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DEVOTED CHOICE GIVEBACK 002 LA (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CHOICE GIVEBACK 002 LA (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 LA (PPO) in 2026, please refer to our full plan details page.
DEVOTED CHOICE GIVEBACK 002 LA (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Greater Baton Rouge. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED CHOICE GIVEBACK 002 LA (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 LA (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 LA (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 $184.70. 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 $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 LA (PPO) Medicare plan features an annual drug deductible of $605. For prescription drug coverage, Tier 1 preferred generics are highly affordable with no copay for one-, two-, or three-month supplies at standard pharmacies and mail-order services. Tier 2 generic drugs have low copays starting at $3 for a one-month supply, reaching up to $9 at standard pharmacies or $7.50 through standard mail order for a three-month supply. For brand-name and specialty medications, costs are based on coinsurance percentages rather than flat copays. Tier 3 preferred brand drugs require a 21% coinsurance for standard pharmacy and mail-order fills. Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance, with specialty drugs limited to a one-month supply.
Additional Benefits
The DEVOTED CHOICE GIVEBACK 002 LA (PPO) plan offers comprehensive coverage for core medical needs, featuring no copay for primary care physician visits, preventive services, and home health care. Specialist visits require a $55 copay, while emergency room visits carry a $115 copay that is waived upon hospital admission. For inpatient hospital stays, members pay a $475 daily copay for days one through four, followed by no copay for days five through 90. Supplemental benefits include routine vision exams with a copay up to $20 and no copay for eyewear up to a $200 yearly limit. Dental care is covered with no copay up to a $250 annual limit, and members receive a $92 credit every three months for over-the-counter items with no copay. Additionally, durable medical equipment is covered with a 15% coinsurance and no copay, and routine hearing exams are available for a $55 copay.
Inpatient Hospital See details
DEVOTED CHOICE GIVEBACK 002 LA (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $475 copay per day for days 1 through 4 and no copay for days 5 through 90. Prior authorization is required, and this benefit is partially covered as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by DEVOTED CHOICE GIVEBACK 002 LA (PPO) with no coinsurance, though prior authorization is required for most benefits. There is no copay for ambulatory surgical center and blood services, while outpatient hospital services range from no copay to a $475 copay, observation services carry a $475 copay per stay, and outpatient substance abuse sessions require a $50 copay.
Partial Hospitalization See details
DEVOTED CHOICE GIVEBACK 002 LA (PPO) covers partial hospitalization services with a $70.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
DEVOTED CHOICE GIVEBACK 002 LA (PPO) covers ground ambulance services with a copay ranging from no copay to $315 and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Prior authorization is required for ambulance services, and while some transportation services are covered, transportation to plan-approved or any other health-related locations is not covered.
Emergency Services See details
Emergency services under the DEVOTED CHOICE GIVEBACK 002 LA (PPO) are covered 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 up to a $40 copay with no coinsurance, while worldwide emergency services are covered up to $25,000 and carry a $115 copay for emergency or urgent care, and a $315 copay plus 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED CHOICE GIVEBACK 002 LA (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits require a $55 copay and no coinsurance. Additional services like occupational therapy, physical therapy, and mental health sessions have copays ranging from $35 to $55 with no coinsurance, though chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by DEVOTED CHOICE GIVEBACK 002 LA (PPO) with no copay and no coinsurance for covered benefits such as annual physical exams, fitness programs, and nutritional counseling. However, several supplemental services are not covered, including in-home safety assessments, personal emergency response systems, and therapeutic massages.
Hearing Services See details
DEVOTED CHOICE GIVEBACK 002 LA (PPO) offers partially covered hearing services, featuring routine hearing exams for a $55 copay and no coinsurance. Up to two prescription hearing aids are covered per year with a copay between $599 and $899 and no coinsurance, but OTC hearing aids as well as inner-ear, outer-ear, and over-the-ear prescription models are not covered.
Vision Services See details
DEVOTED CHOICE GIVEBACK 002 LA (PPO) provides partially covered vision services with no deductible, featuring one annual routine eye exam with a $0 to $20 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 combined yearly maximum for contacts, lenses, frames, and upgrades.
Dental Services See details
DEVOTED CHOICE GIVEBACK 002 LA (PPO) partially covers dental services, offering Medicare-covered dental care for a $55 copay and no coinsurance, and other covered dental services with no copay and no coinsurance up to a $250 annual limit. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED CHOICE GIVEBACK 002 LA (PPO) covers Home Infusion bundled Services with no copay, although prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, carry coinsurance ranging from no coinsurance to 20%, with insulin drugs also having a $35 copay.
Dialysis Services See details
DEVOTED CHOICE GIVEBACK 002 LA (PPO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Medical Equipment is covered by DEVOTED CHOICE GIVEBACK 002 LA (PPO) with no copays, though prior authorization is required and coinsurance rates apply. Durable medical equipment requires a 15% coinsurance, prosthetics and medical supplies range from no coinsurance to 20% coinsurance, and diabetic supplies range from no coinsurance to 15% coinsurance, while diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED CHOICE GIVEBACK 002 LA (PPO) covers diagnostic and radiological services with prior authorization, offering diagnostic services with no coinsurance, no copay for lab services, and a $0 to $95 copay for diagnostic tests. Diagnostic radiological services and outpatient x-rays have no copay, though x-rays require coinsurance and therapeutic radiological services carry a 20% coinsurance.
Home Health Services See details
DEVOTED CHOICE GIVEBACK 002 LA (PPO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by DEVOTED CHOICE GIVEBACK 002 LA (PPO) with no coinsurance, although prior authorization is required. While some services are covered, specific options are not covered in practice, including standard cardiac rehabilitation ($30 copay), intensive cardiac rehabilitation ($30 copay), pulmonary rehabilitation ($25 copay), and supervised exercise therapy for peripheral artery disease ($20 copay).
Skilled Nursing Facility (SNF) See details
DEVOTED CHOICE GIVEBACK 002 LA (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 inpatient hospital stay is not required, and additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
Other services are partially covered by DEVOTED CHOICE GIVEBACK 002 LA (PPO), featuring no copay and no coinsurance for additional preventive services and over-the-counter (OTC) items up to a $92 limit every three months. However, acupuncture and meal benefits are not covered.
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