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Devoted CHOICE GIVEBACK Colorado (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Devoted CHOICE GIVEBACK Colorado (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 Colorado (PPO) in 2025, please refer to our full plan details page.
Devoted CHOICE GIVEBACK Colorado (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Colorado. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Devoted CHOICE GIVEBACK Colorado (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 Colorado (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 Colorado (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 $147.70. 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 $590.00 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 $11300.00 (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 $11300.00 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 Colorado (PPO) plan has an enhanced alternative drug benefit. The plan has a deductible of $590. Once you meet your deductible, you will pay a copay or coinsurance for your prescriptions. During the initial coverage phase, you will pay a $5 copay for preferred generic drugs at standard and mail order pharmacies. For standard generic, preferred brand, and non-preferred drugs, you will pay 25% coinsurance. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs.
Additional Benefits
The Devoted CHOICE GIVEBACK Colorado (PPO) plan offers a range of benefits, including inpatient hospital stays with a copay, outpatient services with varying copays, and coverage for emergency and ambulance services. The plan also includes coverage for primary care, preventive services, hearing, vision, and dental services, with specific copays and coverage limits for each. Additional benefits include home health services with no copay, skilled nursing facility care with copays for some days, and coverage for medical equipment and home infusion services. However, some services like cardiac rehabilitation and certain other services are not covered.
Inpatient Hospital See details
The Devoted CHOICE GIVEBACK Colorado (PPO) plan covers inpatient hospital stays, including acute and psychiatric care, with a copay of $395 for days 1-5 and no copay for days 6-90. Additional days for inpatient hospital-acute are covered, but non-Medicare covered stays and upgrades for both acute and psychiatric care are not covered.
Outpatient Services See details
The Devoted CHOICE GIVEBACK Colorado (PPO) plan covers outpatient services, including outpatient hospital services with a copay between $0 and $495, observation services with a $395 copay, ambulatory surgical center services with no copay, individual and group outpatient substance abuse sessions with a $45 copay, and outpatient blood services. Prior authorization is required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Devoted CHOICE GIVEBACK Colorado (PPO) plan with a $70 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
The Devoted CHOICE GIVEBACK Colorado (PPO) plan covers ambulance services, with a copay of $0-$350 for ground ambulance services and 20% coinsurance for air ambulance services. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Devoted CHOICE GIVEBACK Colorado (PPO) plan. For Emergency Services, there is a $110 copay, and there is no coinsurance; for Urgently Needed Services, the copay is between $0 and $45, and there is no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $110 copay, and Worldwide Emergency Transportation has a $350 copay and 20% coinsurance.
Primary Care See details
The Devoted CHOICE GIVEBACK Colorado (PPO) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, physician specialist services with a $50 copay, and mental health specialty services with a $45 copay for individual and group sessions. The plan also covers other health care professional services with a copay between $0 and $50, psychiatric services with a $45 copay for individual and group sessions, physical therapy and speech-language pathology services with a $50 copay, additional telehealth benefits with a copay between $0 and $50, and opioid treatment program services with a $45 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services are covered, including services not usually covered by Medicare plans. This plan covers Health Education, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Nutritional/Dietary Benefit, Fitness Benefit, Home and Bathroom Safety Devices and Modifications, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. However, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), and Counseling Services are not covered.
Hearing Services See details
Hearing services include coverage for hearing exams with a $50 copay, and the fitting/evaluation for hearing aids is covered. Prescription hearing aids are partially covered, with a copay between $599 and $899 for all types of prescription hearing aids, but inner, outer, and over-the-ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for eye exams with a $50 copay, and eyewear with a combined maximum plan benefit of $250 every year, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Routine eye exams are covered once per year.
Dental Services See details
Devoted CHOICE GIVEBACK Colorado (PPO) covers a range of dental services, including oral exams, dental x-rays, and other diagnostic and preventive services, with no copay; however, there is a $50 copay for Medicare Dental Services. This plan has a $250 annual maximum for dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay, with 20% coinsurance. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is between 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Devoted CHOICE GIVEBACK Colorado (PPO) plan. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with an 18% coinsurance and no copay, Prosthetic Devices with 0-20% coinsurance and no copay, and Medical Supplies with a 20% coinsurance and no copay. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests, lab services, and radiological services. Diagnostic Procedures/Tests have a minimum copay of $0 and a maximum copay of $95. Diagnostic Radiological Services have a copay of at most $300, and Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Devoted CHOICE GIVEBACK Colorado (PPO) plan with no copay and no coinsurance, though authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Devoted CHOICE GIVEBACK Colorado (PPO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Devoted CHOICE GIVEBACK Colorado (PPO) plan, but require prior authorization. For days 1-20 and 61-100, there is no copay, while days 21-60 have a $214 copay.
Other Services See details
Other Services includes acupuncture and other services, with acupuncture being covered. Over-the-counter items, meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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