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DEVOTED CHOICE GIVEBACK 002 KS (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CHOICE GIVEBACK 002 KS (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 KS (PPO) in 2026, please refer to our full plan details page.
DEVOTED CHOICE GIVEBACK 002 KS (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Kansas City Metro/Eastern Kansas. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED CHOICE GIVEBACK 002 KS (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 KS (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 KS (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 KS (PPO) Medicare plan features an annual drug deductible of $605. For Tier 1 preferred generic drugs, members pay no copay for 1-month, 2-month, or 3-month supplies through standard pharmacies and mail order services. Tier 2 generic medications are also highly affordable, with copays starting at just $3.00 for a 1-month supply and standard mail order options costing up to $7.50 for a 3-month supply. For higher-tier medications, cost sharing transitions to coinsurance. Tier 3 preferred brand drugs require a 21% coinsurance for standard fills, while Tier 4 non-preferred drugs and Tier 5 specialty drugs carry a 25% coinsurance. These cost-sharing rates apply to both standard retail pharmacies and standard mail order services, helping you easily plan your healthcare budget.
Additional Benefits
The DEVOTED CHOICE GIVEBACK 002 KS (PPO) plan provides affordable healthcare coverage with no copay for primary care visits, home health services, and routine preventive care. For specialized care, members pay a $55 copay for specialist visits, while inpatient hospital stays require a $475 daily copay for the first four days followed by no copay for days five through 90. Routine dental and vision services are covered with no copay up to annual maximum limits of $250 and $200 respectively, though hearing exams and prescription hearing aids require copayments. Diagnostic lab services, outpatient X-rays, and home infusion services are also covered with no copay, while durable medical equipment requires a 15% coinsurance. Emergency care is available with a $115 copay, and urgent care visits range from no copay to a $40 copay. However, this plan does not cover certain extra benefits such as acupuncture, over-the-counter items, or meal services.
Inpatient Hospital See details
Inpatient hospital services are partially covered by DEVOTED CHOICE GIVEBACK 002 KS (PPO) with no coinsurance and a $475 daily copay for days 1 through 4, followed by no copay for days 5 through 90. While unlimited additional acute care days are covered, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
DEVOTED CHOICE GIVEBACK 002 KS (PPO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services at no copay. Outpatient hospital services have a copay ranging from $0 to $525, observation services require a $475 copay per stay, and outpatient substance abuse individual or group sessions have a $50 copay.
Partial Hospitalization See details
DEVOTED CHOICE GIVEBACK 002 KS (PPO) covers partial hospitalization services with a $70.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
DEVOTED CHOICE GIVEBACK 002 KS (PPO) partially covers ambulance and transportation services, as transportation to plan-approved or health-related locations is not covered. Ground ambulance services require no copay to a $315 copay with no coinsurance, while air ambulance services require a 20% coinsurance with no copay, both of which require prior authorization.
Emergency Services See details
DEVOTED CHOICE GIVEBACK 002 KS (PPO) covers emergency services with a $115 copay (waived if admitted within 24 hours) and no coinsurance, alongside urgent care ranging from no copay to a $40 copay with no coinsurance. Worldwide emergency and urgent care are covered up to a $25,000 limit with a $115 copay and no coinsurance, while worldwide emergency transportation requires a $315 copay and 20% coinsurance.
Primary Care See details
DEVOTED CHOICE GIVEBACK 002 KS (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $55 copay and no coinsurance. Physical, occupational, and mental health therapies have copays ranging from $35 to $55 and no coinsurance, whereas podiatry is not covered, and some chiropractic services are covered though routine and other chiropractic services are not.
Preventive Services See details
Preventive services are partially covered by DEVOTED CHOICE GIVEBACK 002 KS (PPO) with no copay and no coinsurance for covered services, including annual physical exams, fitness benefits, and nutritional counseling. While some additional benefits are covered, other sub-services such as in-home support, therapeutic massage, and personal emergency response systems are not covered.
Hearing Services See details
DEVOTED CHOICE GIVEBACK 002 KS (PPO) provides partially covered hearing services, including one annual routine hearing exam with a $55 copay and no coinsurance. Up to two prescription hearing aids are covered per year with a copay ranging from $599 to $899 and no coinsurance, though over-the-counter (OTC) hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
DEVOTED CHOICE GIVEBACK 002 KS (PPO) offers partially covered vision services, featuring one annual routine eye exam with a $0 to $20 copay and no coinsurance, while other eye exam services are not covered. Covered eyewear, including contacts and eyeglasses, has no copay and no coinsurance up to a $200 combined annual maximum.
Dental Services See details
Dental services are partially covered by DEVOTED CHOICE GIVEBACK 002 KS (PPO) with no copay and no coinsurance for most preventive and comprehensive care, up to a $250 annual maximum for both in-network and out-of-network services. Medicare-covered dental services require a $55 copay and no coinsurance, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED CHOICE GIVEBACK 002 KS (PPO) covers home infusion bundled services with no copay, subject to prior authorization. Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs have no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by DEVOTED CHOICE GIVEBACK 002 KS (PPO) with no copay and 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
DEVOTED CHOICE GIVEBACK 002 KS (PPO) partially covers medical equipment with no copays, though diabetic therapeutic shoes and inserts are not covered. Covered durable medical equipment requires a 15% coinsurance, while other medical supplies, prosthetics, and diabetic supplies range from no coinsurance up to 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED CHOICE GIVEBACK 002 KS (PPO) with no copay and no coinsurance for lab services, diagnostic radiology, and outpatient X-rays. Diagnostic tests and procedures have a copay of $0 to $95 with no coinsurance, while therapeutic radiology requires a 20% coinsurance, and prior authorization is required for all services.
Home Health Services See details
Home Health Services are covered by the DEVOTED CHOICE GIVEBACK 002 KS (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by DEVOTED CHOICE GIVEBACK 002 KS (PPO) with no coinsurance and require prior authorization. However, only some services are covered, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require copayments ranging from $20 to $30.
Skilled Nursing Facility (SNF) See details
DEVOTED CHOICE GIVEBACK 002 KS (PPO) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
DEVOTED CHOICE GIVEBACK 002 KS (PPO) partially covers other services, offering 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 under this plan.
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