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DEVOTED CHOICE GIVEBACK 002 AR (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CHOICE GIVEBACK 002 AR (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 AR (PPO) in 2026, please refer to our full plan details page.
DEVOTED CHOICE GIVEBACK 002 AR (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Arkansas. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED CHOICE GIVEBACK 002 AR (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 AR (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 AR (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 $164.50. 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 002 AR (PPO) plan features an Enhanced Alternative drug benefit with an annual prescription drug deductible of $605.00. After meeting this deductible, you will pay a $3.00 copay for Tier 1 preferred generic drugs at standard pharmacies or through standard mail. For higher tiers, you will pay a 21% coinsurance for Tier 2 standard generics, and a 25% coinsurance for both Tier 3 preferred brands and Tier 4 non-preferred drugs. These initial coverage rates apply until your total drug costs reach $2,100.00, after which you enter the catastrophic coverage phase and have no copay for covered Part D drugs. Additionally, individuals who qualify for the low-income subsidy will benefit from a premium and cost-sharing reduction resulting in no copay.
Additional Benefits
The DEVOTED CHOICE GIVEBACK 002 AR (PPO) plan offers comprehensive health coverage with predictable out-of-pocket costs for essential medical services. Members pay no copay for preventive care, annual physicals, and fitness benefits, while primary care visits range from no copay up to a $50 copay. For hospital care, inpatient stays require a $475 daily copay for the first four days and no copay for days 5 through 90. This plan also includes key supplemental benefits, such as routine vision exams with copays up to $45 and up to $200 yearly for eyewear with no copay. Dental services feature no copay for basic care up to a $250 annual limit, while prescription hearing aids are covered with copays between $599 and $899. Additionally, durable medical equipment and dialysis services require a 20% coinsurance.
Inpatient Hospital See details
DEVOTED CHOICE GIVEBACK 002 AR (PPO) partially covers inpatient hospital services, requiring a $475 daily copayment for days 1 through 4 and no copay for days 5 through 90, with no coinsurance. Non-Medicare-covered stays, room upgrades, and additional days for psychiatric care are not covered.
Outpatient Services See details
Outpatient services are covered by DEVOTED CHOICE GIVEBACK 002 AR (PPO) with no coinsurance. Patients will pay no copay for ambulatory surgical center services, a $45 copay for outpatient substance abuse sessions, a $475 copay per stay for observation services, and a copay ranging from $0 to $575 for outpatient hospital services.
Partial Hospitalization See details
DEVOTED CHOICE GIVEBACK 002 AR (PPO) covers partial hospitalization services with a $70 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
DEVOTED CHOICE GIVEBACK 002 AR (PPO) partially covers ambulance and transportation services, as transportation services to health-related locations are not covered. Ground ambulance services require a copay of $0 to $350 and no coinsurance, while air ambulance services require a 20% coinsurance and no copay.
Emergency Services See details
DEVOTED CHOICE GIVEBACK 002 AR (PPO) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with no copay to a $40 copay and no coinsurance. Worldwide emergency services are covered up to $25,000, with a $115 copay for emergency and urgent care, and a $350 copay paired with 20% coinsurance for emergency transportation.
Primary Care See details
Primary Care benefits are partially covered by DEVOTED CHOICE GIVEBACK 002 AR (PPO), as podiatry services and routine chiropractic care are not covered. Covered services require copays ranging from no copay up to $50, with no coinsurance.
Preventive Services See details
DEVOTED CHOICE GIVEBACK 002 AR (PPO) covers preventive services with no copay and no coinsurance, including annual physicals, fitness benefits, and glaucoma screenings. This benefit is partially covered, as sub-services such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, therapeutic massage, and caregiver support are not covered.
Hearing Services See details
Hearing services are partially covered by DEVOTED CHOICE GIVEBACK 002 AR (PPO), which offers routine hearing exams for a $45 copay and no coinsurance. Prescription hearing aids are covered with a copay ranging from $599 to $899 and no coinsurance, but OTC hearing aids as well as inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by DEVOTED CHOICE GIVEBACK 002 AR (PPO), which offers annual routine eye exams with a copay ranging from $0 to $45 and no coinsurance. The plan also covers eyewear, including contacts and glasses, with no copay, no coinsurance, and no deductible up to a $200 yearly limit.
Dental Services See details
DEVOTED CHOICE GIVEBACK 002 AR (PPO) covers Medicare dental services with a $45 copay and no coinsurance, subject to prior authorization. Other dental services are partially covered with no copay or coinsurance up to a $250 annual maximum, though maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED CHOICE GIVEBACK 002 AR (PPO) covers Home Infusion bundled Services with prior authorization. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by DEVOTED CHOICE GIVEBACK 002 AR (PPO) with a 20% coinsurance and no copay. Prior authorization is required to receive these services.
Medical Equipment See details
Medical Equipment is partially covered by DEVOTED CHOICE GIVEBACK 002 AR (PPO) with no copay for all covered services. Members pay a 20% coinsurance for durable medical equipment, and between no coinsurance and 20% coinsurance for prosthetic devices, medical supplies, and diabetic supplies, while diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED CHOICE GIVEBACK 002 AR (PPO) with no copay for lab services and outpatient X-rays. Prior authorization is required for other services, which feature a $0 to $95 copay for diagnostic procedures, a copay of up to $300 for diagnostic radiology, and a 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home health services are covered under the DEVOTED CHOICE GIVEBACK 002 AR (PPO) plan, though prior authorization is required to receive these benefits.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by the DEVOTED CHOICE GIVEBACK 002 AR (PPO) plan, and while some services are covered, the plan does not cover cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services in practice. Since these specific services are not covered, there are no copays or coinsurance costs for members.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by DEVOTED CHOICE GIVEBACK 002 AR (PPO), requiring prior authorization and featuring no coinsurance. There is no copay for days 1 through 20, a $218 copay for days 21 through 100, and additional days beyond Medicare-covered SNF services are not covered.
Other Services See details
DEVOTED CHOICE GIVEBACK 002 AR (PPO) provides partial coverage for Other Services, which includes additional preventive services not covered by Medicare with no maximum plan benefit limit. Acupuncture, over-the-counter (OTC) items, meal benefits, and dual eligible SNPs are not covered, and specific copay or coinsurance details are not specified for the covered services.
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