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DEVOTED CHOICE GIVEBACK 006 AL (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CHOICE GIVEBACK 006 AL (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 AL (PPO) in 2026, please refer to our full plan details page.
DEVOTED CHOICE GIVEBACK 006 AL (PPO) is a PPO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in North Alabama and Greater Dothan. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that DEVOTED CHOICE GIVEBACK 006 AL (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 AL (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 AL (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 $164.00. 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 006 AL (PPO) plan offers an Enhanced Alternative drug benefit with an annual prescription drug deductible of $605.00. For individuals who qualify for Extra Help, the Part D premium may be reduced to no cost. During the initial coverage phase, you will pay a low $3.00 copay for Tier 1 preferred generic drugs at standard pharmacies and through standard mail. Other medication tiers under this plan require coinsurance, including 21% for Tier 2 standard generics and 25% for both Tier 3 preferred brands and Tier 4 non-preferred drugs. Once your out-of-pocket prescription costs reach $2,100.00 for the year, you will transition to the catastrophic coverage phase where you pay nothing for covered Part D drugs.
Additional Benefits
The DEVOTED CHOICE GIVEBACK 006 AL (PPO) plan offers comprehensive medical coverage with predictable cost-sharing, including no copay for preventive services, annual physicals, and fitness benefits. For inpatient hospital stays, members pay a $450 copay for days 1 through 4 and no copay for days 5 through 90, while emergency room visits carry a $115 copay that is waived upon admission. Outpatient services also feature low out-of-pocket costs, with no copay for ambulatory surgical center visits and copays ranging up to $550 for outpatient hospital services. This plan also includes essential routine care, featuring a $200 annual eyewear allowance and no copay to $50 copays for routine eye and hearing exams. Dental services are covered up to a $250 annual maximum alongside a $50 copay for Medicare-covered dental care, while prescription hearing aids require copays between $599 and $899. Specialist, physical therapy, and mental health visits are accessible with a $50 copay and no coinsurance, making this plan a well-rounded option for daily healthcare needs.
Inpatient Hospital See details
DEVOTED CHOICE GIVEBACK 006 AL (PPO) partially covers inpatient hospital services with a $450 copay for days 1 through 4, no copay for days 5 through 90, and no coinsurance. Prior authorization is required, and non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by DEVOTED CHOICE GIVEBACK 006 AL (PPO) with no coinsurance required across all services. Members will pay no copay for ambulatory surgical center services, a $0 to $550 copay for outpatient hospital services, a $450 copay per stay for observation services, and a $50 copay for outpatient substance abuse sessions.
Partial Hospitalization See details
DEVOTED CHOICE GIVEBACK 006 AL (PPO) covers partial hospitalization benefits with a $70.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by DEVOTED CHOICE GIVEBACK 006 AL (PPO), as transportation services to plan-approved or any health-related locations are not covered. Covered ground ambulance services require no copay to a $350 copay, while air ambulance services require a 20% coinsurance, with prior authorization required for all ambulance services.
Emergency Services See details
DEVOTED CHOICE GIVEBACK 006 AL (PPO) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services feature no coinsurance and cost between no copay and a $40 copay, while worldwide emergency coverage is capped at $25,000 with varying copays up to $350 and up to 20% coinsurance.
Primary Care See details
Primary Care benefits are partially covered by DEVOTED CHOICE GIVEBACK 006 AL (PPO) with no coinsurance, though podiatry and routine chiropractic services are not covered. Covered services require no coinsurance and feature copays ranging from no copay up to $50, including a $35 copay for occupational therapy and $50 copays for specialist, physical therapy, and mental health visits.
Preventive Services See details
DEVOTED CHOICE GIVEBACK 006 AL (PPO) covers a wide range of preventive services, including annual physicals, fitness benefits, and health education with no copay or coinsurance. However, the benefit is only partially covered, as specific services such as in-home support, therapeutic massage, and personal emergency response systems are not covered.
Hearing Services See details
DEVOTED CHOICE GIVEBACK 006 AL (PPO) partially covers hearing services, offering routine hearing exams for a $50 copay and no coinsurance, alongside unlimited fitting evaluations. Up to two prescription hearing aids are covered yearly with a copay ranging from $599 to $899 and no coinsurance, while OTC hearing aids and inner ear, outer ear, and over-the-ear prescription devices are not covered.
Vision Services See details
DEVOTED CHOICE GIVEBACK 006 AL (PPO) covers annual routine eye exams with a copay ranging from no copay to $50 and no coinsurance. Additionally, the plan provides a $200 yearly allowance for eyewear, including glasses and contacts, with no copay or coinsurance.
Dental Services See details
Dental services are covered by DEVOTED CHOICE GIVEBACK 006 AL (PPO), which includes Medicare-covered dental care with a $50 copay and no coinsurance. Other dental services are partially covered up to a $250 annual maximum for both in-network and out-of-network care, though maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by DEVOTED CHOICE GIVEBACK 006 AL (PPO), though prior authorization is required. 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 under the DEVOTED CHOICE GIVEBACK 006 AL (PPO) plan with 20% coinsurance and no copay. Prior authorization is required for these services.
Medical Equipment See details
DEVOTED CHOICE GIVEBACK 006 AL (PPO) partially covers medical equipment, with diabetic therapeutic shoes or inserts excluded from coverage. Covered items like durable medical equipment, prosthetics, and diabetic supplies require prior authorization and carry no copay, with coinsurance ranging from no coinsurance to 20%.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the DEVOTED CHOICE GIVEBACK 006 AL (PPO) plan, with prior authorization required. There is no copay for lab services and outpatient X-rays, while other diagnostic procedures carry a copay of up to $95, diagnostic radiology costs up to $300, and therapeutic radiology requires a 20% coinsurance.
Home Health Services See details
Home health services are covered by the DEVOTED CHOICE GIVEBACK 006 AL (PPO) plan, though prior authorization is required before you can receive this care.
Cardiac Rehabilitation Services See details
DEVOTED CHOICE GIVEBACK 006 AL (PPO) does not cover Cardiac Rehabilitation Services, as all sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are excluded from coverage. Consequently, there are no copays or coinsurance costs for these services under this plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by DEVOTED CHOICE GIVEBACK 006 AL (PPO), requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, with no coinsurance. Prior authorization is required, and additional days beyond the standard Medicare-covered SNF days are not covered.
Other Services See details
DEVOTED CHOICE GIVEBACK 006 AL (PPO) provides a benefit for Other Services that is partially covered, which includes coverage for additional preventive services not covered by Medicare with no maximum benefit limit. Acupuncture, over-the-counter (OTC) items, meal benefits, and dual eligible SNPs are not covered under this plan.
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