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Devoted CHOICE GIVEBACK Alabama (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Devoted CHOICE GIVEBACK Alabama (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 Alabama (PPO) in 2025, please refer to our full plan details page.
Devoted CHOICE GIVEBACK Alabama (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 2.5 out of 5 stars in 2025.
It's important to know that Devoted CHOICE GIVEBACK Alabama (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 Alabama (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 Alabama (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 $137.60. 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 $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 Alabama (PPO) plan has an enhanced alternative drug benefit. The plan has a deductible of $590.00. Once you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you pay a $5 copay for preferred generic drugs at a standard or mail order pharmacy. You will pay 25% coinsurance for standard generic, preferred brand, and non-preferred drugs at a standard or mail order pharmacy. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Devoted CHOICE GIVEBACK Alabama (PPO) plan offers a variety of health benefits with varying costs. This plan covers inpatient hospital stays, outpatient services, and emergency services. You can also expect coverage for primary care, preventive services, hearing, vision, dental, and home infusion services. Other benefits include ambulance services, partial hospitalization, and skilled nursing facilities. The plan also covers dialysis services, medical equipment, and diagnostic services. While some services have no copay, others have copays ranging from $15 to $425, and some services require coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For days 1-4, the copay is $325, and for days 5-90, there is no copay. Additional days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services with a copay between $0 and $425, and observation services with a copay of $425. Ambulatory surgical center services have no copay. Outpatient substance abuse services have a copay of $45 for both individual and group sessions. Outpatient blood services are covered with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered under the Devoted CHOICE GIVEBACK Alabama (PPO) plan, with a $70 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. 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, Urgently Needed Services, and Worldwide Emergency Services are covered by the Devoted CHOICE GIVEBACK Alabama (PPO) plan. Emergency Services have a $110 copay and no coinsurance, and Urgently Needed Services have a copay between $0 and $45 with no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $110 copay with no coinsurance, while Worldwide Emergency Transportation has a $350 copay and 20% coinsurance.
Primary Care See details
The Devoted CHOICE GIVEBACK Alabama (PPO) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, physician specialist services with a $50 copay, and mental health and psychiatric services with a $45 copay for individual and group sessions. This plan also covers physical therapy and speech-language pathology services with a $50 copay, additional telehealth benefits with a $0-$50 copay, and opioid treatment program services with a $45 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services include coverage for Medicare-covered services, annual physical exams, 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 a Welcome Visit. 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 services include hearing exams with a $50 copay, fitting/evaluation for hearing aids, and prescription hearing aids with a copay between $599 and $899 per year for all types. 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
Vision Services includes coverage for eye exams with a $20 copay. Eyewear benefits include a combined maximum of $250 every year for both in-network and out-of-network services.
Dental Services See details
Dental Services includes coverage for Medicare Dental Services with a $50 copay, and other dental services with a $250 annual maximum. 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. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and 20% coinsurance; for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Devoted CHOICE GIVEBACK Alabama (PPO) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 20% coinsurance, and Prosthetics/Medical Supplies with 20% coinsurance for Medicare-covered items, but Durable Medical Equipment for use outside the home is not covered. Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
The Devoted CHOICE GIVEBACK Alabama (PPO) plan covers Diagnostic and Radiological Services, including Diagnostic Procedures/Tests with a copay between $0 and $95, Lab Services with no copay, and Outpatient X-Ray Services with no copay. Diagnostic Radiological Services have a copay of at most $300, while Therapeutic Radiological Services have a coinsurance of at least 20%.
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. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Devoted CHOICE GIVEBACK Alabama (PPO) plan. Specifically, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Devoted CHOICE GIVEBACK Alabama (PPO) plan, but require prior authorization. There is no copay for days 1-20 and days 61-100, but there is a $214 copay for days 21-60. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services are not covered, including acupuncture, over-the-counter items, meal benefit, 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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