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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 Escambia, Santa Rosa Counties. 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 a $590 deductible for prescription drugs. After you meet the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you'll pay a $5 copay for preferred generic drugs at a standard or mail-order pharmacy. For standard generic, preferred brand, and non-preferred drugs, you'll pay 25% coinsurance. Once your total drug costs reach $2000, you will enter the catastrophic coverage phase, where you will pay nothing for your drugs.
Additional Benefits
The Devoted CHOICE GIVEBACK Florida (PPO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a $450 copay for the first four days, and then no copay for the remainder of the stay, with outpatient services having a copay between $0 and $550 depending on the service. Emergency services have a $110 copay, while primary care visits are covered with no copay, but specialist visits have a $45 copay. The plan provides coverage for preventive, hearing, vision, and dental services, with copays ranging from $15 to $45 for exams. Hearing aids are covered with a copay up to $299, and vision has a $1000 annual maximum for eyewear. Additionally, the plan covers ambulance, home infusion, dialysis, and medical equipment with varying copays and coinsurance, and skilled nursing facility stays have no copay for the majority of the stay.
Inpatient Hospital See details
The Devoted CHOICE GIVEBACK Florida (PPO) plan covers inpatient hospital stays, including services not usually covered by Medicare, with a $450 copay for days 1-4, and no copay for days 5-90. Additional days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Inpatient Hospital Psychiatric benefits are also covered, with a $450 copay for days 1-4, and no copay for days 5-90, but Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for 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 $550, observation services have a $450 copay, and ambulatory surgical center services have no copay. Individual and group sessions for outpatient substance abuse have a copay of $45. Outpatient blood services have a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Devoted CHOICE GIVEBACK Florida (PPO) plan with a copay of $80.00. Prior authorization is required for this benefit.
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. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services for the Devoted CHOICE GIVEBACK Florida (PPO) plan include a $110 copay, while Urgently Needed Services have a copay of $0-$45. Worldwide Emergency Services have a $110 copay for Worldwide Emergency and Urgent Coverage and a $350 copay with 20% coinsurance for Worldwide Emergency Transportation.
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, physician specialist services with a $45 copay, mental health specialty services with a $45 copay for individual and group sessions, other health care professional services with a copay between $0 and $45, psychiatric services with a $45 copay for individual and group sessions, physical therapy and speech-language pathology services with a $45 to $50 copay, additional telehealth benefits with a copay between $0 and $45, and opioid treatment program services with a $45 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Devoted CHOICE GIVEBACK Florida (PPO) plan covers preventive services, including annual physical exams and additional preventive services like health education, weight management programs, alternative therapies, nutritional/dietary benefits, fitness benefits, home and bathroom safety devices, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. However, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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, and routine hearing exams are covered once per year. Fitting/evaluation for hearing aids are covered, and prescription hearing aids (all types) are covered with a copay between $0 and $299 for 2 per year, while prescription hearing aids - 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 eye exams with a $45 copay, and eyewear. Eyewear has a combined maximum benefit of $1000 every year for both in-network and out-of-network services.
Dental Services See details
The Devoted CHOICE GIVEBACK Florida (PPO) plan covers Medicare Dental Services with a $45 copay, and covers other dental services including oral exams, dental x-rays, and more with a $1,000 annual maximum. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with a $35 copay for Medicare Part B Insulin Drugs and 20% coinsurance for all other services. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Devoted CHOICE GIVEBACK Florida (PPO) plan. The coinsurance for this benefit is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 17% coinsurance, Prosthetic Devices with 0-20% coinsurance, and Medical Supplies with 20% coinsurance, but Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. There is no copay for any of these services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $95. Lab Services have no copay, while Therapeutic Radiological Services have 20% coinsurance. Diagnostic Radiological Services have a copay of at most $300, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but none of the sub-services are covered, so this benefit is not covered. There is a copay for the services that are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Devoted CHOICE GIVEBACK Florida (PPO) plan, but require prior authorization. For days 1-20 and 61-100, there is no copay, while for days 21-60, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services are not covered, including acupuncture, over-the-counter items, meal benefits, 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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