DEVOTED CHOICE MA ONLY 003 SC (PPO) Medicare Advantage Plan H7028-003 • 2026 • Anderson County, SC
CMS Plan ID H7028-003 identifies the Medicare Advantage plan DEVOTED CHOICE MA ONLY 003 SC, a PPO Part C plan offered by Devoted Health for the 2026 plan year. This plan uses a Preferred Provider Organization (PPO) provider network and comes without Part D prescription drug coverage.
DEVOTED CHOICE MA ONLY 003 SC Overview
Plan Overview for
H7028-003-0
|
|
|---|---|
| CMS Plan ID: |
H7028-003-0
|
| Plan Type: | PPO |
| Plan Year: | 2026 |
| Monthly Premium: |
$0.00
Plus your Medicare Part B premium. |
| Medical Deductible: | $0.00 |
| Maximum Out-of-Pocket: | $9250.00 (In-Network) |
| Part B Give Back: | −$184.70 reduction |
| Prescription Drug Coverage: | Not Included |
| Additional Benefits: | Dental, Vision, Hearing |
| Service Area: | Anderson County, SC |
| Enrollment (Nationwide): | 1,603 beneficiaries |
| Enrollment (CMS – Local) | 96 beneficiaries in Anderson County |
| Provided By: | Devoted Health |
Plan Details for DEVOTED CHOICE MA ONLY 003 SC
This Medicare Advantage Preferred Provider Organization (PPO) plan provides access to Medicare-approved providers and covers Medicare Part A and Part B services. The monthly premium is $0.00, with lower costs when using in-network providers.
Primary care visits have a $0 copay | Out-of-network: $30 copay, specialist visits come with a $50 copay | Out-of-network: $50 copay, urgent care services carry a $0-$40 copay, and ambulance transportation is $0-$350 copay | Out-of-network: $0-$350 copay. These costs apply toward the annual maximum out-of-pocket (MOOP) limit of $9250.00. Once this limit is reached, in-network services are fully covered.
This plan is listed by CMS under Plan ID H7028-003. Cost-sharing details for key services are provided below.
Out-of-Pocket Costs
Cost-sharing for DEVOTED CHOICE MA ONLY 003 SC includes out-of-pocket expenses for covered healthcare services. The table below provides a summary of typical in-network out-of-pocket costs for plan H7028-003.
Certain preventive services are covered 100% by DEVOTED CHOICE MA ONLY 003 SC 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.
| CMS Measure | Star Rating |
|---|---|
| 2026 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 |
How much does plan H7028-003 cost per month?
The plan’s monthly premium is $0.00 for 2026. The Part B premium is not included.
What is the in-network MOOP for plan H7028-003?
The 2026 in-network MOOP is $9250.00. Once this limit is reached, covered in-network costs are fully covered.
What is the current enrollment for DEVOTED CHOICE MA ONLY 003 SC?
CMS reports 1,603 beneficiaries enrolled in this plan.
What is the Part D deductible for plan H7028-003?
The Part D deductible is $0.00.
Contact Information for Devoted Health
| Contact Type | Details |
|---|---|
| Website: | Devoted Health Plan Page |
| New Members: | 1-844-978-2770 |
| Existing Members: | 1-800-338-6833 |
| Plan Address: | Devoted Health | PO Box 211037 | Eagan, MN 55121 |
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at medicare.gov.
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | September 8, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | September 8, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | September 8, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | September 8, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Devoted Health (official source) | http://www.Devoted.com | October 13, 2025 |
| 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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