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DEVOTED CHOICE GIVEBACK 006 KS (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CHOICE GIVEBACK 006 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 006 KS (PPO) in 2026, please refer to our full plan details page.
DEVOTED CHOICE GIVEBACK 006 KS (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Kansas River Valley Area. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED CHOICE GIVEBACK 006 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 006 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 006 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 $159.70. 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 006 KS (PPO) prescription drug plan features an annual drug deductible of $605. Under this plan, Tier 1 preferred generic drugs have no copay for one-month, two-month, or three-month supplies filled through standard pharmacies or standard mail order. Tier 2 generic drugs are also highly affordable, with standard pharmacy copays starting at $3.00 for a one-month supply and standard mail-order copays capped at $7.50 for a three-month supply. For brand-name and specialty medications, cost sharing is structured as coinsurance rather than set copays. Tier 3 preferred brand drugs require a 21% coinsurance through standard pharmacies and standard mail order. Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance for standard pharmacy and mail-order fills.
Additional Benefits
The DEVOTED CHOICE GIVEBACK 006 KS (PPO) plan delivers robust coverage for core medical services with clear, predictable costs. Beneficiaries enjoy no copay and no coinsurance for primary care visits, preventive services, and home health care. For inpatient hospital stays, there is no coinsurance, with a $475 daily copay for days 1 through 4 and no copay for days 5 through 90. Everyday healthcare needs are supported by dental, vision, and hearing benefits that feature low or no copays. Routine eye exams cost between no copay and $20, with covered eyewear requiring no copay up to a $200 annual limit. Dental services are covered with no copay up to a $250 yearly limit, while routine hearing exams require a $55 copay and covered prescription hearing aids carry copays from $599 to $899.
Inpatient Hospital See details
DEVOTED CHOICE GIVEBACK 006 KS (PPO) covers inpatient hospital services with no coinsurance, requiring a $475 daily copay for days 1 through 4 and no copay for days 5 through 90. This benefit is partially covered, as unlimited additional days are included for acute stays, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
DEVOTED CHOICE GIVEBACK 006 KS (PPO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copay. Outpatient hospital services have a copay of $0 to $475, while individual and group outpatient substance abuse sessions require a $50 copay.
Partial Hospitalization See details
DEVOTED CHOICE GIVEBACK 006 KS (PPO) covers partial hospitalization services with a $70.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance services are covered by DEVOTED CHOICE GIVEBACK 006 KS (PPO) with prior authorization, featuring a copay of $0 to $315 and no coinsurance for ground services, and a 20% coinsurance with no copay for air services. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
DEVOTED CHOICE GIVEBACK 006 KS (PPO) covers emergency services with a $115 copay (waived if admitted within 24 hours) and no coinsurance, while urgently needed services feature a copay ranging from no copay to $40 with no coinsurance. Worldwide emergency and urgent services are covered up to a $25,000 maximum benefit with a $115 copay and no coinsurance, except for worldwide emergency transportation which requires a $315 copay and 20% coinsurance.
Primary Care See details
DEVOTED CHOICE GIVEBACK 006 KS (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $55 copay and no coinsurance. Other services like physical and occupational therapy require copays of $35 to $55 with no coinsurance, while podiatry and routine chiropractic services are not covered.
Preventive Services See details
DEVOTED CHOICE GIVEBACK 006 KS (PPO) offers preventive services with no copay and no coinsurance for covered benefits such as annual physicals, kidney disease education, and fitness programs. However, this benefit is only partially covered, excluding services like in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access technologies, and counseling.
Hearing Services See details
DEVOTED CHOICE GIVEBACK 006 KS (PPO) partially covers hearing services with no deductible, offering routine hearing exams for a $55 copay and no coinsurance. Covered prescription hearing aids require no coinsurance with copays ranging from $599 to $899, while 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 006 KS (PPO), as other eye exam services are not covered. Routine eye exams have a $0 to $20 copay and no coinsurance, while covered eyewear has no copay and no coinsurance up to a $200 annual maximum benefit.
Dental Services See details
DEVOTED CHOICE GIVEBACK 006 KS (PPO) dental services are partially covered, featuring a $55 copay and no coinsurance for Medicare-covered dental services, and no copay or coinsurance for other dental services up to a $250 annual limit. While most preventive and comprehensive dental services are fully covered, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED CHOICE GIVEBACK 006 KS (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy, carry a coinsurance ranging from no coinsurance to 20%, while Part B insulin is covered with a $35 copay and up to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by DEVOTED CHOICE GIVEBACK 006 KS (PPO) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
DEVOTED CHOICE GIVEBACK 006 KS (PPO) covers medical equipment with no copays, though prior authorization is required. Durable Medical Equipment carries an 18% coinsurance, while prosthetic devices and medical supplies range from no coinsurance to 20% coinsurance. Diabetic equipment is partially covered with up to 18% coinsurance for 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 006 KS (PPO) with no coinsurance for diagnostic services, no copay for lab services, and diagnostic test copays ranging from $0 to $95. Outpatient X-rays have no copay, therapeutic radiological services require a minimum 20% coinsurance, and prior authorization is required.
Home Health Services See details
DEVOTED CHOICE GIVEBACK 006 KS (PPO) covers Home Health Services with no copay and no coinsurance. Please note that prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the DEVOTED CHOICE GIVEBACK 006 KS (PPO) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage. Although the category technically features no coinsurance and requires prior authorization, none of these specific services are covered in practice.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by DEVOTED CHOICE GIVEBACK 006 KS (PPO) with no coinsurance, featuring no copay for days 1 through 20 and a $215 daily copay for days 21 through 100. Prior authorization is required, no prior three-day hospital stay is needed, and additional days beyond the standard 100-day benefit period are not covered.
Other Services See details
DEVOTED CHOICE GIVEBACK 006 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.
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