DEVOTED CHOICE GIVEBACK 006 OK (PPO) Medicare Advantage Plan H2845-006 • 2027
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $50
- Maximum Out-of-Pocket
- $9850.00In-network
- Part B Giveback
- −$160.00 reduction
- Prescription Coverage
- Enhanced, $461.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- See List
- Total Enrollment
- 585 beneficiaries
DEVOTED CHOICE GIVEBACK 006 OK (PPO) Introduction
This Medicare Advantage PPO plan, DEVOTED CHOICE GIVEBACK 006 OK, is offered by Devoted Health and uses a Preferred Provider Organization (PPO) provider network. It comes with prescription drug coverage. For the 2027 plan year, the monthly premium is $0.00, the medical deductible is $50, and the in-network maximum out-of-pocket is $9850.00. The plan is identified by CMS Plan ID H2845-006. The 2027 Part D prescription drug deductible is $461.00.
Plan Benefits
Cost-sharing for DEVOTED CHOICE GIVEBACK 006 OK includes out-of-pocket expenses for covered healthcare services. The following tables provide a summary of typical in-network out-of-pocket costs for plan H2845-006.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: $0 copay Out-of-network: $5 copay |
In-network: $0 copay Out-of-network: $5 copay |
| Specialist | In-network: $55 copay Out-of-network: $55 copay |
In-network: $55 copay Out-of-network: $55 copay |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay |
| Telehealth benefit | In-network: $0-$55 copay | In-network: $0-$55 copay |
| Routine chiropractic | Not covered | Not covered |
| Fitness benefits | Coming soon | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Health education | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Counseling services | Not covered | Not covered |
| Over-the-counter drug benefits | In-network: $0 copay Out-of-network: 90% coinsurance |
Not covered |
| Health transportation (non-emergency) | Coming soon | Not covered |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | In-network: $25-$250 copay Out-of-network: $25-$300 copay |
In-network: $0-$300 copay Out-of-network: $0-$300 copay |
| Lab services | In-network: $0-$55 copay, 20% coinsurance Out-of-network: $0-$55 copay, 20% coinsurance |
In-network: $0-$20 copay Out-of-network: $0-$20 copay, 20% coinsurance |
| Outpatient x-rays | In-network: $0-$75 copay Out-of-network: $0-$75 copay |
In-network: $0-$75 copay Out-of-network: $0-$75 copay |
| Diagnostic tests and procedures | In-network: $0-$95 copay Out-of-network: $0-$95 copay |
In-network: $0-$95 copay Out-of-network: $0-$95 copay |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | $115 copay | $115 copay |
| Worldwide emergency care | Coming soon | $115 copay |
| Urgent care | $0-$40 copay | $0-$40 copay |
| Inpatient hospital care | In-network: Tier 1 $475 per day for days 1-4 $0 per day for days 5-90 $0 per stay Out-of-network: $475 per day for days 1-4 $0 per day for days 5-90 $0 per stay |
In-network: Tier 1 $475 per day for days 1-4 $0 per day for days 5-90 $0 per stay Out-of-network: $475 per day for days 1-4 $0 per day for days 5-90 $0 per stay |
| Skilled Nursing Facility | In-network: Tier 1 $0 per day for days 1-20 $218 per day for days 21-100 Out-of-network: 35% per stay |
In-network: Tier 1 $0 per day for days 1-20 $218 per day for days 21-100 Out-of-network: 28% per stay |
| Ground ambulance | In-network: $0-$335 copay Out-of-network: $0-$335 copay |
In-network: $0-$315 copay Out-of-network: $0-$315 copay |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | In-network: $50 copay Out-of-network: $55 copay |
In-network: $50 copay Out-of-network: $55 copay |
| Outpatient group therapy | In-network: $50 copay Out-of-network: $55 copay |
In-network: $50 copay Out-of-network: $55 copay |
| Inpatient psychiatric hospital care | In-network: Tier 1 $475 per day for days 1-4 $0 per day for days 5-90 $0 per stay Out-of-network: $475 per day for days 1-4 $0 per day for days 5-90 $0 per stay |
In-network: Tier 1 $475 per day for days 1-4 $0 per day for days 5-90 $0 per stay Out-of-network: $475 per day for days 1-4 $0 per day for days 5-90 $0 per stay |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: $45 copay Out-of-network: $45-$55 copay |
In-network: $55 copay Out-of-network: $55 copay |
| Occupational therapy | In-network: $35 copay Out-of-network: $35 copay |
In-network: $35 copay Out-of-network: $35 copay |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | In-network: $0 copay Out-of-network: 50% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 20%-22% coinsurance |
| Durable medical equipment | In-network: 16% coinsurance Out-of-network: 45% coinsurance |
In-network: 20% coinsurance Out-of-network: 22% coinsurance |
| Prosthetics | In-network: 0%-16% coinsurance Out-of-network: 0%-35% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 0%-40% coinsurance |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | In-network: 0%-20% coinsurance Out-of-network: 40% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 40% coinsurance |
| Other Part B drugs (Medicare-covered) | In-network: 0%-20% coinsurance Out-of-network: 0%-40% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 0%-40% coinsurance |
Dental Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Oral exam | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Dental x-rays | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Cleaning | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Periodontics | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Endodontics | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Restorative services | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Implant services | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
Not covered |
| Orthodontics | Not covered | Not covered |
| Oral/Maxillofacial surgery | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
Vision Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Routine eye exam | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Contact lenses | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Eyeglass frames only | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Eyeglass lenses only | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Eyeglasses (frames & lenses) | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Upgrades | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
Hearing Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Hearing exam | In-network: $0 copay Out-of-network: $35 copay |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Fitting/evaluation | In-network: $0 copay Out-of-network: $35 copay |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Prescription hearing aids | In-network: $599-$899 copay Out-of-network: 90% coinsurance |
In-network: $599-$899 copay Out-of-network: $599-$899 copay |
| OTC hearing aids | Not covered | Not covered |
Additional and Special Needs Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Adult day health services | Not covered | Not covered |
| Home-based palliative care | Not covered | Not covered |
| Personal emergency response system | Coming soon | Not covered |
| Weight management programs | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Wigs for chemotherapy-related hair loss | Coming soon | Not covered |
| Alternative therapies | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Massage therapy | Not covered | Not covered |
| Home/bathroom safety devices | In-network: $0 copay Out-of-network: 45% coinsurance |
In-network: $0 copay Out-of-network: 22% coinsurance |
Certain preventive services are covered 100% by DEVOTED CHOICE GIVEBACK 006 OK as a Part B benefit.
Prescription Drug Coverage
DEVOTED CHOICE GIVEBACK 006 OK includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
This plan includes an enhanced benefit Medicare Part D plan (PDP), providing coverage beyond the standard CMS-defined minimum.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | ($33.80) |
| Supplemental Part D Premium: | $$33.80 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | $11.03 |
| Low-Income Premium Subsidy Paid by CMS: | $0.00 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $461.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Devoted Health starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, DEVOTED CHOICE GIVEBACK 006 OK may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | $0.00 copay | Coming soon |
| Preferred Brand | 15% coinsurance | Coming soon |
| Non-Preferred Drug | 25% coinsurance | Coming soon |
| Specialty Tier | 26% coinsurance | Coming soon |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H2845)
Medicare Advantage (Part C) and Part D plans are rated each year by CMS on a 5-star scale. Ratings summarize plan performance across clinical care and member experience measures.
| CMS Measure | Star Rating |
|---|---|
| 2027 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | Plan too new to be measured |
| Managing Chronic (Long Term) Conditions | Plan too new to be measured |
| Member Experience with Health Plan | Plan too new to be measured |
| Complaints and Changes in Plans Performance | Plan too new to be measured |
| Health Plan Customer Service | Plan too new to be measured |
| Drug Plan Customer Service | Plan too new to be measured |
| Complaints and Changes in the Drug Plan | Plan too new to be measured |
| Member Experience with the Drug Plan | Plan too new to be measured |
| Drug Safety and Accuracy of Drug Pricing | Plan too new to be measured |
Contact Information for Devoted Health
- Website
- Devoted Health Plan Page
- Providers
- Devoted Health Providers Page
- Formulary
- Devoted Health Formulary Page
- Pharmacy
- Devoted Health Pharmacy Page
- New Member Health Plan Help
- (844)978-2770
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (844)978-2770
- New Member Part D TTY Users
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Plan Availability
DEVOTED CHOICE GIVEBACK 006 OK (H2845-006-0) is available in the following locations:
Frequently Asked Questions
Here are some of the most frequently asked questions about this plan (click to open).
Frequently Asked Questions About DEVOTED CHOICE GIVEBACK 006 OK (PPO)
What is the monthly premium for DEVOTED CHOICE GIVEBACK 006 OK (PPO)?
The plan’s monthly premium is $0.00 for 2027. The Part B premium is not included.
What is the MOOP for DEVOTED CHOICE GIVEBACK 006 OK in 2027?
The 2027 in-network MOOP is $9850.00. Once this limit is reached, covered in-network costs are fully covered.
What is the CMS star rating for DEVOTED CHOICE GIVEBACK 006 OK?
For 2027, plan H2845-006 has a CMS star rating of ★0.0 out of 5 stars.
What is the current enrollment for DEVOTED CHOICE GIVEBACK 006 OK?
CMS reports 585 beneficiaries enrolled in this plan.
What is the prescription drug deductible for 2027?
For 2027, the prescription drug deductible is $461.00.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | CMS Version |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | CY2027 Landscape (202609.1) |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | 2027 Star Ratings Data Tables |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | PBP Benefits-2027 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | 2026-09 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Devoted Health (official source) | http://www.devoted.com | October 4, 2026 |
| Medicare.gov | Understanding Medicare Advantage Plans | 25 May, 2025 |
| NCOA.org | 5 Steps to Choosing the Right Medicare Plan for You | 25 May, 2025 |
| Medicare.gov | Explore your Medicare coverage options | 25 May, 2025 |
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Page content independently curated and maintained by David W. Bynon, Editorial Steward, using a standardized, data-driven methodology for accurate, non-commercial Medicare plan interpretation and resolution.