Plan H2526-002-0: Devoted LIBERTY CHOICE Ohio (PPO) – 2025 Coverage Details for Miami County, OH
This page provides coverage, cost, and availability details for Devoted Health’s H2526-002-0 Medicare Advantage plan for 2025.
See more Medicare Advantage Plans in Miami County, Ohio.
*CMS rated this Devoted Health plan (H2526-002-0) 4.5 (Good+) out of 5 stars.
Devoted LIBERTY CHOICE Ohio Basic Plan Details
- Plan ID
- H2526-002-0
- Plan Type
- PPO
- Plan Year
- 2025
- Premium
- $0.00/mo
Plus your Medicare Part B premium. - Health Plan Deductible
- $0.00
- Out-of-Pocket Maximum
- 9,350.00 /yr (in-network)
- Part B Reduction
- $0.00/mo
- Drug Plan Benefit
- Not Included
- Supplemental Benefits
- Vision, Hearing
- Availability
- Miami County, OH
- Insured By
- Devoted Health
| Summary of Benefits |
|---|
Health Plan Out-of-Pocket Costs
This Devoted Health Part C plan has cost-sharing. These are costs you pay out-of-pocket when you use approved health services. The following table summarizes the most common in-network out-of-pocket costs in plan H2526-002-0.
NOTE: Certain preventive services are covered 100% by the plan as a Part B benefit.
Doctor's Office Visits
- Primary
- Not Covered
- Specialist
- $45 Copay
Emergency, Urgent, and Inpatient Hospital Coverage
- Emergency room care
- $110 Copay
- Urgent care
- $45 Copay
- Ground ambulance
- $350 Copay
- Inpatient hospital care
- $375.00 per day for days 1 through 4
$0.00 per day for days 5 and beyond - Skilled Nursing Facility
- $0.00 per day for days 1 through 20
$214.00 per day for days 21 through 60
$0.00 per day for days 61 and beyond
Foot Care
- Foot Exams and Treatments (Medicare-covered)
- $45 Copay
- Routine Foot Care
- Not Covered
Chiropractic Care
- Medicare-covered chiropractic
- Not Covered
- Routine chiropractic
- Not Covered
Mental Health Services
- Outpatient individual therapy
- $45 Copay
- Outpatient group therapy
- $45 Copay
- Inpatient psychiatric hospital care
- $375.00 per day for days 1 through 4
$0.00 per day for days 5 and beyond
Rehabilitation Services
- Physical therapy and speech and language therapy
- $50 Copay
- Occupational therapy
- $35 Copay
Medical Equipment and Supplies
- Diabetes supplies
- Not Covered
- Durable medical equipment
- 18% Coinsurance
Prior Authorization Required - Prosthetics
- 20% Coinsurance
Diagnostics, Lab Services, and Imaging
- Diagnostic radiology services
- $300 Copay
Prior Authorization Required - Lab services
- $40 Copay
Prior Authorization Required - Outpatient x-rays
- $75 Copay
Prior Authorization Required - Diagnostic tests and procedures
- $95 Copay
Prior Authorization Required
Medicare Part B Drugs
- Chemotherapy
- 20% Coinsurance
- Other Part B drugs (Medicare-covered)
- 20% Coinsurance
Dental Services
- Medicare Covered Preventive Dental
- $45 Copay
Prior Authorization Required - Oral exam
- $0
- Dental x-rays
- $0
- Cleaning
- $0
- Periodontics
- Not Covered
- Endodontics
- Not Covered
- Restorative Services
- Not Covered
- Maximum dental benefit
- $250.00 (Every year)
Hearing Aids and Services
- Fitting/evaluation
- Covered
Limits may apply - Hearing aids
- Not Covered
- Hearing exam
- Covered
Limits may apply
Vision Services
- Medicare-covered eye exam
- $ to $20 Copay
- Routine eye exam
- Covered
Limits may apply - Eyewear benefits
- None
Get a copy of the Devoted LIBERTY CHOICE Ohio Summary of Benefits.
Prescription Drug Costs & Benefits
This plan does not include a Medicare Part D plan for prescriptions.
CMS 5-Star Rating Marks
Each year the Centers for Medicare & Medicaid Services (CMS) rates health plans (Part C) and drug plans (Part D) in several major categories using a 5-star rating system. These ratings are designed to help you understand the quality of care and service you can expect if you join Devoted LIBERTY CHOICE Ohio .
| CMS Measure | Star Rating |
|---|---|
| 2025 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 | |
| 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 | |
| Complaints and Changes in the Drug Plan | Plan too new to be measured |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Additional Plan Options
The Medicare Part C program offers a myriad of HMO, PPO, and PFFS plan options, including these plans:
If you are enrolled in a Part C plan with prescription drug coverage, you cannot be enrolled in a stand-alone Medicare Part D plan, regardless of your chosen insurance company.
You cannot be enrolled in a Part C health plan and simultaneously hold Medicare Supplement Insurance (Medigap). Medicare Supplement plans are only compatible with Medicare Parts A and B.
Contact Us About Devoted Health
| Website: | Devoted Health Plan Page (opens in new tab) |
|---|---|
| Providers: | Devoted Health Providers Page (opens in new tab) |
| New Member Health Plan Help: | (800)376-5889 |
| New Member Health Plan TTY: | 711 |
If you qualify for Medicare benefits but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Part C program on www.medicare.gov or call 1-800-MEDICARE.
Citations & References
- Devoted Health, http://www.Devoted.com, Last Accessed March 1, 2025
- Medicare.gov, "Understanding Medicare Advantage Plans", Last Accessed January 21, 2024
- Medicare.gov, "Compare Original Medicare & Medicare Advantage", Last Accessed February 19, 2024
- Medicare.gov, "Medicare & You in Different Formats", Last Accessed February 19, 2024
- Medicare.gov, "Your Medicare Coverage", Last Accessed March 19, 2025
- CMS.gov, Landscape Source Files, Last Accessed March 15, 2025
- CMS.gov, Medicare Part C & D Performance, Last Accessed March 15, 2025
- CMS.gov, Plan Benefits Package,Last Accessed March 15, 2025
Research Note: This content is based on independent analysis of CMS data by David Bynon, Medicare analyst and founder of MedicareWire.
For details on how this plan was analyzed and constructed using CMS data, see our Medicare Plan Research Methodology.
Disclaimer: MedicareWire does not endorse or rank Medicare plans. Plan information is provided for educational and research purposes only and may not reflect the most current data available from CMS or the plan provider.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Baylor Scott & White Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, GlobalHealth, Health Care Service Corporation, Healthy Blue, HealthSun, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.