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DEVOTED CHOICE GIVEBACK 008 PA (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CHOICE GIVEBACK 008 PA (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 008 PA (PPO) in 2026, please refer to our full plan details page.
DEVOTED CHOICE GIVEBACK 008 PA (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Eastern Pennsylvania. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that DEVOTED CHOICE GIVEBACK 008 PA (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 008 PA (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 008 PA (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 $149.70. 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 008 PA (PPO) medicare plan features an annual drug deductible of $605. Tier 1 preferred generic drugs have no copay for one, two, or three-month fills at standard pharmacies and standard mail order. Tier 2 generic drugs require a low copay starting at $3.00 for a one-month supply, with standard mail order offering a reduced copay of $7.50 for a three-month supply. Brand-name and specialty medications are covered through coinsurance rather than flat copays. You will pay 21% coinsurance for Tier 3 preferred brand drugs, and 25% coinsurance for Tier 4 non-preferred drugs and Tier 5 specialty drugs. These coinsurance rates apply to standard retail pharmacies as well as standard mail-order deliveries.
Additional Benefits
The Devoted Choice Giveback 008 PA (PPO) plan offers affordable coverage with no copay for primary care visits, home health services, and routine preventive care. Specialist visits and routine hearing exams require a $45 copay with no coinsurance, while urgent care ranges from no copay to a $40 copay. Emergency room visits have a $115 copay, which is waived if you are admitted to the hospital within 24 hours. For inpatient hospital stays, members pay a $475 daily copay for days 1 through 4 and no copay for days 5 through 90. Skilled nursing facility care is also highly accessible, featuring no copay for the first 20 days. Additionally, the plan helps cover personal care with a $200 annual eyewear allowance and up to $250 for select dental services with no copay.
Inpatient Hospital See details
DEVOTED CHOICE GIVEBACK 008 PA (PPO) covers inpatient hospital acute and psychiatric stays with no coinsurance, requiring a $475 daily copay for days 1 through 4 and no copay for days 5 through 90. Unlimited additional days are covered for acute stays, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
DEVOTED CHOICE GIVEBACK 008 PA (PPO) covers outpatient services with no coinsurance, featuring copays ranging from $0 to $575 for outpatient hospital services and $475 per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions carry a $45 copay.
Partial Hospitalization See details
Partial hospitalization is covered under the DEVOTED CHOICE GIVEBACK 008 PA (PPO) plan 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 008 PA (PPO) with prior authorization, featuring a copay ranging from no copay to $350 and coinsurance for ground transport, and a 20% coinsurance and a copay for air transport. Transportation services to health-related locations are not covered.
Emergency Services See details
DEVOTED CHOICE GIVEBACK 008 PA (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgent care with no copay to a $40 copay and no coinsurance. Worldwide emergency and urgent services are covered up to a $25,000 limit with a $115 copay and no coinsurance, while worldwide emergency transportation has a $350 copay and 20% coinsurance.
Primary Care See details
DEVOTED CHOICE GIVEBACK 008 PA (PPO) offers primary care physician visits with no copay and no coinsurance, and specialist services with a $45 copay and no coinsurance. Therapy, mental health, and telehealth services are covered with copays ranging from $0 to $50 and no coinsurance, though podiatry is not covered, and for chiropractic care, some services are covered but routine and other chiropractic services are not covered.
Preventive Services See details
DEVOTED CHOICE GIVEBACK 008 PA (PPO) provides partially covered preventive services with no copay and no coinsurance for covered options like annual physical exams, kidney disease education, and fitness benefits. However, several sub-services are not covered, including 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
Hearing services are partially covered by DEVOTED CHOICE GIVEBACK 008 PA (PPO), offering routine hearing exams for a $45 copay and no coinsurance, and up to two prescription hearing aids per year with a copay between $599 and $899 and no coinsurance. OTC hearing aids, as well as inner ear, outer ear, and over-the-ear prescription hearing aids, are not covered.
Vision Services See details
Vision services are partially covered by DEVOTED CHOICE GIVEBACK 008 PA (PPO), featuring routine eye exams with no copay to a $45 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a combined annual maximum benefit of $200 for contacts, frames, lenses, and upgrades.
Dental Services See details
DEVOTED CHOICE GIVEBACK 008 PA (PPO) covers Medicare dental services with a $45 copay and no coinsurance, and other dental services with no copay and no coinsurance up to a combined $250 annual limit. The dental benefit is partially covered, as maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED CHOICE GIVEBACK 008 PA (PPO) covers home infusion bundled services with no copay, subject to prior authorization. Associated Medicare Part B chemotherapy and other drugs require between no coinsurance and 20% coinsurance, 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 008 PA (PPO) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
DEVOTED CHOICE GIVEBACK 008 PA (PPO) partially covers medical equipment with no copays, though prior authorization is required. Durable medical equipment carries a 19% to 20% coinsurance, while prosthetics, medical supplies, and diabetic supplies range from no coinsurance to 20% coinsurance, with diabetic therapeutic shoes and inserts not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the DEVOTED CHOICE GIVEBACK 008 PA (PPO) plan, with prior authorization required for these services. Lab services and outpatient X-rays feature no copays, diagnostic procedures carry a copay between $0 and $95 with no coinsurance, and therapeutic radiological services require a copay and a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by DEVOTED CHOICE GIVEBACK 008 PA (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
DEVOTED CHOICE GIVEBACK 008 PA (PPO) covers cardiac rehabilitation services with no coinsurance and prior authorization, though only some services are covered. Standard cardiac ($30 copay), intensive cardiac ($30 copay), pulmonary ($25 copay), and SET for PAD ($20 copay) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
DEVOTED CHOICE GIVEBACK 008 PA (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
DEVOTED CHOICE GIVEBACK 008 PA (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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