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DEVOTED CHOICE GIVEBACK 002 DE (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CHOICE GIVEBACK 002 DE (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED CHOICE GIVEBACK 002 DE (PPO) in 2026, please refer to our full plan details page.
DEVOTED CHOICE GIVEBACK 002 DE (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Delaware. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED CHOICE GIVEBACK 002 DE (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about DEVOTED CHOICE GIVEBACK 002 DE (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For DEVOTED CHOICE GIVEBACK 002 DE (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $159.90. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $605.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $13900.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $13900.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The DEVOTED CHOICE GIVEBACK 002 DE (PPO) Medicare plan features an annual prescription drug deductible of $605. For Tier 1 preferred generic medications, you will pay no copay for one-, two-, or three-month supplies at standard pharmacies and standard mail order. Tier 2 generic drugs are also highly affordable, starting with a low $3 copay for a one-month supply. Higher-tier medications are covered under a coinsurance model for standard pharmacies and mail-order services. You will pay a 21% coinsurance for Tier 3 preferred brand drugs, and a 25% coinsurance for both Tier 4 non-preferred drugs and Tier 5 specialty drugs. This clear structure makes it easy to estimate your out-of-pocket prescription expenses.
Additional Benefits
The DEVOTED CHOICE GIVEBACK 002 DE (PPO) plan provides comprehensive medical coverage with no copay and no coinsurance for primary care doctor visits, home health services, and preventive care. For more specialized needs, members pay a $35 to $55 copay for specialist visits and therapy services, while inpatient hospital stays require a $475 daily copay for the first few days with no copay for subsequent days. Outpatient hospital services and emergency care are also covered, with emergency visits requiring a $115 copay that is waived upon admission. Supplemental benefits under this plan include preventive and comprehensive dental care with no copay up to a $250 annual limit, alongside routine eye exams and a $200 annual allowance for eyewear with no copay. Hearing benefits include routine exams for a $55 copay and prescription hearing aids with copays ranging from $599 to $899. Additionally, durable medical equipment is covered with no copay and a 15% coinsurance, while skilled nursing facility stays offer no copay for the first 20 days.
Inpatient Hospital See details
DEVOTED CHOICE GIVEBACK 002 DE (PPO) covers inpatient hospital services with no coinsurance, requiring a $475 daily copay for days 1-4 of acute stays and days 1-3 of psychiatric stays, with no copay for subsequent days. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered under this benefit.
Outpatient Services See details
DEVOTED CHOICE GIVEBACK 002 DE (PPO) covers outpatient services with no coinsurance, offering no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay of $0 to $575, observation services cost a $475 copay per stay, and outpatient substance abuse services carry a $50 copay, with prior authorization required for most services.
Partial Hospitalization See details
DEVOTED CHOICE GIVEBACK 002 DE (PPO) covers partial hospitalization services with a $70.00 copay and no coinsurance. Prior authorization is required to access this covered benefit.
Ambulance and Transportation Services See details
DEVOTED CHOICE GIVEBACK 002 DE (PPO) covers ground ambulance services with a copay of $0 to $315 and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required for both. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered by DEVOTED CHOICE GIVEBACK 002 DE (PPO) with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services feature no coinsurance and a copay ranging from no copay to $40, while worldwide emergency services are covered up to a $25,000 limit with a $115 copay for emergency or urgent care, and a $315 copay and 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED CHOICE GIVEBACK 002 DE (PPO) offers primary care physician services with no copay and no coinsurance, while specialist visits, physical, occupational, and speech therapies, and mental health services require copays ranging from $35 to $55 and no coinsurance. Chiropractic and podiatry services are not covered under this plan.
Preventive Services See details
Preventive services are partially covered by DEVOTED CHOICE GIVEBACK 002 DE (PPO) with no copay and no coinsurance for covered benefits like annual physicals, fitness programs, and glaucoma screenings. However, several sub-services are not covered, including in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, and therapeutic massage.
Hearing Services See details
DEVOTED CHOICE GIVEBACK 002 DE (PPO) partially covers hearing services with no deductible, offering routine hearing exams for a $55.00 copay and no coinsurance. Prescription hearing aids are covered with no coinsurance and copays ranging from $599.00 to $899.00, but OTC hearing aids and inner ear, outer ear, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by DEVOTED CHOICE GIVEBACK 002 DE (PPO), as other eye exam services are not covered. Routine eye exams feature a $0 to $55 copay and no coinsurance with no deductible, while eyewear is covered with no copay, no coinsurance, and a $200 annual combined maximum limit.
Dental Services See details
DEVOTED CHOICE GIVEBACK 002 DE (PPO) offers partially covered dental services, featuring no copay and no coinsurance for covered preventive and comprehensive care up to a combined $250 annual limit. Medicare-covered dental services require a $55 copay and no coinsurance, while implant services, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
DEVOTED CHOICE GIVEBACK 002 DE (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs have no copay and a 0% to 20% coinsurance, while Part B insulin has a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
DEVOTED CHOICE GIVEBACK 002 DE (PPO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Medical Equipment See details
DEVOTED CHOICE GIVEBACK 002 DE (PPO) covers durable medical equipment with no copay and 15% coinsurance, and prosthetics and medical supplies with no copay and no coinsurance to 20% coinsurance. Diabetic equipment is partially covered with no copay and no coinsurance to 15% coinsurance for diabetic supplies, but diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED CHOICE GIVEBACK 002 DE (PPO) with no coinsurance for diagnostic services, which feature no copay for lab services and a $0 to $95 copay for diagnostic procedures. Outpatient X-rays have no copay but may require coinsurance, while therapeutic radiological services carry a minimum 20% coinsurance, and prior authorization is required.
Home Health Services See details
Home Health Services are covered by the DEVOTED CHOICE GIVEBACK 002 DE (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the DEVOTED CHOICE GIVEBACK 002 DE (PPO) plan, as all sub-services, including intensive cardiac, pulmonary, and SET for PAD rehabilitation, are excluded from coverage.
Skilled Nursing Facility (SNF) See details
DEVOTED CHOICE GIVEBACK 002 DE (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the standard 100-day limit are not covered.
Other Services See details
Other services are partially covered by DEVOTED CHOICE GIVEBACK 002 DE (PPO), which offers additional preventive services not covered by Medicare with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
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