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Medicare Advantage Plans in Rowan County, NC

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Devoted CHOICE GIVEBACK North Carolina (PPO)
Devoted CHOICE North Carolina (PPO)
Devoted GIVEBACK North Carolina (HMO)

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Summary of Benefits (PDF)

Updated September 12, 2024

Devoted CHOICE GIVEBACK North Carolina (PPO)

Summary of Benefits (PDF)
Updated September 12, 2024

Devoted CHOICE North Carolina (PPO)

Summary of Benefits (PDF)
Updated September 12, 2024

Devoted GIVEBACK North Carolina (HMO)

Summary of Benefits (PDF)
Updated September 12, 2024

Monthly premium

$0

$0

$0

Part B premium reduction

$157.70 per month back in your Social Security check

None

$147.70 per month back in your Social Security check

Annual out-of-pocket maximum

$8,000*, in-network


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

$4,600*, in-network


$5,500, in- and out-of-network

$6,700*

Food & Home Card

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

Not covered

$92 per month

Not covered

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

$500 per year on a preloaded card 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*

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

$25 copay*, in-network


$25 copay, out-of-network

$45 copay*

Inpatient hospital stays

In-network*:
Days 1 - 5
$340 copay per day

Day 6+
$0 copay per day

Out-of-network:
Days 1 - 5
$340 copay per day

Day 6+
$0 copay per day

In-network*:
Days 1 - 6
$325 copay per day

Day 7+
$0 copay per day

Out-of-network:
Days 1 - 6
$325 copay per day

Day 7+
$0 copay per day

In-network*:
Days 1 - 4
$440 copay per day

Day 5+
$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.

$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: $5 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: $5 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: $5 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.