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- Jackson, TN
Plans in Your Area
Do you have a chronic health condition? View our C-SNP HMO plan
Want help enrolling? Give us a call.
Devoted CHOICE Tennessee (PPO)Summary of Benefits (PDF)Updated August 30, 2023 | Devoted CHOICE GIVEBACK Tennessee (PPO)Summary of Benefits (PDF)Updated August 30, 2023 | Devoted GIVEBACK Tennessee (HMO)Summary of Benefits (PDF)Updated August 30, 2023 | Devoted CORE Tennessee (HMO)Summary of Benefits (PDF)Updated August 30, 2023 | |
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Monthly Premium | $0 You must continue to pay your part B premium. | $0 Also, your Part B premium is reduced by up to $155 per month. | $0 Also, your Part B premium is reduced by up to $105 per month. | $0 You must continue to pay your part B premium. |
Part B GivebackThis amount goes back into your Social Security check each month. | None | Up to $155 per month | Up to $105 per month | None |
Annual Out-of-Pocket MaximumThis is the most you'll pay in a year for Medicare covered medical services. Your out-of-pocket Part D drug costs don't count toward this amount. | In-network:
In- and Out-of-network:
| In-network:
In- and Out-of-network:
| $6,700 | $5,400 |
Primary Care Provider (PCP) Visits | In-network:
Out-of-network:
| In-network:
Out-of-network:
| $0 copay* | $0 copay* |
Specialist Visits | In-network:
Out-of-network:
| In-network:
Out-of-network:
| $40 copay* | $15 copay* |
Inpatient Hospital Stays | In-network:
Out-of-network:
| In-network:
Out-of-network:
| Days 1 - 5 | Days 1 - 5 |
Outpatient SurgeryAmbulatory surgery centers are different from hospitals and focus just on outpatient surgery. | In-network:
Out-of-network:
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Out-of-network:
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Emergency Room VisitIf admitted to the hospital within 24 hours, you won't have a copay for emergency care. | $120 copay per stay | $100 copay per stay | $100 copay per stay | $120 copay per stay |
Urgent Care Center VisitTo treat a non-emergency illness, injury, or condition that requires immediate medical care. | $40 copay | $55 copay | $40 copay | $40 copay |
LabsIf the lab is part of a hospital system, you might pay the higher copay. Call us to find out. | In-network:
Out-of-network:
| In-network:
Out-of-network:
| $0 copay* | $0 copay* |
X-rays and UltrasoundsIf the provider is part of a hospital system, you might pay the higher copay. Call us to find out. | In-network:
Out-of-network:
| In-network:
Out-of-network:
| $0 copay* | $0 copay* |
Diagnostic Tests and ProceduresIf the provider is part of a hospital system, you might pay the higher copay. Call us to find out. | In-network:
Out-of-network:
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Out-of-network:
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Pharmacy (Part D) Deductible | This plan does not have a deductible. | $545 for Tiers 3-5 only | This plan does not have a deductible. | This plan does not have a deductible. |
30-Day Supply Retail PharmacyIf you get Extra Help from Medicare, your costs may be lower. |
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100-Day Supply Mail-Order PharmacyIf you get Extra Help from Medicare, your costs may be lower. |
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Erectile Dysfunction DrugsSildenafil (Viagra) and tadalfil (Cialis) are covered medications for up to 6 pills a month. | $2 per prescription* | $5 per prescription* | $7 per prescription* | $0 per prescription* |
Dental |
This plan also includes out-of-network dental coverage. | $1,000 a year for all covered dental services | $1,000 a year for all covered dental services |
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Food & Home CardPre-loaded card for purchase of groceries, utilities, mortgage, or rent | $50 per month The Food & Home Card is available to members with eligible chronic health conditions. | Not covered | Not covered | $85 per month The Food & Home Card is available to members with eligible chronic health conditions. |
Over-the-Counter CreditFor items like toothpaste, vitamins, blood pressure cuffs, and more | $95 per quarter (every 3 months) | Not covered | $65 per quarter (every 3 months) | $75 per quarter (every 3 months) |
Medical Alert DeviceCall for emergency help with the press of a button. | Free device and free monthly monitoring* | Free device and free monthly monitoring* | Free device and free monthly monitoring* | Free device and free monthly monitoring* |
Hearing AidsPlan covers 2 hearing aids a year, plus free batteries. |
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Vision | In-network:
Out-of-network:
$300 per year toward glasses or contacts | In-network:
Out-of-network:
$200 per year toward glasses or contacts |
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Fitness |
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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.