A non-government entity
Devoted Health
Plan ID: H5334-8-0
DEVOTED CHOICE GIVEBACK 008 NY (PPO)
2027 DEVOTED CHOICE GIVEBACK 008 NY (PPO) H5334 — 008 — 0 is a Medicare Advantage plan with drug coverage.
Learn more about DEVOTED CHOICE GIVEBACK 008 NY (PPO) H5334 - 008 - 0, including the health and drug services it covers, by reading our easy-to-use guide. Or contact a licensed insurance agent for help now.
$0.00 /mo
Monthly premium
$50.00
Health deductible
$650.00
Drug deductible
$9850.00 / $14800.00
Out-of-pocket maximum (In-Network / Combined)
Enroll online
Call to enroll
OR
Get personalized help from a licensed insurance agent
1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
Plan Overview
2027 DEVOTED CHOICE GIVEBACK 008 NY (PPO) H5334 — 008 — 0 is a PPO offered in Kings and Queens counties by Devoted Health Insurance Company of New York. It has a monthly premium of $0.00 and includes a Part B premium discount of $118.00.
Premium Breakdown
Monthly plan premium
$0.00
Standard Part B premium (estimated)
$209.50
Part B premium reduction
$118.00
Estimated net Part B premium after giveback
$91.50
Note:
CMS has not yet announced the official 2027 standard Medicare Part B premium. The estimated 2027 premium is $209.50, per the 2026 Medicare Trustees Report; we'll update this page when CMS publishes the final amount. Your actual Part B premium may differ based on income (IRMAA), late enrollment penalties, Medicaid assistance, disability status, or other factors. Most people enrolled in Medicare Part B are required to pay this premium.
Special needs plan type
No
Out-of-pocket maximum (In-Network)
$9850.00
Out-of-pocket maximum (Out-of-Network)
Not applicable
Out-of-pocket maximum (Combined)
$14800.00
Plan Organization:
Devoted Health Insurance Company of New York
Parent Company:
Devoted Health, Inc.
Plan Type:
PPO
Location:
Kings and Queens counties
Drugs Covered:
Yes
Drug Formulary:
Pharmacies:
Doctors Link:
Deductibles
The amount you must pay each year before your plan starts to pay for covered services or drugs.
Health deductible
$50.00
Drug deductible
$650
Note:
This plan does not charge an annual deductible for all drugs. The $650.00 annual deductible only applies to drugs in certain tiers.
Sign up for DEVOTED CHOICE GIVEBACK 008 NY (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
Drug Coverage
DEVOTED CHOICE GIVEBACK 008 NY (PPO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
Drug Benefit Type
Enhanced Alternative
Prescription drug deductible
$650.00
Part D Premium Reduction
This plan's premium may be reduced for you if you qualify for the low-income subsidy (also known as LIS or "Extra help"). The following is what you'll pay for with LIS.
Part D | LIS Full |
|---|---|
$0.00 | $0.00 |
Initial Coverage Phase
After you meet any applicable drug deductible ($650.00 for this plan), you pay the plan's cost sharing until your out-of-pocket costs for covered Part D drugs, including certain payments made on your behalf, reach $2,400 in 2027. You then enter catastrophic coverage and pay nothing for covered Part D drugs for the rest of the calendar year.
Tier | Preferred Pharmacy | Standard Pharmacy | Preferred Mail | Standard Mail |
|---|---|---|---|---|
1. Preferred Generic | - | $0.00 copay | - | $0.00 copay |
2. Generic | - | $5.00 copay | - | $5.00 copay |
3. Preferred Brand | - | 25% coinsurance | - | 25% coinsurance |
4. Non-Preferred Drug | - | 25% coinsurance | - | 25% coinsurance |
5. Specialty Tier | - | 26% coinsurance | - | 26% coinsurance |
Catastrophic Coverage Phase
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2,400, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
DEVOTED CHOICE GIVEBACK 008 NY (PPO) also provides the following benefits.
Inpatient Hospital
Inpatient Hospital benefits are covered.
Inpatient Hospital-Acute
Inpatient Hospital-Acute benefits are covered.
| Days 1-5: | Days 6-90: | |
|---|---|---|
| Copayment | 490.00 | 0.00 |
More Details:
Copayment for Medicare-covered stay
0.00
Additional Days for Inpatient Hospital-Acute
Not covered.
Non-Medicare-covered Stay for Inpatient Hospital-Acute
Not covered.
Upgrades for Inpatient Hospital-Acute
Not covered.
Inpatient Hospital Psychiatric
Inpatient Hospital Psychiatric benefits are covered.
| Days 1-4: | Days 5-90: | |
|---|---|---|
| Copayment | 490.00 | 0.00 |
More Details:
Copayment for Medicare-covered stay
0.00
Additional Days for Inpatient Hospital Psychiatric
Not covered.
Non-Medicare-covered Stay for Inpatient Hospital Psychiatric
Not covered.
Outpatient Services
Outpatient Services benefits are covered.
All Outpatient Hospital Services
All Outpatient Hospital Services benefits are covered.
Outpatient Hospital Services
Outpatient Hospital Services benefits are covered.
Cost Sharing:
Observation Services
Observation Services benefits are covered.
Cost Sharing:
Ambulatory Surgical Center (ASC) Services
Ambulatory Surgical Center (ASC) Services benefits are covered.
Cost Sharing:
Outpatient Substance Abuse Services
Not covered.
Individual Sessions for Outpatient Substance Abuse
Individual Sessions for Outpatient Substance Abuse benefits are covered.
More Details:
Minimum copayment
50.00
Maximum copayment
50.00
Group Sessions for Outpatient Substance Abuse
Group Sessions for Outpatient Substance Abuse benefits are covered.
More Details:
Minimum copayment
50.00
Maximum copayment
50.00
Outpatient Blood Services
Not covered.
Partial Hospitalization
Partial Hospitalization benefits are covered.
Partial Hospitalization
Partial Hospitalization benefits are covered.
Cost Sharing:
Partial Hospitalization
Partial Hospitalization benefits are covered.
Cost Sharing:
Ambulance and Transportation Services
Ambulance and Transportation Services benefits are covered.
All Ambulance Services
All Ambulance Services benefits are covered.
Ground Ambulance Services
Ground Ambulance Services benefits are covered.
Cost Sharing:
Air Ambulance Services
Air Ambulance Services benefits are covered.
Cost Sharing:
Transportation Services
Not covered.
Transportation Services - Plan Approved Health-related Location
Not covered.
Transportation Services - Any Health-related Location
Not covered.
Emergency Services
Emergency Services benefits are covered.
Emergency Services
Emergency Services benefits are covered.
Cost Sharing:
More Details:
Enter number of days or hours
24
Urgently Needed Services
Urgently Needed Services benefits are covered.
Cost Sharing:
Worldwide Emergency Services
Worldwide Emergency Services benefits are covered.
More Details:
Maximum amount
25000.00
Worldwide Emergency Coverage
Worldwide Emergency Coverage benefits are covered.
Cost Sharing:
Worldwide Urgent Coverage
Worldwide Urgent Coverage benefits are covered.
Cost Sharing:
Worldwide Emergency Transportation
Worldwide Emergency Transportation benefits are covered.
Cost Sharing:
Primary Care
Primary Care benefits are covered.
Primary Care Physician Services
Not covered.
Chiropractic Services
Chiropractic Services benefits are covered.
Cost Sharing:
Routine Chiropractic Care
Not covered.
Occupational Therapy Services
Occupational Therapy Services benefits are covered.
Cost Sharing:
Physician Specialist Services
Physician Specialist Services benefits are covered.
Cost Sharing:
Mental Health Specialty Services
Not covered.
Individual Sessions for Mental Health Specialty Services
Individual Sessions for Mental Health Specialty Services benefits are covered.
More Details:
Minimum copayment
50.00
Maximum copayment
50.00
Group Sessions for Mental Health Specialty Services
Group Sessions for Mental Health Specialty Services benefits are covered.
More Details:
Minimum copayment
50.00
Maximum copayment
50.00
Podiatry Services
Podiatry Services benefits are covered.
More Details:
Minimum copayment
50.00
Maximum copayment
50.00
Other Health Care Professional
Other Health Care Professional benefits are covered.
More Details:
Minimum copayment
0.00
Maximum copayment
50.00
Psychiatric Services
Not covered.
Individual Sessions for Psychiatric Services
Individual Sessions for Psychiatric Services benefits are covered.
More Details:
Minimum copayment
50.00
Maximum copayment
50.00
Group Sessions for Psychiatric Services
Group Sessions for Psychiatric Services benefits are covered.
More Details:
Minimum copayment
50.00
Maximum copayment
50.00
Physical Therapy and Speech-Language Pathology Services
Physical Therapy and Speech-Language Pathology Services benefits are covered.
Cost Sharing:
Additional Telehealth Benefits
Additional Telehealth Benefits benefits are covered.
Cost Sharing:
Opioid Treatment Program Services
Opioid Treatment Program Services benefits are covered.
More Details:
Minimum copayment
50.00
Maximum copayment
50.00
Preventive Services
Preventive Services benefits are covered.
Medicare-covered Zero Dollar Preventive Services
Medicare-covered Zero Dollar Preventive Services benefits are covered.
Annual Physical Exam
Not covered.
Additional Preventive Services
Not covered.
Health Education
Not covered.
In-Home Safety Assessment
Not covered.
Personal Emergency Response System (PERS)
Not covered.
Medical Nutrition Therapy (MNT)
Not covered.
Post discharge In-Home Medication Reconciliation
Not covered.
Re-admission Prevention
Not covered.
Wigs for Hair Loss Related to Chemotherapy
Not covered.
Weight Management Programs
Not covered.
Alternative Therapies
Not covered.
Therapeutic Massage
Not covered.
Adult Day Health Services
Not covered.
Nutritional/Dietary Benefit
Not covered.
Home-Based Palliative Care
Not covered.
In-Home Support Services
Not covered.
Support for Caregivers of Enrollees
Not covered.
Additional Sessions of Smoking and Tobacco Cessation Counseling
Not covered.
Fitness Benefit
Not covered.
Enhanced Disease Management
Not covered.
Telemonitoring Services
Not covered.
Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline)
Not covered.
Home and Bathroom Safety Devices and Modifications
Not covered.
Counseling Services
Not covered.
Kidney Disease Education Services
Not covered.
Other Preventive Services
Other Preventive Services benefits are covered.
Glaucoma Screening
Not covered.
Diabetes Self-Management Training
Not covered.
Digital Rectal Exams
Not covered.
EKG following Welcome Visit
Not covered.
Hearing Services
Hearing Services benefits are covered.
Hearing Exams
Hearing Exams benefits are covered.
Cost Sharing:
Routine Hearing Exams
Routine Hearing Exams benefits are covered.
More Details:
Number of visits
1
Fitting/Evaluation for Hearing Aid
Not covered.
Prescription Hearing Aids
Not covered.
Prescription Hearing Aids (all types)
Prescription Hearing Aids (all types) benefits are covered.
More Details:
Quantity for Hearing Aids
2
Minimum copayment
599.00
Maximum copayment
899.00
Prescription Hearing Aids - Inner Ear
Not covered.
Prescription Hearing Aids - Outer Ear
Not covered.
Prescription Hearing Aids - Over the Ear
Not covered.
OTC Hearing Aids
Not covered.
Vision Services
Vision Services benefits are covered.
Eye Exams
Eye Exams benefits are covered.
Cost Sharing:
Routine Eye Exams
Routine Eye Exams benefits are covered.
More Details:
Number of visits
1
Eyewear
Eyewear benefits are covered.
More Details:
Combined maximum amount
400.00
Contact Lenses
Not covered.
Eyeglasses (lenses and frames)
Not covered.
Eyeglass lenses
Not covered.
Eyeglass frames
Not covered.
Upgrades
Not covered.
Dental Services
Dental Services benefits are covered.
Medicare Dental Services
Medicare Dental Services benefits are covered.
Cost Sharing:
Other Dental Services
Other Dental Services benefits are covered.
More Details:
Maximum amount
250.00
Oral Exams
Oral Exams benefits are covered.
More Details:
Number of visits
2
Description
Plan covers up to two oral exams per year.
Dental X-Rays
Dental X-Rays benefits are covered.
More Details:
Number of X-Rays
1
Description
Plan covers dental x-rays, and coverage frequency varies. For example, plan covers bitewing x-rays once per year and panoramic x-rays once every three years.
Prophylaxis (Cleaning)
Prophylaxis (Cleaning) benefits are covered.
More Details:
Number of visits
2
Description
Plan covers up to two basic cleanings per year.
Fluoride Treatment
Fluoride Treatment benefits are covered.
More Details:
Number of visits
2
Description
Plan covers up to two fluoride treatments per year.
Orthodontic Services
Not covered.
Restorative Services
Restorative Services benefits are covered.
More Details:
Number of visits
1
Description
Plan covers restorative services, such as fillings, once per surface every two years.
Adjunctive General Services
Adjunctive General Services benefits are covered.
More Details:
Number of visits
1
Description
Plan covers non-routine service such as pain treatment once per year.
Endodontics
Endodontics benefits are covered.
More Details:
Number of visits
1
Description
Plan covers endodontic services, such as root canal treatments, once per tooth per lifetime.
Periodontics
Periodontics benefits are covered.
More Details:
Number of visits
1
Description
Plan covers periodontal services, such as deep cleaning, once every three years.
Prosthodontics, removable
Prosthodontics, removable benefits are covered.
More Details:
Number of visits
1
Description
Plan covers dentures (once every five years)
Maxillofacial Prosthetics
Not covered.
Implant Services
Implant Services benefits are covered.
More Details:
Number of visits
1
Description
Plan covers implant maintenance services once every year
Prosthodontics, fixed
Prosthodontics, fixed benefits are covered.
More Details:
Number of visits
1
Description
Plan covers fixed prosthodontics, such as the fake tooth (pontic) of the bridge, every five years.
Oral and Maxillofacial Surgery
Oral and Maxillofacial Surgery benefits are covered.
More Details:
Number of visits
1
Description
Plan covers routine or surgical extractions once per tooth per lifetime.
Orthodontics
Not covered.
Home Infusion bundled Services
Not covered.
Dialysis Services
Dialysis Services benefits are covered.
More Details:
Minimum coinsurance
20
Maximum coinsurance
20
Medical Equipment
Medical Equipment benefits are covered.
Durable Medical Equipment (DME)
Durable Medical Equipment (DME) benefits are covered.
More Details:
Minimum coinsurance
15
Maximum coinsurance
15
Prosthetics/Medical Supplies - Non-Medicare benefit
Not covered.
Prosthetic Devices
Prosthetic Devices benefits are covered.
More Details:
Minimum coinsurance
0
Maximum coinsurance
15
Medical Supplies
Medical Supplies benefits are covered.
Cost Sharing:
Diabetic Equipment
Not covered.
Diabetic Supplies
Not covered.
Diabetic Therapeutic Shoes/Inserts
Not covered.
Diabetic Equipment
Diabetic Equipment benefits are covered.
More Details:
Minimum coinsurance
0
Maximum coinsurance
15
Diagnostic and Radiological Services
Diagnostic and Radiological Services benefits are covered.
All Diagnostic services
Not covered.
Diagnostic Procedures/Tests
Diagnostic Procedures/Tests benefits are covered.
More Details:
Minimum copayment
0.00
Maximum copayment
95.00
Lab Services
Lab Services benefits are covered.
Cost Sharing:
More Details:
Minimum coinsurance
20
All Radiological Services
Not covered.
Diagnostic Radiological Services
Diagnostic Radiological Services benefits are covered.
Cost Sharing:
More Details:
Minimum copayment
25.00
Therapeutic Radiological Services
Therapeutic Radiological Services benefits are covered.
Cost Sharing:
More Details:
Minimum coinsurance
20
Outpatient X-Ray Services
Outpatient X-Ray Services benefits are covered.
Cost Sharing:
Home Health Services
Not covered.
Cardiac Rehabilitation Services
Not covered.
Skilled Nursing Facility (SNF)
Skilled Nursing Facility (SNF) benefits are covered.
| Days 1-20: | Days 21-100: | |
|---|---|---|
| Copayment | 0.00 | 200.00 |
Additional Days beyond Medicare-covered for Skilled Nursing Facility (SNF)
Not covered.
Other Services
Other Services benefits are covered.
Acupuncture
Not covered.
Over-the-Counter (OTC) Items
Over-the-Counter (OTC) Items benefits are covered.
More Details:
Maximum plan benefit coverage amount
39.00
Attestation
The Nicotine Replacement Therapy (NRT) being offered does not duplicate any Part D OTC or formulary drugs.
Meal Benefit
Not covered.
Other 2
Other 2 benefits are covered.
More Details:
Service Name
Additional Preventive Services not covered by Medicare
Other 3
Other 3 benefits are covered.
More Details:
Service Name
Compression Stockings and Mastectomy Sleeves not covered by Medicare
Dual Eligible SNPs with Highly Integrated Services
Not covered.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
SMID: MULTIPLAN_HCIHNMEDADVRX27_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 or 1-800-MEDICARE 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.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
© 2026 Dog Media Solutions LLC. All rights reserved