A non-government entity
DEVOTED CHOICE GIVEBACK 001 TX (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CHOICE GIVEBACK 001 TX (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 001 TX (PPO) in 2026, please refer to our full plan details page.
DEVOTED CHOICE GIVEBACK 001 TX (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Austin. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that DEVOTED CHOICE GIVEBACK 001 TX (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 001 TX (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 001 TX (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 $163.90. 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 $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:
Sign up for DEVOTED CHOICE GIVEBACK 001 TX (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The prescription drug coverage for the DEVOTED CHOICE GIVEBACK 001 TX (PPO) Medicare plan includes an annual drug deductible of $605. Tier 1 preferred generic drugs feature no copay for 1-month, 2-month, or 3-month supplies filled at standard pharmacies or through standard mail order. Tier 2 generic drugs are also budget-friendly, requiring a low copay starting at $1.00 for a 1-month supply. For brand-name and specialty medications, costs are based on a percentage of the drug's price. Tier 3 preferred brand drugs require 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require 25% coinsurance. These coinsurance rates apply to both standard pharmacy fills and standard mail-order services.
Additional Benefits
The DEVOTED CHOICE GIVEBACK 001 TX (PPO) plan offers comprehensive medical coverage with no copay for primary care doctor visits, preventive services, or home health care. Specialist visits require a $45 copay, while inpatient hospital stays have a $375 copay for the first few days and no copay for subsequent days. Emergency room visits carry a $115 copay, which is waived upon admission, and outpatient hospital services range from no copay up to $475. For additional care, this plan provides coverage for dental, vision, and hearing services with no coinsurance. You can access select dental care and routine eyewear with no copay up to set annual limits of $250 and $200 respectively. Skilled nursing facility stays are also covered with no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
Inpatient hospital services are covered by DEVOTED CHOICE GIVEBACK 001 TX (PPO) with no coinsurance, requiring a $375 copay for days 1 through 6 of acute care and days 1 through 5 of psychiatric care, followed by no copay for subsequent days. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED CHOICE GIVEBACK 001 TX (PPO) covers outpatient services with no coinsurance, featuring copays ranging from $0 to $475 for hospital services and $375 per stay for observation services. There is no copay for ambulatory surgical center and blood services, while outpatient substance abuse services carry a $45 copay, with prior authorization required for these benefits.
Partial Hospitalization See details
DEVOTED CHOICE GIVEBACK 001 TX (PPO) covers partial hospitalization services with a $70.00 copay and no coinsurance. Prior authorization is required to access this covered benefit.
Ambulance and Transportation Services See details
Ambulance services are covered by DEVOTED CHOICE GIVEBACK 001 TX (PPO) with prior authorization, featuring a copay of no copay to $350 and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. Transportation services are not covered.
Emergency Services See details
DEVOTED CHOICE GIVEBACK 001 TX (PPO) covers emergency services 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, and worldwide emergency services are covered up to $25,000 with a $115 copay and no coinsurance for emergency or urgent care, and a $350 copay plus 20% coinsurance for emergency transportation.
Primary Care See details
Primary care benefits under DEVOTED CHOICE GIVEBACK 001 TX (PPO) feature no copay and no coinsurance for primary care provider visits, while specialist visits require a $45 copay and no coinsurance. Other covered services, including physical, occupational, and mental health therapies, have copays ranging from $35 to $50 with no coinsurance, though podiatry and routine chiropractic care are not covered.
Preventive Services See details
Preventive services are partially covered under the DEVOTED CHOICE GIVEBACK 001 TX (PPO) plan, featuring no copay and no coinsurance for covered care such as annual physical exams, kidney disease education, and select screenings. While fitness benefits, weight management, and nutritional counseling are included, several additional services like in-home safety assessments, therapeutic massages, and personal emergency response systems are not covered.
Hearing Services See details
DEVOTED CHOICE GIVEBACK 001 TX (PPO) covers hearing services with no deductible, including one annual routine exam for a $45 copay and no coinsurance, and unlimited fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with a copay of $599.00 to $899.00 and no coinsurance for up to two devices per year, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
DEVOTED CHOICE GIVEBACK 001 TX (PPO) partially covers vision services, offering one routine eye exam per year with a $0 to $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 $200 yearly limit for contacts, lenses, frames, and upgrades.
Dental Services See details
DEVOTED CHOICE GIVEBACK 001 TX (PPO) covers Medicare-covered dental services with a $45 copay and no coinsurance, and other dental services with no copay and no coinsurance up to a $250 annual maximum. The dental benefit is partially covered, as maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered under the DEVOTED CHOICE GIVEBACK 001 TX (PPO) plan with no copay and no coinsurance, subject to prior authorization. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs require no copay and 0% to 20% coinsurance, while Part B insulin drugs have a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
DEVOTED CHOICE GIVEBACK 001 TX (PPO) covers Dialysis Services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is partially covered by the DEVOTED CHOICE GIVEBACK 001 TX (PPO) plan with no copays, though prior authorization is required. Durable medical equipment has a 20% coinsurance, while prosthetics, medical supplies, and diabetic supplies range from no coinsurance to 20% coinsurance, but diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED CHOICE GIVEBACK 001 TX (PPO) covers diagnostic and radiological services with prior authorization, offering lab services and outpatient X-rays with no copay. Diagnostic procedures and tests carry a copay ranging from $0 to $95 with no coinsurance, while diagnostic radiological services have a minimum $0 copay and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered by DEVOTED CHOICE GIVEBACK 001 TX (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the DEVOTED CHOICE GIVEBACK 001 TX (PPO) plan, as standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are all not covered.
Skilled Nursing Facility (SNF) See details
DEVOTED CHOICE GIVEBACK 001 TX (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the standard 100 days are not covered.
Other Services See details
Other services are partially covered by DEVOTED CHOICE GIVEBACK 001 TX (PPO), featuring 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.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved