DEVOTED CHOICE MA ONLY 002 OH (PPO) Medicare Advantage Plan H2526-002 • 2026 • Pike County, OH

DEVOTED CHOICE MA ONLY 002 OH Overview

Coverage Overview for DEVOTED CHOICE MA ONLY 002 OH

As a Medicare Advantage PPO plan, DEVOTED CHOICE MA ONLY 002 OH 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: $5 copay, specialist visits come with a $45 copay | Out-of-network: $45 copay, urgent care services carry a $0-$40 copay, and ambulance transportation is $0-$350 copay | Out-of-network: $0-$350 copay. These expenses apply toward the annual maximum out-of-pocket (MOOP) limit of $9250.00. After this limit is reached, in-network services are fully covered.

This plan is registered with CMS under Plan ID H2526-002. Cost-sharing details are outlined below.

Out-of-Pocket Costs

DEVOTED CHOICE MA ONLY 002 OH 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 H2526-002.

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 Ratings

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.