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DEVOTED CHOICE MA ONLY 003 GA (PPO) Medicare Advantage Plan H5453-003 • 2027 • Paulding County, GA

CMS Rating: ☆☆☆☆☆ (4.0 out of 5 stars*)
Monthly Premium
$0.00Plus Part B premium.
Medical Deductible
$0.00
Maximum Out-of-Pocket
$9250.00In-network
Part B Giveback
−$184.70 reduction
Prescription Coverage
Not Included
Additional Benefits
Dental, Vision, Hearing
Service Area
Paulding County, GA
Local Enrollment
52 beneficiaries in Paulding County
Last update:

DEVOTED CHOICE MA ONLY 003 GA (PPO) Introduction

This Medicare Advantage PPO plan, DEVOTED CHOICE MA ONLY 003 GA, is offered by Devoted Health and uses a Preferred Provider Organization (PPO) provider network. It comes without prescription drug coverage. For the 2027 plan year, the monthly premium is $0.00, the medical deductible is $0.00, and the in-network maximum out-of-pocket is $9250.00. The plan is identified by CMS Plan ID H5453-003.

Enrollment in this plan requires residence in Paulding County, Georgia. CMS enrollment data reports 52 plan members in Paulding County. New members can call the plan directly at (844)978-2770 (TTY 711) for assistance.

Compare Similar Plans in Paulding County

Compare this plan with the two most-enrolled PPO plans available in Paulding County, Georgia. Enrollment is based on CMS local enrollment data.

PPO plan comparison for Paulding County, Georgia
Plan Detail DEVOTED CHOICE MA ONLY 003 GA Aetna Medicare Signature Care HumanaChoice Giveback H7617-094
CMS Plan ID H5453-003-0 H2293-029-0 H7617-094-0
Local Enrollment 52 1,001 774
Monthly Premium $0.00 $0.00 $0.00
Medical Deductible $0.00 $0.00 $470
Maximum Out-of-Pocket $9,250.00 $9,850.00 $9,850.00
Part B Giveback −$184.70 reduction Not offered −$108.00 reduction
Primary Care $0 copay $0 copay $0 copay
Specialist $50 copay $10-$48 copay $45 copay
Part D Deductible Not Applicable $600.00 $700.00
CMS Star Rating 4.0 3.5 4.5
Dental $0 copay $0 copay $0 copay
Vision $0 copay $0 copay $0 copay
Hearing $0 copay $0 copay $0 copay

Want to explore more options? Browse all Medicare Advantage plans in Paulding County, or compare Medicare Advantage plans across Georgia, including premiums, out-of-pocket costs, CMS ratings, and enrollment.

Plan Benefits

DEVOTED CHOICE MA ONLY 003 GA includes cost-sharing, which refers to out-of-pocket expenses for covered healthcare services. The tables below outline the most common in-network out-of-pocket costs associated with plan H5453-003.

You can also compare 2027 costs and coverage with last year, side-by-side: Plan H5453-003-0 Cost Compare.

Office Visits

Primary care
In-network: $0 copay
Out-of-network: $15 copay
Specialist
In-network: $50 copay
Out-of-network: $60 copay

Preventive and Wellness Services

Annual wellness exam
In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Telehealth benefit
In-network: $0-$50 copay
Routine chiropractic
Not covered
Fitness benefits
Coming soon
Health education
In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Counseling services
Not covered
Over-the-counter drug benefits
Not covered
Health transportation (non-emergency)
Coming soon

Diagnostic, Lab, and Imaging Services

Diagnostic radiology services
In-network: $25-$300 copay
Out-of-network: $35-$350 copay
Lab services
In-network: $0-$50 copay, 20% coinsurance
Out-of-network: $10-$60 copay, 20% coinsurance
Outpatient x-rays
In-network: $0-$75 copay
Out-of-network: $0-$85 copay
Diagnostic tests and procedures
In-network: $0-$95 copay
Out-of-network: $0-$105 copay

Emergency and Urgent Care Services

Emergency room care
$115 copay
Worldwide emergency care
Coming soon
Urgent care
$0-$40 copay
Inpatient hospital care
In-network:
Tier 1
$425 per day for days 1-4
$0 per day for days 5-90
$0 per stay
Out-of-network:
$425 per day for days 1-4
$0 per day for days 5-90
$0 per stay
Skilled Nursing Facility
In-network:
Tier 1
$0 per day for days 1-20
$221 per day for days 21-100
Out-of-network:
40% per stay
Ground ambulance
In-network: $0-$350 copay
Out-of-network: $0-$350 copay

Mental Health Services

Outpatient individual therapy
In-network: $50 copay
Out-of-network: $60 copay
Outpatient group therapy
In-network: $50 copay
Out-of-network: $60 copay
Inpatient psychiatric hospital care
In-network:
Tier 1
$425 per day for days 1-4
$0 per day for days 5-90
$0 per stay
Out-of-network:
$425 per day for days 1-4
$0 per day for days 5-90
$0 per stay

Rehabilitation Services

Physical therapy and speech and language therapy
In-network: $50 copay
Out-of-network: $60 copay
Occupational therapy
In-network: $35 copay
Out-of-network: $45 copay

Medical Equipment and Supplies

Diabetes supplies
In-network: $0 copay
Out-of-network: 50% coinsurance
Durable medical equipment
In-network: 20% coinsurance
Out-of-network: 50% coinsurance
Prosthetics
In-network: 0%-20% coinsurance
Out-of-network: 0%-40% coinsurance

Medicare Part B Drugs

Chemotherapy
In-network: 0%-20% coinsurance
Out-of-network: 40% coinsurance
Other Part B drugs (Medicare-covered)
In-network: 0%-20% coinsurance
Out-of-network: 0%-40% coinsurance

Dental Services

Oral exam
In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Dental x-rays
In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Cleaning
In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Periodontics
In-network: 50% coinsurance
Out-of-network: 50% coinsurance
Endodontics
In-network: 50% coinsurance
Out-of-network: 50% coinsurance
Restorative services
In-network: 50% coinsurance
Out-of-network: 50% coinsurance
Implant services
In-network: 50% coinsurance
Out-of-network: 50% coinsurance
Orthodontics
Not covered
Oral/Maxillofacial surgery
In-network: 50% coinsurance
Out-of-network: 50% coinsurance

Vision Services

Routine eye exam
In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Contact lenses
In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Eyeglass frames only
In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Eyeglass lenses only
In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Eyeglasses (frames & lenses)
In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Upgrades
In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance

Hearing Services

Hearing exam
In-network: $0 copay
Out-of-network: $35 copay
Fitting/evaluation
In-network: $0 copay
Out-of-network: $35 copay
Prescription hearing aids
In-network: $599-$899 copay
Out-of-network: 90% coinsurance
OTC hearing aids
Not covered

Additional and Special Needs Services

Adult day health services
Not covered
Home-based palliative care
Not covered
Personal emergency response system
Coming soon
Weight management programs
In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Wigs for chemotherapy-related hair loss
Coming soon
Alternative therapies
In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Massage therapy
Not covered
Home/bathroom safety devices
In-network: $0 copay
Out-of-network: 50% coinsurance

Certain preventive services are covered 100% by DEVOTED CHOICE MA ONLY 003 GA as a Part B benefit.

Prescription Drug Coverage

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

CMS 5-Star Performance Ratings (Contract ID: H5453)

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.

2027 Medicare Star Ratings for Contract H5453
CMS Measure Star Rating
2027 Overall Rating ☆☆☆☆☆
Staying Healthy: Screenings, Tests, Vaccines Plan too new to be measured
Managing Chronic (Long Term) Conditions Plan too new to be measured
Member Experience with Health Plan Plan too new to be measured
Complaints and Changes in Plans Performance Plan too new to be measured
Health Plan Customer Service Plan too new to be measured
Drug Plan Customer Service ☆☆☆☆☆
Complaints and Changes in the Drug Plan Plan too new to be measured
Member Experience with the Drug Plan Plan too new to be measured
Drug Safety and Accuracy of Drug Pricing Plan too new to be measured
Medicare Advantage Plan Availability

DEVOTED CHOICE MA ONLY 003 GA is available to eligible Medicare beneficiaries residing in Paulding County, Georgia, including communities such as Dallas, Hiram, and other areas throughout the county. Enrollment eligibility is based on county of residence, not city.

Medicare Plan Data Sources and Methodology
Primary CMS datasets used for this Medicare Advantage Plan resource.
Data Source Publisher Last Accessed
Landscape Source Files Centers for Medicare & Medicaid Services October 5, 2026
Medicare Part C & D Performance Centers for Medicare & Medicaid Services October 5, 2026
Plan Benefits Package Centers for Medicare & Medicaid Services October 5, 2026
Monthly Enrollment by Contract/Plan/State/County Centers for Medicare & Medicaid Services October 5, 2026

Data sources and methodology documentation.

Official plan information and secondary Medicare references.
Publisher Reference Last Accessed
Devoted Health (official source) http://www.devoted.com October 4, 2026
Medicare.gov Compare types of Medicare Advantage Plans 25 May, 2025
AARP.org The Big Choice: Original Medicare vs. Medicare Advantage 25 May, 2025
Medicare.gov Explore your Medicare coverage options 25 May, 2025

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Data provenance is documented in accordance with the U.S. Core Data for Interoperability (USCDI) Provenance standard.