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DEVOTED CHOICE GIVEBACK 002 MS (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CHOICE GIVEBACK 002 MS (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 002 MS (PPO) in 2026, please refer to our full plan details page.
DEVOTED CHOICE GIVEBACK 002 MS (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Mississippi. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED CHOICE GIVEBACK 002 MS (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 002 MS (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 002 MS (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 $164.40. 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 002 MS (PPO) Medicare plan features an annual drug deductible of $605. For Tier 1 preferred generic drugs, there is no copay for one-month, two-month, or three-month fills at standard pharmacies and standard mail order. Tier 2 generic medications require a low copay, starting at $3.00 for a one-month supply and capping at $7.50 for a three-month standard mail order supply. Higher-tier prescription drugs are subject to coinsurance rather than flat copayments. You will pay a 21% coinsurance for Tier 3 preferred brand drugs, while Tier 4 non-preferred drugs and Tier 5 specialty medications carry a 25% coinsurance. These coinsurance rates apply to standard retail pharmacy and standard mail order options.
Additional Benefits
The DEVOTED CHOICE GIVEBACK 002 MS (PPO) plan offers affordable medical coverage with no copay and no coinsurance for primary care visits and preventive services, while specialist visits require a $45 copay. For hospital care, inpatient stays feature a $475 daily copay for the first four days followed by no copay, and emergency room visits carry a $115 copay. Outpatient hospital services range from no copay up to a $575 copay, with no coinsurance required for these services. This Medicare Advantage PPO plan also includes essential supplemental benefits, featuring routine dental and vision eyewear with no copay up to specified annual limits. Routine hearing exams require a $45 copay, while prescription hearing aids are covered with copays ranging from $599 to $899. Additionally, beneficiaries receive home health services and skilled nursing facility stays for the first 20 days with no copay or coinsurance.
Inpatient Hospital See details
DEVOTED CHOICE GIVEBACK 002 MS (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance and a $475 daily copay for days 1 through 4, followed by no copay for days 5 through 90. 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 002 MS (PPO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copay. Outpatient hospital services have a copay ranging from $0 to $575, observation services require a $475 copay per stay, and outpatient substance abuse sessions carry a $45 copay.
Partial Hospitalization See details
Partial hospitalization is covered by DEVOTED CHOICE GIVEBACK 002 MS (PPO) with a $70.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are offered by the DEVOTED CHOICE GIVEBACK 002 MS (PPO), featuring ground ambulance services with a copay ranging from no copay to $350 plus coinsurance, and air ambulance services with a 20% coinsurance and a copay. Transportation services to plan-approved or any health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered by DEVOTED CHOICE GIVEBACK 002 MS (PPO) with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services have no coinsurance and a copay ranging from no copay up to $40, while worldwide emergency services are covered up to a $25,000 maximum with a $115 copay for emergency or urgent care, and a $350 copay with 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED CHOICE GIVEBACK 002 MS (PPO) offers primary care physician services with no copay and no coinsurance, while specialist visits require a $45 copay and no coinsurance. Physical, occupational, and speech therapy services are covered with copays ranging from $35 to $50 and no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
DEVOTED CHOICE GIVEBACK 002 MS (PPO) preventive services are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, and various screenings. Additional preventive benefits are partially covered with no copay and no coinsurance, excluding in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, extra smoking cessation sessions, enhanced disease management, telemonitoring, remote access technologies, and counseling.
Hearing Services See details
Hearing services are partially covered by DEVOTED CHOICE GIVEBACK 002 MS (PPO), featuring no deductibles and no coinsurance. Routine hearing exams require a $45 copay (limited to one per year) and fitting evaluations have no copay, while up to two prescription hearing aids are covered annually with a $599 to $899 copay. OTC hearing aids and inner ear, outer ear, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered under the DEVOTED CHOICE GIVEBACK 002 MS (PPO) plan, as other eye exam services are not covered. Covered routine eye exams have a $0 to $45 copay and no coinsurance, while eyewear is covered with no copay, no coinsurance, and no deductible up to a $200 yearly limit.
Dental Services See details
Dental services are partially covered by DEVOTED CHOICE GIVEBACK 002 MS (PPO), featuring a $45 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered preventive and comprehensive services up to a $250 annual maximum. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED CHOICE GIVEBACK 002 MS (PPO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Associated Medicare Part B chemotherapy, radiation, and other drugs carry a 0% to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by DEVOTED CHOICE GIVEBACK 002 MS (PPO) with no copay and a 20% coinsurance. Prior authorization is required to receive this benefit.
Medical Equipment See details
Medical equipment is covered by DEVOTED CHOICE GIVEBACK 002 MS (PPO) with no copays, though coinsurance and prior authorization are required. Durable medical equipment carries a 20% coinsurance, prosthetics and medical supplies require no coinsurance to 20% coinsurance, and diabetic equipment is partially covered because diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED CHOICE GIVEBACK 002 MS (PPO) covers diagnostic and radiological services, with diagnostic tests and procedures carrying no coinsurance and copays ranging from $0 to $95. Lab services and outpatient X-rays feature no copay, while diagnostic radiological services have copays starting at $0 and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the DEVOTED CHOICE GIVEBACK 002 MS (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
DEVOTED CHOICE GIVEBACK 002 MS (PPO) covers some Cardiac Rehabilitation Services with no copay and no coinsurance, subject to prior authorization. However, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by DEVOTED CHOICE GIVEBACK 002 MS (PPO) with no coinsurance and prior authorization required, allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
DEVOTED CHOICE GIVEBACK 002 MS (PPO) partially covers other services, providing 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.
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