DEVOTED CHOICE 001 NE (PPO) Medicare Advantage Plan H9802-001 • 2027 • Buffalo County, NE
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $4800.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $650.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Buffalo County, NE
- Local Enrollment
- 64 beneficiaries in Buffalo County
DEVOTED CHOICE 001 NE (PPO) Introduction
This Medicare Advantage PPO plan, DEVOTED CHOICE 001 NE, is offered by Devoted Health and uses a Preferred Provider Organization (PPO) provider network. It comes with 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 $4800.00. The plan is identified by CMS Plan ID H9802-001. The 2027 Part D prescription drug deductible is $650.00.
Enrollment in this plan requires residence in Buffalo County, Nebraska. CMS enrollment data reports 64 plan members in Buffalo County. New members can call the plan directly at (844)978-2770 (TTY 711) for assistance.
Compare Similar Plans in Buffalo County
Compare this plan with the two most-enrolled PPO plans available in Buffalo County, Nebraska. Enrollment is based on CMS local enrollment data.
| Plan Detail | DEVOTED CHOICE 001 NE | Blue Cross and Blue Shield of Nebraska MA Connect | DEVOTED CHOICE GIVEBACK 002 NE |
|---|---|---|---|
| CMS Plan ID | H9802-001-0 |
H8181-002-0 |
H9802-002-0 |
| Local Enrollment | 64 | 272 | 29 |
| Monthly Premium | $0.00 | $0.00 | $0.00 |
| Medical Deductible | $0.00 | $0.00 | $50 |
| Maximum Out-of-Pocket | $4,800.00 | $6,650.00 | $9,850.00 |
| Part B Giveback | Not offered | Not offered | −$159.80 reduction |
| Primary Care | $0 copay | $0 copay | $0 copay |
| Specialist | $5-$40 copay | $50 copay | $55 copay |
| Part D Deductible | $650.00 | $400.00 | $461.00 |
| CMS Star Rating | Not yet rated | Not yet rated | Not yet rated |
| Dental | $0 copay | $0 copay | $0 copay |
| Vision | $0 copay | $0 copay | $0 copay |
| Hearing | $0 copay | $0 copay | $0 copay |
Plan Benefits
DEVOTED CHOICE 001 NE 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 H9802-001.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H9802-001-0 Cost Compare.
Office Visits
- Primary care
- In-network: $0 copay
Out-of-network: $5 copay - Specialist
- In-network: $5-$40 copay
Out-of-network: $5-$40 copay
Preventive and Wellness Services
- Annual wellness exam
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Telehealth benefit
- In-network: $0-$45 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
- In-network: $0 copay
Out-of-network: 90% coinsurance - Health transportation (non-emergency)
- Coming soon
Diagnostic, Lab, and Imaging Services
- Diagnostic radiology services
- In-network: $25-$300 copay
Out-of-network: $25-$300 copay - Lab services
- In-network: $0-$40 copay, 20% coinsurance
Out-of-network: $0-$40 copay, 20% coinsurance - Outpatient x-rays
- In-network: $0-$75 copay
Out-of-network: $0-$75 copay - Diagnostic tests and procedures
- In-network: $0-$95 copay
Out-of-network: $0-$95 copay
Emergency and Urgent Care Services
- Emergency room care
- $130 copay
- Worldwide emergency care
- Coming soon
- Urgent care
- $0-$45 copay
- Inpatient hospital care
- In-network:
Tier 1
$395 per day for days 1-6
$0 per day for days 7-90
$0 per stay
Out-of-network:
$395 per day for days 1-6
$0 per day for days 7-90
$0 per stay - Skilled Nursing Facility
- In-network:
Tier 1
$10 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: $40 copay
Out-of-network: $40 copay - Outpatient group therapy
- In-network: $40 copay
Out-of-network: $40 copay - Inpatient psychiatric hospital care
- In-network:
Tier 1
$395 per day for days 1-6
$0 per day for days 7-90
$0 per stay
Out-of-network:
$395 per day for days 1-6
$0 per day for days 7-90
$0 per stay
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: $20-$50 copay
Out-of-network: $20-$50 copay - Occupational therapy
- In-network: $40-$50 copay
Out-of-network: $40-$50 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: 45% 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: $399-$699 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: 45% coinsurance
Certain preventive services are covered 100% by DEVOTED CHOICE 001 NE as a Part B benefit.
Prescription Drug Coverage
DEVOTED CHOICE 001 NE includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
This plan includes an enhanced benefit Medicare Part D plan (PDP), providing coverage beyond the standard CMS-defined minimum.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | ($9.40) |
| Supplemental Part D Premium: | $$9.40 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | $24.60 |
| Low-Income Premium Subsidy Paid by CMS: | $0.00 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $650.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Devoted Health starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, DEVOTED CHOICE 001 NE may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | $0.00 copay | Coming soon |
| Preferred Brand | 25% coinsurance | Coming soon |
| Non-Preferred Drug | 25% coinsurance | Coming soon |
| Specialty Tier | 26% coinsurance | Coming soon |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H9802)
CMS evaluates Medicare Advantage (Part C) and Part D plans annually using a 5-star rating system. Ratings reflect performance in preventive care, chronic condition management, and member experience.
| 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 | Plan too new to be measured |
| 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 |
Contact Information for Devoted Health
- Website
- Devoted Health Plan Page
- Providers
- Devoted Health Providers Page
- Formulary
- Devoted Health Formulary Page
- Pharmacy
- Devoted Health Pharmacy Page
- New Member Health Plan Help
- (844)978-2770
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (844)978-2770
- New Member Part D TTY Users
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Medicare Plan Data Sources and Methodology
| 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.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Devoted Health (official source) | http://www.devoted.com | October 4, 2026 |
| CMS.gov | Medicare Advantage Plan Fact Sheet | 25 May, 2025 |
| Medicare.gov | Joining a plan | 25 May, 2025 |
| Medicare.gov | Your coverage options | 25 May, 2025 |
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Provenance documentation for this data is maintained under the U.S. Core Data for Interoperability (USCDI) Provenance standard.
Page content independently curated and maintained by David W. Bynon, Editorial Steward, using a standardized, data-driven methodology for accurate, non-commercial Medicare plan interpretation and resolution.