Skip to main content
Medicare Advocates
Medicare Advantage · PPO · Plan ID H7191-006-000

DEVOTED CHOICE GIVEBACK EXTRAS 006 NH (PPO)

The DEVOTED CHOICE GIVEBACK EXTRAS 006 NH (PPO) is a 2027 PPO Medicare Advantage plan from Devoted Health with a $0 monthly premium. It may include allowances for vision, otc / flex allowance, and part b giveback. It's available in 3 counties across 1 state.

Reviewed by the Medicare Advocates team · 2027 plan year · sourced from CMS data

Offered in 3 counties across 1 state

2027 plan at a glance
  • Monthly premium$0
  • In-network max out-of-pocket$7,650
Yearly benefit allowances
  • Vision$200
  • OTC / Flex allowance$272
  • Part B giveback$840

2027 plan-year figures (premium, star rating, MOOP) from the CMS Landscape file; allowance amounts from CMS PBP data. Amounts vary by plan; not all plans offer all benefits.

About this plan

DEVOTED CHOICE GIVEBACK EXTRAS 006 NH (PPO), plan H7191-006-000, is a 2027 Medicare Advantage plan from Devoted Health, sold in New Hampshire. It pairs a $0 plan premium with a Part B giveback worth $840 a year.

In-network and out-of-network care

This is a PPO, so it pays toward care both inside and outside its network. In-network care costs you less, and an out-of-network provider has to accept Medicare and agree to bill the plan. The plan's Summary of Benefits lists an out-of-network amount for each service next to the in-network one, and that is the column to read before you book a visit outside the network.

Who can enroll

To join, you need Medicare Part A and Part B and you have to live in the plan's service area, which covers 3 counties in New Hampshire for 2027. You keep paying your Part B premium to Medicare.

Counties in the service area include Carroll, Coos, Grafton, Hillsborough and Sullivan.

Premium and giveback

This plan reduces your Part B premium, which people call a giveback. It is worth $840 over a year, about $70 a month, and it shows up as a lower Part B deduction rather than a payment to you.

A $0 plan premium is not the same as $0 total cost. You still pay a copay or coinsurance when you get care, up to the plan's yearly out-of-pocket limit.

What the DEVOTED CHOICE GIVEBACK EXTRAS 006 NH (PPO) plan may include

  • Vision: up to $200 per year in plan allowance (2027).
  • OTC / Flex allowance: up to $272 per year in plan allowance (2027).
  • Part B giveback: up to $840 per year in plan allowance (2027).

Costs & coverage detail

Annual Part D drug deductible: $700 (2027).

Doctor visits

  • Specialist visit$50 copay
  • Telehealth$0–$50 copay
  • Chiropractic (Medicare-covered)$15 copay
  • Podiatry (Medicare-covered)$50 copay

Emergency & urgent care

  • Emergency room$115 copay
  • Urgent care$0–$40 copay

Tests, labs & imaging

  • Lab services$0–$50 copay
  • Diagnostic tests & procedures$0–$95 copay
  • X-rays$0–$75 copay
  • Diagnostic radiology (CT/MRI/PET)$25–$300 copay

Outpatient hospital & surgery

  • Outpatient hospital services$0–$565 copay
  • Ambulatory surgical center$0–$465 copay
  • Outpatient substance abuse (individual)$50 copay

Medical equipment & supplies

  • Durable medical equipment (DME)18% coinsurance
  • Medical supplies (Medicare-covered)0–18% coinsurance
  • Part B drugs (other)0–20% coinsurance
  • Part B chemotherapy drugs0–20% coinsurance

Ambulance

  • Ground ambulance$0–$355 copay

Dental

  • Comprehensive dental (restorative)50% coinsurance

Vision

  • Routine eye exam$0–$50 copay

Hearing

  • Routine hearing exam$50 copay
  • Hearing aids$599–$899 copay

Mental health

  • Mental health visit (individual)$50 copay
  • Mental health visit (group)$50 copay
  • Psychiatric services (individual)$50 copay
  • Inpatient psychiatric hospital$465/day, days 1–4; $0/day, days 5–90

Therapy

  • Occupational therapy visit$35 copay

Hospital stays

  • Inpatient hospital$490/day, days 1–5; $0/day, days 6–90
  • Skilled nursing facility (SNF)$0/day, days 1–20; $221/day, days 21–100

In-network, Medicare-covered cost sharing for the 2027 plan year (CMS PBP data). Costs vary by service and setting; see the Summary of Benefits for full detail.

Extra benefit allowances

  • Eyewear allowance$200 per year
  • Over-the-counter (OTC) allowance$68 per quarter

What everyday care costs

In network, a specialist visit is $50, the emergency room is $115 and urgent care is $0 to $40. Emergency care and urgently needed services are covered whether or not the provider is in the plan's network, which matters when you are away from home.

An individual mental health visit is $50 and occupational therapy is $35.

Physical therapy and speech therapy are covered too, at cost shares the plan lists in its Summary of Benefits rather than in the CMS benefit files, so check those two there.

Preventive care and vaccines

You pay $0 for the preventive services Original Medicare covers when you use a provider in the plan's network. That includes your annual wellness visit, the recommended screenings for your age, and most vaccines. Preventive care is the easiest value to collect from any Medicare Advantage plan, so book the wellness visit early in the year.

Dental, vision and hearing

Beyond what Original Medicare covers, this plan includes $200 toward glasses or contacts and $68 a year for over-the-counter health items. These allowances almost always have to be used with providers and suppliers the plan works with, so check that before you buy, particularly for hearing aids where the plan usually names its own vendor.

The eyewear allowance covers eyeglasses or contact lenses, and it resets each plan year rather than rolling over, so an unused allowance is lost at the end of December.

Prescription drug coverage

Part D prescription drug coverage is included, so you do not need a separate drug plan. Check the plan's formulary, which is its list of covered drugs, for every medicine you take before you enroll.

For 2027, the drug deductible is $700 and your own drug costs are capped at $2,400 for the year.

If a medicine you take is not on the formulary, your prescriber can ask the plan for an exception, and if your income is limited, Extra Help can cut what you pay for drugs regardless of which plan you choose.

Prior authorization

Some care on this plan needs prior authorization, which means Devoted Health has to approve it before you get it. Specialist services are among those that do. Your doctor's office usually files the request, but the plan may not pay if the approval is skipped, so confirm it is in hand before a scheduled procedure. The plan's evidence of coverage lists every service that needs it.

How this plan compares in Hillsborough County

Here is how DEVOTED CHOICE GIVEBACK EXTRAS 006 NH (PPO) sits against other plans sold in Hillsborough County for 2027.

Humana USAA Honor Giveback (PPO) has a lower in-network limit at $4,950.

Who this plan may fit

This plan may fit people in the service area who want a $0 plan premium and are comfortable with a $7,650 ceiling on in-network costs. Because it is a PPO, you also keep some coverage outside the network, at a higher cost.

Like any Medicare Advantage plan, it changes how your Medicare claims are paid. If you travel often, or you want to use any doctor who accepts Medicare without checking a network, compare it against Original Medicare with a Medicare Supplement and a separate drug plan before you decide.

Questions to ask before you enroll

A licensed insurance agent can check all of these against your own doctors and prescriptions at no cost.

  • Are my doctors in the plan's network, and what would an out-of-network visit cost me?
  • Are all of my prescriptions on the plan's drug list, and at which tier?
  • Which of the services I use regularly need prior authorization?
  • When does the Part B giveback start, and how will I see it?
  • What counts toward the $7,650 out-of-pocket limit, and what does not?

Common questions

What is the DEVOTED CHOICE GIVEBACK EXTRAS 006 NH (PPO) plan?
It is a Medicare Advantage plan (CMS plan ID H7191-006-000) offered by Devoted Health for the 2027 plan year. Medicare Advantage plans bundle your Part A and Part B coverage, and most include extra benefits Original Medicare does not.
What extra benefits could this plan include?
Depending on the plan, supplemental benefits may include allowances toward vision, otc / flex allowance, part b giveback. Amounts shown are for the 2027 plan year and vary by plan and area. A licensed agent can confirm what is available to you.
Where is this plan available?
For 2027, this plan is offered in 3 counties across 1 state. Availability and benefits depend on your specific ZIP code.
How do I enroll or compare plans?
Call to speak with a licensed insurance agent who can review this plan alongside the other options in your area at no cost. There is no obligation to enroll, and enrollment may be limited to certain times of year unless you qualify for a Special Enrollment Period.

Counties served

New Hampshire (5 counties)

Carroll, Coos, Grafton, Hillsborough, Sullivan

Ready when you are.

No cost. No pressure. There is no obligation to enroll.One licensed insurance agent, for as long as you’re on Medicare.