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DEVOTED CHOICE GIVEBACK 006 AZ (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CHOICE GIVEBACK 006 AZ (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 AZ (PPO) in 2026, please refer to our full plan details page.
DEVOTED CHOICE GIVEBACK 006 AZ (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Rural Arizona. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that DEVOTED CHOICE GIVEBACK 006 AZ (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 AZ (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 AZ (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 $125.60. 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 $10000.00 (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 $10000.00 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 AZ (PPO) plan offers an Enhanced Alternative drug benefit with a $605.00 prescription drug deductible. If you qualify for Extra Help, you will pay no premium for Part D coverage. During the initial coverage phase, standard pharmacy and standard mail-order services require a $3.00 copay for Tier 1 preferred generics, 22% coinsurance for Tier 2 standard generics, and 25% coinsurance for Tier 3 and Tier 4 drugs. After your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase. In this phase, you pay nothing for Medicare Part D covered prescription drugs. This plan provides clear cost-sharing phases to help you manage your healthcare budget in Arizona.
Additional Benefits
The DEVOTED CHOICE GIVEBACK 006 AZ (PPO) plan provides reliable coverage for essential medical services, featuring inpatient hospital stays with a $475 daily copay for the first four days and no copay for days 5 through 90. Routine primary care visits range from no copay up to $50, while specialist visits require a $45 copay. Emergency care is available with a $115 copay, which is waived upon hospital admission, alongside urgent care visits that range from no copay to $40. Supplemental benefits include dental care up to a $250 annual limit and routine hearing exams for a $45 copay, with prescription hearing aids ranging from $599 to $899. Vision care is also covered, offering routine eye exams with copays up to $45 and a $200 annual limit for eyewear with no copay. Additionally, diagnostic labs and outpatient X-rays feature no copay, while dialysis and durable medical equipment require up to a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by DEVOTED CHOICE GIVEBACK 006 AZ (PPO) with a $475 daily copay for days 1 through 4, no copay for days 5 through 90, and no coinsurance. Prior authorization is required, but upgrades and non-Medicare-covered stays for acute care, along with additional days and non-Medicare-covered stays for psychiatric care, are not covered.
Outpatient Services See details
DEVOTED CHOICE GIVEBACK 006 AZ (PPO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center services and a $0 to $575 copay for outpatient hospital services. Patients will pay a $475 copay per stay for observation services, a $45 copay for outpatient substance abuse sessions, and no deductible for outpatient blood services.
Partial Hospitalization See details
DEVOTED CHOICE GIVEBACK 006 AZ (PPO) covers partial hospitalization services with a $70 copay and no coinsurance. Prior authorization is required to receive these covered benefits.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by DEVOTED CHOICE GIVEBACK 006 AZ (PPO), as transportation services to plan-approved or any health-related locations are not covered. Covered ground ambulance services require no coinsurance and a copay of up to $395 (with no copay for some services), while air ambulance services require a 20% coinsurance and no copay.
Emergency Services See details
Emergency services are covered by DEVOTED CHOICE GIVEBACK 006 AZ (PPO) with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services range from no copay to a $40 copay with no coinsurance, while worldwide emergency services are covered up to a $25,000 limit with copays up to $395 and up to 20% coinsurance.
Primary Care See details
DEVOTED CHOICE GIVEBACK 006 AZ (PPO) partially covers Primary Care benefits with no coinsurance, though podiatry and routine chiropractic care are not covered. Covered services feature copayments ranging from no copay up to $50, including a $35 copay for occupational therapy, a $45 copay for specialists and psychiatric services, and a $20 to $50 copay for physical and speech therapy.
Preventive Services See details
DEVOTED CHOICE GIVEBACK 006 AZ (PPO) offers partially covered preventive services with no copay and no coinsurance for covered benefits like annual physicals, fitness programs, and health education. Uncovered sub-services include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission 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, and counseling.
Hearing Services See details
Hearing services are covered by DEVOTED CHOICE GIVEBACK 006 AZ (PPO), including one annual routine hearing exam for a $45 copay and fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with a limit of two per year and a copay of $599 to $899, while OTC hearing aids and inner, outer, or over-the-ear models are not covered.
Vision Services See details
DEVOTED CHOICE GIVEBACK 006 AZ (PPO) covers vision services, including annual routine eye exams with copays ranging from no copay to $45 and no coinsurance. Eyewear is also covered up to a $200 yearly limit with no deductible, copay, or coinsurance.
Dental Services See details
DEVOTED CHOICE GIVEBACK 006 AZ (PPO) partially covers dental services, offering Medicare-covered dental care with a $45 copay and no coinsurance. Other covered dental services have a combined in-network and out-of-network annual maximum benefit of $250, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED CHOICE GIVEBACK 006 AZ (PPO) covers home infusion bundled services, which require prior authorization and may involve step therapy. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy, radiation, and other covered Part B drugs feature no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by DEVOTED CHOICE GIVEBACK 006 AZ (PPO) with a 20% coinsurance and no copay. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment is partially covered by DEVOTED CHOICE GIVEBACK 006 AZ (PPO) with no copays and coinsurance ranging from no coinsurance to 20% depending on the item. Covered services include durable medical equipment, prosthetics, and diabetic supplies, though 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 AZ (PPO) with prior authorization required. Lab services and outpatient X-rays have no copay, diagnostic procedures and radiological services range from no copay up to $95 and $300 respectively, and therapeutic radiological services require 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the DEVOTED CHOICE GIVEBACK 006 AZ (PPO) plan, though prior authorization is required before you can receive care.
Cardiac Rehabilitation Services See details
DEVOTED CHOICE GIVEBACK 006 AZ (PPO) does not cover Cardiac Rehabilitation Services. This includes cardiac, intensive cardiac, and pulmonary rehabilitation, as well as supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by DEVOTED CHOICE GIVEBACK 006 AZ (PPO), requiring prior authorization and offering no coinsurance. 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
Other Services are partially covered by DEVOTED CHOICE GIVEBACK 006 AZ (PPO), which covers additional preventive services not covered by Medicare with no maximum limit, though specific copay and coinsurance details are not provided. Acupuncture, over-the-counter (OTC) items, meal benefits, and dual eligible SNPs with highly integrated services are not covered.
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