DEVOTED CHOICE MA ONLY 002 OH (PPO) Medicare Advantage Plan H2526-002 • 2027 • Franklin County, OH
- 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
- Franklin County, OH
- Local Enrollment
- 110 beneficiaries in Franklin County
DEVOTED CHOICE MA ONLY 002 OH (PPO) Introduction
This Medicare Advantage PPO plan, DEVOTED CHOICE MA ONLY 002 OH, 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 H2526-002.
Qualifying residents of Franklin County, Ohio may enroll in this plan. CMS enrollment data reports 110 plan members in Franklin County. New members can call the plan directly at (844)978-2770 (TTY 711) for assistance.
Compare Similar Plans in Franklin County
Compare this plan with the two most-enrolled PPO plans available in Franklin County, Ohio. Enrollment is based on CMS local enrollment data.
| Plan Detail | DEVOTED CHOICE MA ONLY 002 OH | Aetna Medicare Signature | HumanaChoice H7617-004 |
|---|---|---|---|
| CMS Plan ID | H2526-002-0 |
H5521-089-0 |
H7617-004-0 |
| Local Enrollment | 110 | 8,573 | 1,502 |
| Monthly Premium | $0.00 | $0.00 | $0.00 |
| Medical Deductible | $0.00 | $0.00 | $0.00 |
| Maximum Out-of-Pocket | $9,250.00 | $5,900.00 | $6,750.00 |
| Part B Giveback | −$184.70 reduction | Not offered | Not offered |
| Primary Care | $0 copay | $0 copay | $0 copay |
| Specialist | $45 copay | $0-$55 copay | $40 copay |
| Part D Deductible | Not Applicable | $700.00 | $700.00 |
| 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 MA ONLY 002 OH 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 H2526-002.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H2526-002-0 Cost Compare.
Office Visits
- Primary care
- In-network: $0 copay
Out-of-network: $5 copay - Specialist
- In-network: $45 copay
Out-of-network: $45 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
- Not covered
- 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-$45 copay, 20% coinsurance
Out-of-network: $0-$45 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
- $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: $45 copay
Out-of-network: $45 copay - Outpatient group therapy
- In-network: $45 copay
Out-of-network: $45 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: $45-$50 copay
Out-of-network: $45-$50 copay - Occupational therapy
- In-network: $35 copay
Out-of-network: $35 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 002 OH 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: H2526)
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 | Not enough data available |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
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
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 | CMS Version |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | CY2027 Landscape (202609.1) |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | 2027 Star Ratings Data Tables |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | PBP Benefits-2027 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | 2026-09 |
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.