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Devoted CHOICE GIVEBACK Austin (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Devoted CHOICE GIVEBACK Austin (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 Austin (PPO) in 2025, please refer to our full plan details page.
Devoted CHOICE GIVEBACK Austin (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 2025.
It's important to know that Devoted CHOICE GIVEBACK Austin (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 Austin (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 Austin (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 $148.00. 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 Austin (PPO) plan has a $590 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, for standard generic drugs, you pay a $1 copay at a standard pharmacy and 25% coinsurance at a standard pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Devoted CHOICE GIVEBACK Austin (PPO) plan offers a wide range of benefits with varying cost-sharing. Hospital stays have copays, with outpatient services having copays that range from $0 to $475. Emergency services have a $110 copay, and primary care visits range from $0 to $45. Preventive services and home health services are covered with no copay, while hearing and vision services have copays of $20. Dental services are covered up to $250 per year. The plan also covers prescription hearing aids with a copay between $599 and $899.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with a copay of $350 for days 1-6 and $0 for days 7-90 for Inpatient Hospital-Acute, and a copay of $350 for days 1-5 and $0 for days 6-90 for Inpatient Hospital Psychiatric. Additional Days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services, including all outpatient hospital services, are covered by the Devoted CHOICE GIVEBACK Austin (PPO) plan. Outpatient hospital services have a copay ranging from $0 to $475, observation services have a $375 copay, and ambulatory surgical center services have no copay. Outpatient substance abuse services have a $45 copay for both individual and group sessions, and outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Devoted CHOICE GIVEBACK Austin (PPO) plan, with a $70 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground ambulance services have a copay between $0 and $350, while air ambulance services have a 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by Devoted CHOICE GIVEBACK Austin (PPO), with a $110 copay. Urgently Needed Services have a copay between $0 and $45, and Worldwide Emergency Services are covered, including Worldwide Emergency Coverage with a $110 copay, Worldwide Urgent Coverage with a $110 copay, and Worldwide Emergency Transportation with a $350 copay and 20% coinsurance.
Primary Care See details
The Devoted CHOICE GIVEBACK Austin (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 $45 copay, Mental Health Specialty Services with a $45 copay for individual and group sessions, Other Health Care Professional with a copay between $0 and $45, Psychiatric Services with a $45 copay for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with a copay between $45 and $50, Additional Telehealth Benefits with a copay between $0 and $45, and Opioid Treatment Program Services with a $45 copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
The Devoted CHOICE GIVEBACK Austin (PPO) plan covers preventive services, including Medicare-covered services with no copay, annual physical exams, health education, weight management programs, alternative therapies, nutritional/dietary benefits, home and bathroom safety devices, fitness benefits, kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. 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, Therapeutic Massage, 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, and Counseling Services are not covered.
Hearing Services See details
Hearing exams are covered with a $20 copay, including routine hearing exams and fitting/evaluation for hearing aids. Prescription hearing aids are partially covered, with a copay between $599 and $899 for all types of prescription hearing aids, but inner ear, outer ear, and over-the-ear prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for eye exams with a $20 copay, and routine eye exams once per year. The plan also covers eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, with a combined maximum benefit of $250.00 every year.
Dental Services See details
Dental Services are covered, with a maximum plan benefit of $250 per year for both in-network and out-of-network services. Medicare Dental Services require prior authorization and have a $45 copay. Other services like oral exams, dental x-rays, and more are covered with no copay or coinsurance. However, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 20% coinsurance, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by Devoted CHOICE GIVEBACK Austin (PPO) with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered under the Devoted CHOICE GIVEBACK Austin (PPO) plan. Durable Medical Equipment (DME) has a 20% coinsurance, and Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 0-20% coinsurance, and Medical Supplies have a 20% coinsurance. Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $95, Lab Services with no copay, and Diagnostic Radiological Services with a copay up to $300. Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Devoted CHOICE GIVEBACK Austin (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Devoted CHOICE GIVEBACK Austin (PPO) plan, but the plan does not cover any of the sub-services. There is a copay for the covered services, but the amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Devoted CHOICE GIVEBACK Austin (PPO) plan. You will have no copay for days 1-20, and a $214 copay per day for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services are not covered by the Devoted CHOICE GIVEBACK Austin (PPO) plan, including acupuncture, over-the-counter items, meal benefits, Dual Eligible SNPs with Highly Integrated Services, 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. Some services, such as "Other 2" are covered, but it is unclear what the cost of the service is.
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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.
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