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Devoted CHOICE GIVEBACK Mississippi (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Devoted CHOICE GIVEBACK Mississippi (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 Mississippi (PPO) in 2025, please refer to our full plan details page.
Devoted CHOICE GIVEBACK Mississippi (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 2025.
It's important to know that Devoted CHOICE GIVEBACK Mississippi (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 Mississippi (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 Mississippi (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 $117.70. 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 $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 $14000.00 (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 $14000.00 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 Mississippi (PPO) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy. For example, in the initial coverage phase, you will pay a $10 copay for a preferred generic drug at a standard or mail order pharmacy. You will pay 25% coinsurance for standard generic, preferred brand, and non-preferred drugs. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Devoted CHOICE GIVEBACK Mississippi (PPO) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays. This plan provides coverage for primary care, specialist visits, mental health, and other therapies, often with copays ranging from $0 to $45. Additional benefits include hearing, vision, and dental services, with copays and annual maximums. The plan also covers home health, skilled nursing facility stays, and various diagnostic and radiological services. However, certain services like cardiac rehabilitation, additional hours of care, and some other services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered. For days 1-4 of an inpatient hospital stay, the copay is $375, and for days 5-90, there is no copay.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay between $0 and $475, Observation Services have a $475 copay, Ambulatory Surgical Center (ASC) Services have no copay, and both Individual and Group Sessions for Outpatient Substance Abuse have a $45 copay. Outpatient Blood Services also include an enhanced benefit where the three-pint deductible is waived.
Partial Hospitalization See details
Partial Hospitalization is covered by the Devoted CHOICE GIVEBACK Mississippi (PPO) plan, with a $70 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance services are covered, with prior authorization required. 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, Urgently Needed Services, and Worldwide Emergency Services are covered by the Devoted CHOICE GIVEBACK Mississippi (PPO) plan. Emergency Services has a $110 copay, Urgently Needed Services has a copay between $0 and $45, and Worldwide Emergency Services have varying costs including a $110 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a $350 copay with 20% coinsurance for Worldwide Emergency Transportation.
Primary Care See details
The Devoted CHOICE GIVEBACK Mississippi (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, and specialist services with a $45 copay. Mental health specialty services, including individual and group sessions, have a $45 copay, while other health care professionals have a copay ranging from $0 to $45. Physical therapy and speech-language pathology services have a copay between $45 and $50, and Opioid Treatment Program Services have a $45 copay. Additional telehealth benefits are covered with a copay from $0 to $45. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Devoted CHOICE GIVEBACK Mississippi (PPO) plan covers preventive services, including annual physical exams, health education, weight management programs, alternative therapies, nutritional/dietary benefits, fitness benefits, home and bathroom safety devices and modifications, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. However, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission 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 services include routine hearing exams with a $45 copay, and fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered with a copay between $599 and $899, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams for a $20 copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are covered, with a combined maximum plan benefit of $250 every year.
Dental Services See details
The Devoted CHOICE GIVEBACK Mississippi (PPO) plan covers dental services, including Medicare dental services with a $45 copay, and other dental services with a $250 maximum benefit per year. Oral exams, dental X-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered. 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.
Dialysis Services See details
Dialysis Services are covered by the Devoted CHOICE GIVEBACK Mississippi (PPO) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and no copay, though Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 0-20% coinsurance and no copay, while Medical Supplies have a 20% coinsurance and no copay. 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 all diagnostic services, diagnostic procedures/tests, lab services, all radiological services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services. Diagnostic procedures/tests have a copay between $0 and $95, while lab services have no copay. Diagnostic radiological services have a copay of up to $300, and therapeutic radiological services have a 20% coinsurance, while outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered by the Devoted CHOICE GIVEBACK Mississippi (PPO) plan with no copay and no coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Devoted CHOICE GIVEBACK Mississippi (PPO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Devoted CHOICE GIVEBACK Mississippi (PPO) plan, but require prior authorization. For days 1-20 and 61-100, there is no copay, while for days 21-60, there is a $214 copay.
Other Services See details
Other Services are not covered by the Devoted CHOICE GIVEBACK Mississippi (PPO) plan.
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