DEVOTED CHOICE GIVEBACK EXTRAS 023 GA (PPO) (2027)

Medicare Advantage plan with drug coverage from Devoted Health, plan ID H5453-023-000. Sold in 103 counties in Georgia.

★★★★★4.0

2027 costs

Monthly premium$0

Drug deductible$700

Medical deductible$150

Out-of-pocket maximum (in network)$8,900

Plan typeMedicare Advantage plan with drug coverage, PPO

Referral needed to see a specialistNo

Plan IDH5453-023-000

With a Medicare Advantage plan you also keep paying your Medicare Part B premium.

What this plan would cost for your prescriptions

Add your prescriptions to see this plan's estimated yearly cost for them, which of them are on its drug list, and how each compares with Cost Plus Drugs prices.

See this plan with my prescriptions

What you pay for medical care

Primary care visit$0

Specialist visit$40

Preventive care$0

Urgent care$0–$40

Emergency room$115

Hospital stay$490/day

Outpatient surgery$0–$540

Lab tests$0–$95

X-rays and scans$25

Mental health visit$40

Physical therapy$40–$50

Medical equipment20%

TelehealthCovered

In-network amounts. A range means it depends on the service or provider.

Extra benefits

DentalCovered — up to $2500 allowance

VisionCovered — up to $400/yr allowance

HearingCovered — $599–$899 copay per aid

Over-the-counter itemsCovered — up to $81/quarter allowance

FitnessCovered

Rides to appointmentsNot covered

Drug costs by tier

Tier	30 days, standard pharmacy	30 days, preferred pharmacy	90 days by mail
1 Preferred Generic	$0	$0	$0
2 Generic	$1	$1	$2.50
3 Preferred Brand	25%	25%	25%
4 Non-Preferred Drug	25%	25%	25%
5 Specialty Tier	25%	25%	N/A

A percentage is coinsurance: your share of the drug's price. The drug deductible may apply first, depending on the tier. Your Part D out-of-pocket costs are capped at $2,400 for 2027.

Where it's sold

Georgia (103 counties)

Plan costs and benefits are from CMS's 2027 Medicare plan data (data as of October 27, 2026). Star ratings are CMS's 2027 Star Ratings. Every year, Medicare evaluates plans based on a 5-star rating system. Benefits, premiums and copays can change from year to year; check the plan's Evidence of Coverage, call the plan, or use Medicare.gov before you enroll.