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- Elkhart County, IN
Medicare Advantage Plans in Elkhart County, IN
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Devoted CHOICE GIVEBACK Indiana (PPO)Summary of Benefits (PDF)Updated September 12, 2024 | Devoted CHOICE Indiana (PPO)Summary of Benefits (PDF)Updated September 12, 2024 | Devoted CHOICE PLUS Indiana (PPO)Summary of Benefits (PDF)Updated September 12, 2024 | |
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Monthly premium | $0 | $0 | $49.60 If you receive Extra Help from Medicare to help pay for your Medicare prescription drug plan costs, your monthly plan premium may be reduced to $0. |
Part B premium reduction | $157.70 per month back in your Social Security check | None | None |
Annual out-of-pocket maximum | $9,350*, in-network $14,000, in- and out-of-network | $5,900*, in-network $9,550, in- and out-of-network | $5,900*, in-network $9,550, in- and out-of-network |
Food & Home CardPre-loaded card for purchase of food, over-the-counter, utilities, and mortgage or rent.** | Not covered | $82 per month | $95 per month |
Dental & Eyewear | $250 per year for dental and eyewear coverage, for use at any dentist or eyewear retailer | $1,000 per year for dental and eyewear coverage, for use at any dentist or eyewear retailer | $1,250 per year for dental and eyewear coverage, for use at any dentist or eyewear retailer |
Primary care provider (PCP) visits | $0 copay*, in-network $0 copay, out-of-network | $0 copay*, in-network $0 copay, out-of-network | $0 copay*, in-network $0 copay, out-of-network |
Specialist visitsCost shares for Balance Exams with a Specialist may differ. See your Summary of Benefits for details. | $45 copay*, in-network $45 copay, out-of-network | $45 copay*, in-network $45 copay, out-of-network | $45 copay*, in-network $45 copay, out-of-network |
Inpatient hospital stays | In-network*: | In-network*: | In-network*: |
Pharmacy (Part D) Deductible | $590 for Tiers 3-5 only If you receive Extra Help from Medicare, your deductible is $0. The deductible does not apply to covered Part D insulins and most adult Part D vaccines. | $590 for Tiers 3-5 only If you receive Extra Help from Medicare, your deductible is $0. The deductible does not apply to covered Part D insulins and most adult Part D vaccines. | $590 for Tiers 3-5 only If you receive Extra Help from Medicare, your deductible is $0. The deductible does not apply to covered Part D insulins and most adult Part D vaccines. |
30-Day Supply Retail PharmacyFor Part D prescriptions. If you get Extra Help from Medicare, your costs may be lower. |
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*When you use an in-network provider or pharmacy.
Next Steps
Now that you know what our plans are all about, you can:
- See if your doctors are in our network
- Make sure we cover your medications
And if you have any questions, call us at (1-800-990-0723) (TTY 711) You can also see and compare more plan options at www.Medicare.gov.