DEVOTED CHOICE GIVEBACK 002 SC (PPO) Medicare Advantage Plan H7028-002 • 2026 • Dorchester County, SC
DEVOTED CHOICE GIVEBACK 002 SC is a Medicare Advantage PPO plan offered by Devoted Health for the 2026 plan year. It is identified by CMS Plan ID H7028-002 and uses a Preferred Provider Organization (PPO) provider network. The plan comes with prescription drug coverage.
DEVOTED CHOICE GIVEBACK 002 SC Overview
Plan Overview for
H7028-002-0
|
|
|---|---|
| CMS Plan ID: |
H7028-002-0
|
| Plan Type: | PPO |
| Plan Year: | 2026 |
| Monthly Premium: |
$0.00
Plus your Medicare Part B premium. |
| Medical Deductible: | $0.00 |
| Maximum Out-of-Pocket: | $6750.00 (In-Network) |
| Part B Give Back: | −$184.70 reduction |
| Prescription Drug Coverage: | Enhanced, $605.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Service Area: | Dorchester County, SC |
| Enrollment (Nationwide): | 18,188 beneficiaries |
| Enrollment (CMS – Local) | 941 beneficiaries in Dorchester County |
| Provided By: | Devoted Health |
Coverage Overview for DEVOTED CHOICE GIVEBACK 002 SC
This MAPD PPO Medicare Advantage plan includes Medicare Part A and Part B services along with integrated prescription drug coverage. The monthly premium is $0.00, and the plan allows access to Medicare-approved providers, with lower costs when using in-network providers. The annual Part D deductible is $605.00.
Primary care visits have a $0 copay | Out-of-network: $30 copay, and specialist visits come with a $45 copay | Out-of-network: $45 copay. Urgent care services carry a $0-$45 copay, and ground ambulance transportation is $0-$315 copay | Out-of-network: $0-$315 copay. These costs apply toward the annual maximum out-of-pocket (MOOP) limit of $6750.00. After this limit is reached, in-network services are fully covered.
This plan is recognized by CMS under Plan ID H7028-002. Cost-sharing details are outlined below.
Cost Sharing Expenses
Cost-sharing for DEVOTED CHOICE GIVEBACK 002 SC includes out-of-pocket expenses for covered healthcare services. The table below provides a summary of typical in-network out-of-pocket costs for plan H7028-002.
Certain preventive services are covered 100% by DEVOTED CHOICE GIVEBACK 002 SC as a Part B benefit.
Prescription Drug Coverage
DEVOTED CHOICE GIVEBACK 002 SC 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 Advantage coverage.
| Basic Part D Premium: | $-29.80 |
|---|---|
| Supplemental Part D Premium: | $29.80 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | $35.66 |
| 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 $605.00 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 002 SC 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 | $3.00 copay | Coming soon |
| Preferred Brand | 22% coinsurance | Coming soon |
| Non-Preferred Drug | 25% coinsurance | Coming soon |
| Specialty Tier | 25% coinsurance | Coming soon |
| *Deductible does not apply. | ||
CMS Star Ratings
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 |
|---|---|
| 2026 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | Not enough data available |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
What is the monthly premium for DEVOTED CHOICE GIVEBACK 002 SC (PPO)?
The 2026 monthly premium is $0.00. The Medicare Part B premium is paid separately.
What is the MOOP for DEVOTED CHOICE GIVEBACK 002 SC in 2026?
The 2026 in-network MOOP is $6750.00. Once this limit is reached, covered in-network costs are fully covered.
What is the star rating for plan H7028-002 in 2026?
For 2026, plan H7028-002 has a CMS star rating of ★4.5 out of 5 stars.
What is the total enrollment for plan H7028-002?
Total enrollment is 18,188 beneficiaries based on the latest CMS data.
What is the Part D deductible for plan H7028-002?
The Part D deductible is $605.00.
Contact Information for Devoted Health
| Contact Type | Details |
|---|---|
| Website: | Devoted Health Plan Page |
| New Members: | 1-844-978-2770 |
| Existing Members: | 1-800-338-6833 |
| Plan Address: | Devoted Health | PO Box 211037 | Eagan, MN 55121 |
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at medicare.gov.
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | September 8, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | September 8, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | September 8, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | September 8, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Devoted Health (official source) | http://www.Devoted.com | October 13, 2025 |
| CMS.gov | Medicare Advantage Plan Fact Sheet | 25 May, 2025 |
| NCOA.org | 5 Steps to Choosing the Right Medicare Plan for You | 25 May, 2025 |
| Medicare.gov | Compare Original Medicare & Medicare Advantage | 25 May, 2025 |
MedicarePlans.com is an independent informational resource and is not affiliated with or endorsed by the U.S. Government or the federal Medicare program.
Data provenance documentation is maintained in alignment with the U.S. Core Data for Interoperability (USCDI) Provenance standard.
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.