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DEVOTED GIVEBACK 013 FL (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED GIVEBACK 013 FL (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED GIVEBACK 013 FL (HMO) in 2026, please refer to our full plan details page.
DEVOTED GIVEBACK 013 FL (HMO) is a HMO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Miami-Dade County. This plan received an overall rating of 5 out of 5 stars in 2026.
It's important to know that DEVOTED GIVEBACK 013 FL (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about DEVOTED GIVEBACK 013 FL (HMO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For DEVOTED GIVEBACK 013 FL (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $184.70. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $605.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6750.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The DEVOTED GIVEBACK 013 FL (HMO) Medicare plan features an annual prescription drug deductible of $605. For Tier 1 preferred generic drugs, members enjoy no copay for up to a three-month supply filled at standard pharmacies or via standard mail order. Tier 2 generic drugs are also budget-friendly, requiring a low $5.00 copay for a one-month supply at standard pharmacies and mail-order services. For brand-name and specialty medications, costs are based on coinsurance rather than flat copays during the initial coverage phase. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance. These standard pharmacy and standard mail-order rates apply directly to your out-of-pocket prescription costs.
Additional Benefits
The DEVOTED GIVEBACK 013 FL (HMO) plan offers essential healthcare coverage with no copay and no coinsurance for primary care doctor visits, preventive services, and home health care. For more intensive medical needs, members pay a $130 copay for emergency room visits and a $395 daily copay for the first few days of inpatient hospital stays, with no coinsurance. Specialist visits and diagnostic tests are also highly affordable, featuring copays that range from no copay up to $125. Supplemental benefits further enhance the plan, offering dental coverage up to a $1,250 annual limit with no copay for preventive services. Members also benefit from a $350 annual eyewear allowance and a $100 quarterly allowance for over-the-counter items, both with no copay. Routine hearing exams are available for a $45 copay, and up to two prescription hearing aids are covered yearly with copays ranging from $599 to $899.
Inpatient Hospital See details
Inpatient hospital services are covered by DEVOTED GIVEBACK 013 FL (HMO) with no coinsurance, requiring a $395 copay for days 1 to 6 of acute stays (no copay for days 7 to 90) and a $395 copay for days 1 to 5 of psychiatric stays (no copay for days 6 to 90). The benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED GIVEBACK 013 FL (HMO) covers outpatient services with no coinsurance, featuring a $0 to $395 copay for outpatient hospital services and a $395 copay per stay for observation services. Ambulatory surgical center and blood services are covered with no copay and no coinsurance, while outpatient substance abuse services require a $45 copay per session and no coinsurance.
Partial Hospitalization See details
DEVOTED GIVEBACK 013 FL (HMO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
DEVOTED GIVEBACK 013 FL (HMO) covers ambulance services with prior authorization, requiring a copay ranging from no copay to $350 for ground ambulance and a 20% coinsurance for air ambulance. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
DEVOTED GIVEBACK 013 FL (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require no copay to a $50 copay and no coinsurance, and worldwide emergency services are covered up to $25,000 with copays up to $350 and up to 20% coinsurance.
Primary Care See details
Primary care benefits under the DEVOTED GIVEBACK 013 FL (HMO) plan include primary care physician services with no copay and no coinsurance. Other covered services, such as specialist visits, therapies, and mental health care, feature copays ranging from $0 to $65 and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
DEVOTED GIVEBACK 013 FL (HMO) covers preventive services, including annual physicals, kidney disease education, and glaucoma screenings, with no copay and no coinsurance. Additional preventive benefits are partially covered with no copay and no coinsurance, featuring fitness benefits and nutritional programs, while services like in-home safety assessments, personal emergency response systems, and therapeutic massages are not covered.
Hearing Services See details
Hearing services are partially covered by DEVOTED GIVEBACK 013 FL (HMO), with routine hearing exams requiring a $45 copay and no coinsurance. Up to two prescription hearing aids are covered per year with copays between $599 and $899 and no coinsurance, though OTC hearing aids and inner ear, outer ear, or over-the-ear prescription models are not covered.
Vision Services See details
Vision Services are partially covered by DEVOTED GIVEBACK 013 FL (HMO), which offers one routine eye exam per year with a $0 to $45 copay, no coinsurance, and no deductible, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, up to a $350 annual maximum allowance for contacts, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered by DEVOTED GIVEBACK 013 FL (HMO) up to a $1,250 annual limit, featuring no copay and no coinsurance for preventive care, periodontics, and oral surgery. Restorative and endodontic services have no copay and 0% to 50% coinsurance, while Medicare-covered dental requires a $45 copay and no coinsurance; however, implant services, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
DEVOTED GIVEBACK 013 FL (HMO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs require between no coinsurance and 20% coinsurance, while Medicare Part B insulin has a $35 copay and the same coinsurance range.
Dialysis Services See details
Dialysis Services are covered by DEVOTED GIVEBACK 013 FL (HMO) with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
DEVOTED GIVEBACK 013 FL (HMO) covers medical equipment with no copays, though prior authorization is required. Durable medical equipment carries a 20% to 50% coinsurance, prosthetics and medical supplies range from no coinsurance to 20% coinsurance, and diabetic equipment is partially covered with no coinsurance to 50% coinsurance, excluding diabetic therapeutic shoes and inserts which are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED GIVEBACK 013 FL (HMO), with prior authorization required. Diagnostic tests and procedures carry no coinsurance and a $0 to $125 copay, lab services and outpatient X-rays have no copay, and diagnostic radiological services start at a $0 copay while therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
DEVOTED GIVEBACK 013 FL (HMO) covers home health services with no copay and no coinsurance, although prior authorization is required. This benefit allows eligible members to receive necessary medical care in the comfort of their home at no cost.
Cardiac Rehabilitation Services See details
DEVOTED GIVEBACK 013 FL (HMO) features no coinsurance and requires prior authorization for cardiac rehabilitation, indicating some services are covered. However, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice.
Skilled Nursing Facility (SNF) See details
DEVOTED GIVEBACK 013 FL (HMO) covers Skilled Nursing Facility (SNF) care with no coinsurance, featuring no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, and while a prior 3-day inpatient hospital stay is not required, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by DEVOTED GIVEBACK 013 FL (HMO), offering additional preventive services and over-the-counter items with no copay and no coinsurance. Over-the-counter items are covered up to $100 every three months, while acupuncture and meal benefits are not covered.
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