DEVOTED CHOICE 001 MO (PPO)
Available to residents of Gentry County, MO for 2027. Contract H4030, plan 001, segment 0.
2027 drug-by-drug coverage is not published by CMS yet. The drug lookup covers 2026, whose formulary is live.
New for 2027. This plan has no 2026 predecessor in the CMS crosswalk.
Plan details
| Monthly premium (Part C + D) | $0.00 |
|---|---|
| — medical (Part C) part | $0.00 |
| — drug (Part D) part | $0.00 |
| In-network out-of-pocket maximum | $3,950.00 |
| Drug deductible | $650.00Tier 1 and 2 exempt |
| Drug out-of-pocket threshold | $2,400.00 |
| Plan type | PPO |
| Contract / plan | H4030-001-0 |
| Offered by | Devoted Health |
| Parent organization | Devoted Health, Inc. |
| Formulary tiers | 5 |
| Member services | (844)978-2770TTY 711 |
CMS star ratings
- Overall
- —
- Health plan (Part C)
- —
- Drug plan (Part D)
- —
Published per contract — every plan under contract H4030 shares this rating.
Drug tiers — preferred pharmacy, initial coverage
| Tier | Cost-sharing |
|---|---|
| Tier 1 · Preferred Generic | $0.00 |
| Tier 2 · Generic | $2.00 |
| Tier 3 · Preferred Brand | 25% |
| Tier 4 · Non-Preferred Drug | 25% |
| Tier 5 · Specialty Tier | 26% |
Also available in 24 other MO counties
Plan facts come from the CMS plan Landscape file and the CMS plan benefit package (PBP) files.