A non-government entity
DEVOTED CHOICE GIVEBACK 006 LA (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CHOICE GIVEBACK 006 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 006 LA (PPO) in 2026, please refer to our full plan details page.
DEVOTED CHOICE GIVEBACK 006 LA (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Greater New Orleans. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED CHOICE GIVEBACK 006 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 006 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 006 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:
Sign up for DEVOTED CHOICE GIVEBACK 006 LA (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The DEVOTED CHOICE GIVEBACK 006 LA (PPO) plan has an annual prescription drug deductible of $605. Tier 1 preferred generic drugs feature no copay for one-, two-, or three-month supplies at standard pharmacies and standard mail order. Tier 2 generic drugs require a low copay, starting at $3.00 for a one-month supply at standard pharmacies and standard mail order. For higher-tier medications, your costs are determined by coinsurance. Tier 3 preferred brand drugs require a 21% coinsurance for all supply durations at standard pharmacies and standard mail order. Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance, with Tier 5 coverage limited to a one-month supply.
Additional Benefits
The DEVOTED CHOICE GIVEBACK 006 LA (PPO) plan offers affordable healthcare coverage with no copay for primary care visits, annual physicals, or preventive services, while specialist visits require a $50 to $55 copay. For hospital care, inpatient stays require a $450 daily copay for days one through four and no copay for days five through ninety, while outpatient hospital services range from no copay to a $450 copay. Emergency services carry a $115 copay, which is waived upon hospital admission, and urgent care visits range from no copay to a $40 copay. Supplemental benefits include dental and vision coverage, featuring no copay for preventive dental services up to a $250 annual limit and no copay to a $20 copay for routine eye exams, plus a $200 annual eyewear allowance. Hearing services are also covered, with a $55 copay for routine exams and a $599 to $899 copay for prescription hearing aids. Additionally, members can access home health services with no copay and receive a $92 quarterly allowance with no copay for over-the-counter health items.
Inpatient Hospital See details
DEVOTED CHOICE GIVEBACK 006 LA (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $450 daily copay for days 1 through 4 and no copay for days 5 through 90. The benefit is partially covered because unlimited additional acute days are included, whereas upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED CHOICE GIVEBACK 006 LA (PPO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay ranging from no copay to $450, while individual and group outpatient substance abuse sessions have a $50 copay.
Partial Hospitalization See details
Partial hospitalization is covered by DEVOTED CHOICE GIVEBACK 006 LA (PPO) with a $70.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
DEVOTED CHOICE GIVEBACK 006 LA (PPO) covers ground ambulance services with a copay of no copay to $300 plus coinsurance, and air ambulance services with a 20% coinsurance plus a copay, with prior authorization required. Transportation services are not covered under this plan.
Emergency Services See details
DEVOTED CHOICE GIVEBACK 006 LA (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgent care with no copay to a $40 copay and no coinsurance. Worldwide emergency and urgent services are covered up to a $25,000 limit with a $115 copay and no coinsurance, while worldwide emergency transportation has a $300 copay and 20% coinsurance.
Primary Care See details
DEVOTED CHOICE GIVEBACK 006 LA (PPO) covers primary care physician visits with no copay and no coinsurance, and telehealth benefits with a $0 to $55 copay and no coinsurance. Other covered services feature no coinsurance and require copays, including $35 for occupational therapy, $50 to $55 for specialists, $50 for mental health, psychiatric, and opioid treatment, and $55 for physical and speech therapy, while podiatry is not covered, and though some chiropractic services are covered, routine and other chiropractic services are not.
Preventive Services See details
DEVOTED CHOICE GIVEBACK 006 LA (PPO) preventive services are covered with no copay and no coinsurance, including annual physical exams, fitness benefits, and kidney disease education. This benefit is partially covered, as sub-services such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, and therapeutic massages are not covered.
Hearing Services See details
Hearing services are covered by DEVOTED CHOICE GIVEBACK 006 LA (PPO), including routine exams for a $55 copay and no coinsurance, and unlimited fitting evaluations. Prescription hearing aids are partially covered with a copay of $599 to $899 and no coinsurance for up to two aids per year, though OTC hearing aids and inner ear, outer ear, and over-the-ear prescription aids are not covered.
Vision Services See details
DEVOTED CHOICE GIVEBACK 006 LA (PPO) provides partially covered vision services, featuring one annual routine eye exam with a $0 to $20 copay and no coinsurance, while other eye exams are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, up to a $200 annual maximum benefit for contacts, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered by DEVOTED CHOICE GIVEBACK 006 LA (PPO), featuring a $50 copay and no coinsurance for Medicare-covered dental care. Other dental benefits, including preventive and most comprehensive services, offer no copay and no coinsurance up to a $250 annual maximum for both in- and out-of-network services, though maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED CHOICE GIVEBACK 006 LA (PPO) covers Home Infusion bundled services with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy and other Part B drugs have no copay and a coinsurance ranging from no coinsurance to 20%, while Part B insulin has a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered by DEVOTED CHOICE GIVEBACK 006 LA (PPO) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
DEVOTED CHOICE GIVEBACK 006 LA (PPO) covers medical equipment with no copays and coinsurance ranging from 0% to 20%, though prior authorization is required. This benefit is partially covered because diabetic therapeutic shoes and inserts are not covered under this plan.
Diagnostic and Radiological Services See details
DEVOTED CHOICE GIVEBACK 006 LA (PPO) covers diagnostic services with no coinsurance, offering no copay for lab services and copays from $0 to $95 for diagnostic tests. Radiological services are also covered, featuring no copay for outpatient X-rays, a $0 minimum copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered under the DEVOTED CHOICE GIVEBACK 006 LA (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered under DEVOTED CHOICE GIVEBACK 006 LA (PPO) with no coinsurance, although prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by DEVOTED CHOICE GIVEBACK 006 LA (PPO) with no coinsurance, requiring no prior three-day hospital stay but requiring prior authorization. There is no copay for days 1 through 20, a $218 copay for days 21 through 100, and additional days beyond standard Medicare-covered services are not covered.
Other Services See details
Other Services are partially covered by DEVOTED CHOICE GIVEBACK 006 LA (PPO), excluding acupuncture and meal benefits. Covered benefits include additional preventive services and over-the-counter (OTC) items up to $92 every three months, both of which feature no copay and no coinsurance.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved