Medicare Advantage Plans in Cochise County, AZ

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H6586-006-000-2025
H6586-002-000-2025

Want help enrolling? Give us a call.

1-800-990-0723 (TTY 711)

Devoted CHOICE GIVEBACK Arizona (PPO)

Summary of Benefits (PDF)
Updated September 12, 2024

Devoted CHOICE Arizona (PPO)

Summary of Benefits (PDF)
Updated September 12, 2024

Monthly premium

$0

$0

Part B premium reduction

$122.70 per month back in your Social Security check

None

Annual out-of-pocket maximum

$8,300*, in-network


$10,000, in- and out-of-network

$5,900*, in-network


$8,950, in- and out-of-network

Food & Home Card

Pre-loaded card for purchase of food, over-the-counter, utilities, and mortgage or rent.**

Not covered

$63 per month

Dental & Eyewear

$250 per year for dental and eyewear coverage, for use at any dentist or eyewear retailer

$1,500 per year for dental and eyewear coverage, for use at any dentist or eyewear retailer

Primary care provider (PCP) visits

$0 copay*, in-network


$25 copay, out-of-network

$0 copay*, in-network


$25 copay, out-of-network

Specialist visits

Cost 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

$40 copay*, in-network


$40 copay, out-of-network

Inpatient hospital stays

In-network*:
Days 1 - 4
$475 copay per day

Day 5+
$0 copay per day

Out-of-network:
Days 1 - 4
$475 copay per day

Day 5+
$0 copay per day

In-network*:
Days 1 - 7
$335 copay per day

Day 8+
$0 copay per day

Out-of-network:
Days 1 - 7
$335 copay per day

Day 8+
$0 copay per day

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.

30-Day Supply Retail Pharmacy

For Part D prescriptions. If you get Extra Help from Medicare, your costs may be lower.

  • Tier 1: $0 per prescription
  • Tier 2: $10 per prescription
  • Tier 3: 25% of the total cost
  • Tier 4: 25% of the total cost
  • Tier 5: 25% of the total cost

  • Tier 1: $0 per prescription
  • Tier 2: $4 per prescription
  • Tier 3: 25% of the total cost
  • Tier 4: 25% of the total cost
  • Tier 5: 25% of the total cost

*When you use an in-network provider or pharmacy.

Next Steps

Now that you know what our plans are all about, you can:

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.