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Medicare Advantage Plans in St. Francis County, AR

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Devoted CHOICE GIVEBACK Arkansas (PPO)
Devoted CHOICE Arkansas (PPO)

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Summary of Benefits (PDF)

Updated September 12, 2024

Devoted CHOICE GIVEBACK Arkansas (PPO)

Summary of Benefits (PDF)
Updated September 12, 2024

Devoted CHOICE Arkansas (PPO)

Summary of Benefits (PDF)
Updated September 12, 2024

Monthly premium

$0

$0

Part B premium reduction

$137.60 per month back in your Social Security check

None

Annual out-of-pocket maximum

$8,800*, in-network


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

$5,400*, in-network


$9,550, 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

$65 per month

Dental & Eyewear

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

$1,700 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

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

$35 copay*, in-network


$35 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 - 6
$335 copay per day

Day 7+
$0 copay per day

Out-of-network:
Days 1 - 6
$335 copay per day

Day 7+
$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: $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.