Plan year 2027 · Medicare AdvantageCMS files of Sept. 22 and Oct. 1, 2026

Devoted Choice Giveback 012 TN, 2027

H9231Contract012Plan

PPO · 5 counties in Tennessee

Run by Devoted Health Insurance Company of Tennessee Inc (contract H9231), sold as Devoted Health, owned by Devoted Health, Inc.

Renews for 2027

2026 star rating, contract H9231: 3.5 of 5

Devoted Choice Giveback 012 TN (H9231-012) costs $0 a month in 2027, the same as in 2026, with an in-network out-of-pocket limit of $9,300 ($8,300 in 2026).

What changes from 2026 to 2027?

The changed lines are marked and come first. In-network amounts; members keep paying the Part B premium unless the plan reduces it.
What you pay or get	2026	2027	Change
In-network out-of-pocket limit	$8,300	$9,300	up $1,000
Drug deductible	$605	$461	down $144
Part B premium reduction, monthly	$184.70	$154.70	down $30
Specialist visit	$50 copay	$55 copay	up $5
Medical deductible, in network	none	$275	added
Skilled nursing facility, in network	$0 a day for days 1–20, then $218 a day for days 21–100	$0 a day for days 1–20, then $221 a day for days 21–100	up $30for a 30-day stay
Drug tier 2, generic	$3	$0	down $3
Drug tier 3, preferred brand	21% of the cost	15% of the cost	down 6 points
Drug tier 5, specialty tier	25% of the cost	26% of the cost	up 1 point
12 lines do not change
Monthly premium	$0	$0	no change
Primary care visit	$0 copay	$0 copay	no change
Emergency room	$115 copay	$115 copay	no change
Hospital stay, in network	$475 a day for days 1–4, then $0 a day for days 5–90	$475 a day for days 1–4, then $0 a day for days 5–90	no change
Ground ambulance, in network	$0 copay	$0 copay	no change
Comprehensive dental, yearly limit	not offered	not offered	no change
Eyewear, yearly limit	$200 a year	$200 a year	no change
Hearing aids, yearly limit for both ears	not offered	not offered	no change
Over-the-counter items, yearly	$464 a year	$464 a year	no change
Counties served	5	5	no change
Drug tier 1, preferred generic	$0	$0	no change
Drug tier 4, non-preferred drug	25% of the cost	25% of the cost	no change

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS plan benefit package files, 2027 and 2026; CMS plan crosswalk from 2026 to 2027 (Oct. 1, 2026). Plan details can change during the year; confirm on Medicare Plan Finder.

What will prescriptions cost?

Your share for a 30-day supply at a retail pharmacy, as filed with CMS; tiers whose share changes are marked
Tier	What the tier holds	2026	2027
Tier 1	Preferred Generic	$0	$0
Tier 2	Generic	$3	$0
Tier 3	Preferred Brand	21% of the cost	15% of the cost
Tier 4	Non-Preferred Drug	25% of the cost	25% of the cost
Tier 5	Specialty Tier	25% of the cost	26% of the cost

Source: CMS plan benefit package files, 2027 and 2026. Insulin is capped at $35 a month by law. A drug's tier is set by the plan's formulary.

How does it compare with plans sold where it is?

In the counties it serves, 43 plans open to everyone are sold for 2027, this one included. Against the others, 38 plans have a lower out-of-pocket limit, 4 a higher one. On the premium, 28 the same, 14 a higher one.

Out-of-pocket limits of the 43 plans open to everyone

$0 to under $2,0000 plans

$2,000 to under $4,0003 plans

$4,000 to under $6,00015 plans

$6,000 to under $8,00017 plans

$8,000 to $10,000 (this plan)8 plans

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).

Where is it sold, and what does it cost there?

The premium and the out-of-pocket limit are the same in all 5 counties: $0 a month and $9,300.

Tennessee

Benton Fayette Hardeman Haywood Shelby

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).

Who runs this plan?

Plan ID: H9231-012
Legal name of the contract: Devoted Health Insurance Company of Tennessee Inc
Sold as: Devoted Health
Parent company: Devoted Health, Inc.
Plan type: PPO
2026 star rating of the contract: 3.5 of 5 overall; health plan 3 of 5, drug plan 3.5 of 5
Members, September 2026: 1,053
Plan website, as filed with CMS: www.devoted.com

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS 2026 Star Ratings (October 2025); CMS monthly enrollment by plan and by county, September 2026 (CMS hides counts under 11). CMS publishes the 2027 Star Ratings in October 2026.

What else should you check?

Other 2027 plans in Shelby, TNWhere most of its members live; premiums and limits side by side
Every Devoted Health plan for 2027Its contracts, counties and plans that end
The other 6 plans of contract H9231Same company, same contract
Is your prescription covered?Coverage share and tier for 2,259 drugs

Data, not advice. These are the plan's filed amounts, not a quote for you; confirm on Medicare Plan Finder or call the plan before you enroll.