DEVOTED CHOICE MA ONLY 006 TX (PPO) Medicare Advantage Plan H6813-006 • 2027
CMS Rating:
(3.5 out of 5 stars*)
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $200
- Maximum Out-of-Pocket
- $9250.00In-network
- Part B Giveback
- −$158.00 reduction
- Prescription Coverage
- Not Included
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- See List
- Total Enrollment
- 140 beneficiaries
Last update:
DEVOTED CHOICE MA ONLY 006 TX (PPO) Introduction
This Medicare Advantage PPO plan, DEVOTED CHOICE MA ONLY 006 TX, 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 $200, and the in-network maximum out-of-pocket is $9250.00. The plan is identified by CMS Plan ID H6813-006.
Plan Benefits
Cost-sharing for DEVOTED CHOICE MA ONLY 006 TX includes out-of-pocket expenses for covered healthcare services. The following tables provide a summary of typical in-network out-of-pocket costs for plan H6813-006.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: $0 copay Out-of-network: $5 copay |
In-network: $0 copay Out-of-network: $5 copay |
| Specialist | In-network: $45 copay Out-of-network: $45 copay |
In-network: $45 copay Out-of-network: $45 copay |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay |
| Telehealth benefit | In-network: $0-$45 copay | In-network: $0-$45 copay |
| Routine chiropractic | Not covered | Not covered |
| Fitness benefits | Coming soon | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Health education | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Counseling services | Not covered | Not covered |
| Over-the-counter drug benefits | Not covered | Not covered |
| Health transportation (non-emergency) | Coming soon | Not covered |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | In-network: $25-$300 copay Out-of-network: $25-$300 copay |
In-network: $0-$300 copay Out-of-network: $0-$300 copay |
| Lab services | In-network: $0-$45 copay, 20% coinsurance Out-of-network: $0-$45 copay, 20% coinsurance |
In-network: $0-$40 copay Out-of-network: $0-$40 copay, 20% coinsurance |
| Outpatient x-rays | In-network: $0-$75 copay Out-of-network: $0-$75 copay |
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 |
In-network: $0-$95 copay Out-of-network: $0-$95 copay |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | $115 copay | $115 copay |
| Worldwide emergency care | Coming soon | $115 copay |
| Urgent care | $0-$40 copay | $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 |
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 |
In-network: Tier 1 $0 per day for days 1-20 $218 per day for days 21-100 Out-of-network: 20% per stay |
| Ground ambulance | In-network: $0-$350 copay Out-of-network: $0-$350 copay |
In-network: $0-$350 copay Out-of-network: $0-$350 copay |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | In-network: $45 copay Out-of-network: $45 copay |
In-network: $45 copay Out-of-network: $45 copay |
| Outpatient group therapy | In-network: $45 copay Out-of-network: $45 copay |
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 |
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
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: $45-$50 copay Out-of-network: $45-$50 copay |
In-network: $45-$50 copay Out-of-network: $45-$50 copay |
| Occupational therapy | In-network: $35 copay Out-of-network: $35 copay |
In-network: $35 copay Out-of-network: $35 copay |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | In-network: $0 copay Out-of-network: 50% coinsurance |
In-network: 0%-15% coinsurance Out-of-network: 20% coinsurance |
| Durable medical equipment | In-network: 19% coinsurance Out-of-network: 45% coinsurance |
In-network: 15% coinsurance Out-of-network: 20% coinsurance |
| Prosthetics | In-network: 0%-19% coinsurance Out-of-network: 0%-35% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 0%-40% coinsurance |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | In-network: 0%-20% coinsurance Out-of-network: 40% coinsurance |
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 |
In-network: 0%-20% coinsurance Out-of-network: 0%-40% coinsurance |
Dental Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Oral exam | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
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 |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Cleaning | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Periodontics | In-network: 50% coinsurance Out-of-network: 50% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Endodontics | In-network: 50% coinsurance Out-of-network: 50% coinsurance |
In-network: 0%-50% coinsurance Out-of-network: 0%-50% coinsurance |
| Restorative services | In-network: 50% coinsurance Out-of-network: 50% coinsurance |
In-network: 0%-50% coinsurance Out-of-network: 0%-50% coinsurance |
| Implant services | In-network: 50% coinsurance Out-of-network: 50% coinsurance |
Not covered |
| Orthodontics | Not covered | Not covered |
| Oral/Maxillofacial surgery | In-network: 50% coinsurance Out-of-network: 50% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
Vision Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Routine eye exam | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Contact lenses | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
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 |
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 |
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 |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Upgrades | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
Hearing Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Hearing exam | In-network: $0 copay Out-of-network: $35 copay |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Fitting/evaluation | In-network: $0 copay Out-of-network: $35 copay |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Prescription hearing aids | In-network: $599-$899 copay Out-of-network: 90% coinsurance |
In-network: $599-$899 copay Out-of-network: $599-$899 copay |
| OTC hearing aids | Not covered | Not covered |
Additional and Special Needs Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Adult day health services | Not covered | Not covered |
| Home-based palliative care | Not covered | Not covered |
| Personal emergency response system | Coming soon | Not covered |
| Weight management programs | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Wigs for chemotherapy-related hair loss | Coming soon | Not covered |
| Alternative therapies | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Massage therapy | Not covered | Not covered |
| Home/bathroom safety devices | In-network: $0 copay Out-of-network: 45% coinsurance |
In-network: $0 copay Out-of-network: 20% coinsurance |
Certain preventive services are covered 100% by DEVOTED CHOICE MA ONLY 006 TX 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: H6813)
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.
Plan Availability
DEVOTED CHOICE MA ONLY 006 TX (H6813-006-0) is available in the following locations:
Frequently Asked Questions
Here are some of the most frequently asked questions about this plan (click to open).
Frequently Asked Questions About DEVOTED CHOICE MA ONLY 006 TX (PPO)
What is the monthly premium for DEVOTED CHOICE MA ONLY 006 TX (PPO)?
The 2027 monthly premium is $0.00. The Medicare Part B premium is paid separately.
What is the in-network MOOP for plan H6813-006?
For 2027, the in-network maximum out-of-pocket is $9250.00. The plan pays 100% of covered in-network services beyond this amount.
What is the total enrollment for plan H6813-006?
Total enrollment is 140 beneficiaries based on the latest CMS data.
What is the Part D deductible for plan H6813-006?
The plan’s Part D deductible is $0.00, applied to covered prescription drug costs.
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 |
| AARP.org | The Big Choice: Original Medicare vs. Medicare Advantage | 25 May, 2025 |
| Medicare.gov | Your coverage options | 25 May, 2025 |
MedicarePlans.com is an independent informational resource and is not affiliated with or endorsed by the U.S. Government or the federal Medicare program.
Data provenance documentation is maintained in alignment with 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.