. The table below outlines the most common in-network out-of-pocket costs associated with plan H6586-005.

Certain preventive services are covered 100% by DEVOTED CHOICE MA ONLY 005 AZ as a Part B benefit.

Prescription Drug Coverage

This plan does not include a Medicare Part D plan for prescriptions.

CMS Star Ratings

The Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (Part C) and Part D prescription drug plans each year using a 5-star system. These ratings measure plan performance in areas such as preventive care, management of chronic conditions, and member experience.