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Devoted CHOICE GIVEBACK Florida (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Devoted CHOICE GIVEBACK Florida (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 Florida (PPO) in 2025, please refer to our full plan details page.
Devoted CHOICE GIVEBACK Florida (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Florida. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Devoted CHOICE GIVEBACK Florida (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 Florida (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 Florida (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 $174.70. 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 Florida (PPO) plan has an enhanced alternative drug benefit. The plan has a deductible of $590.00. If you qualify for the low-income subsidy, you will have no copay. During the initial coverage phase, after the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you will pay a $5.00 copay for preferred generic drugs at a standard pharmacy. After your total drug costs reach $2000.00, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Devoted CHOICE GIVEBACK Florida (PPO) plan offers a range of benefits, including coverage for inpatient and outpatient hospital services, with varying copays. Primary care visits have no copay, while specialist visits have a $45 copay. The plan also covers preventive, hearing, vision, and dental services, with specific copays and maximum benefits for each. Additional benefits include coverage for ambulance, emergency, and home health services. The plan covers home infusion services, dialysis, medical equipment, and diagnostic services. However, certain services like acupuncture, over-the-counter items, and specific types of hearing aids and medical equipment are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered with prior authorization. For days 1-4, the copay is $475, and there is no copay for days 5-90. Additional days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered stays and Upgrades are not covered.
Outpatient Services See details
Outpatient Services are covered by the Devoted CHOICE GIVEBACK Florida (PPO) plan. Outpatient Hospital Services have a copay between $0 and $475, Observation Services have a $475 copay, and Ambulatory Surgical Center (ASC) Services have no copay. Outpatient Substance Abuse Services have a $45 copay for both Individual and Group Sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Devoted CHOICE GIVEBACK Florida (PPO) plan with a $70 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Devoted CHOICE GIVEBACK Florida (PPO) plan. Ground ambulance services have a copay between $0 and $350, while air ambulance services have a 20% coinsurance; however, 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 Florida (PPO) plan. Emergency Services have a $110 copay, while Urgently Needed Services have a copay between $0 and $45. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $110 copay, while Worldwide Emergency Transportation has a $350 copay and 20% coinsurance.
Primary Care See details
The Devoted CHOICE GIVEBACK Florida (PPO) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $15 copay, Occupational Therapy Services with a $35 copay, and Physician Specialist Services with a $45 copay. The plan also covers Mental Health Specialty Services with a $45 copay for both individual and group sessions, Physical Therapy and Speech-Language Pathology Services with a $45-$50 copay, and Opioid Treatment Program Services with a $45 copay. Additionally, Other Health Care Professional services are covered with a copay that ranges from $0 to $45, and Additional Telehealth Benefits are covered with a copay between $0 and $45.
Preventive Services See details
The Devoted CHOICE GIVEBACK Florida (PPO) plan covers preventive services with no copay, including health education, weight management programs, alternative therapies, nutritional/dietary benefits, fitness benefits, home and bathroom safety devices and modifications, kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. However, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy (MNT), post-discharge in-home medication reconciliation, re-admission 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 exams are covered with a $45 copay, including routine hearing exams and fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered with a copay between $0 and $299, 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
The Devoted CHOICE GIVEBACK Florida (PPO) plan covers vision services, including routine eye exams with a $45 copay. Eyewear is covered with a combined maximum benefit of $1000 every year for both in-network and out-of-network services. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental Services includes coverage for Medicare Dental Services with a $45 copay, and other dental services with a $1,000 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. Orthodontic Services are covered under Diagnostic and Preventive Dental. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Devoted CHOICE GIVEBACK Florida (PPO) plan. For Medicare Part B Insulin Drugs, there is a $35 copay and 20% coinsurance, while other Medicare Part B Drugs and Medicare Part B Chemotherapy/Radiation Drugs have between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered by the Devoted CHOICE GIVEBACK Florida (PPO) plan, with Durable Medical Equipment (DME) subject to a 20% coinsurance and Prosthetic Devices with 0-20% coinsurance; however, Durable Medical Equipment for use outside the home, Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered. Medical Supplies have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services and radiological services. Diagnostic Procedures/Tests have a minimum copay of $0 and a maximum copay of $95, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $300, and Therapeutic Radiological Services have at most 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Devoted CHOICE GIVEBACK Florida (PPO) plan with no copay and no coinsurance, but prior authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Devoted CHOICE GIVEBACK Florida (PPO) plan, but the specific services of Medicare-covered Intensive Cardiac Rehabilitation, Medicare-covered Pulmonary Rehabilitation, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD), and Additional Cardiac Rehabilitation Services are not covered. There is a copay for the covered services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Devoted CHOICE GIVEBACK Florida (PPO) plan, with a $0 copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays are not covered.
Other Services See details
Other Services under the Devoted CHOICE GIVEBACK Florida (PPO) plan does not cover acupuncture, over-the-counter (OTC) items, or meal benefits; other services are not covered, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services.
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