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DEVOTED GIVEBACK 014 FL (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED GIVEBACK 014 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 014 FL (HMO) in 2026, please refer to our full plan details page.
DEVOTED GIVEBACK 014 FL (HMO) is a HMO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Broward County. This plan received an overall rating of 5 out of 5 stars in 2026.
It's important to know that DEVOTED GIVEBACK 014 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 014 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 014 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 014 FL (HMO) Medicare plan has a $605 prescription drug deductible. For Tier 1 preferred generic drugs, there is no copay for a 1-month, 2-month, or 3-month supply at standard pharmacies and standard mail-order services. Tier 2 generic drugs are available with standard copays starting at $5.00 for a 1-month supply, up to a maximum of $15.00 for a 3-month retail pharmacy supply. Higher-tier medications under this plan require coinsurance instead of flat copays. Tier 3 preferred brand drugs carry a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance for standard pharmacy and mail-order fills.
Additional Benefits
The DEVOTED GIVEBACK 014 FL (HMO) plan offers affordable core medical coverage, featuring no copay and no coinsurance for primary care doctor visits and a $45 copay for specialists. For hospital stays, inpatient care requires a daily copay for the first few days followed by no copay, all with no coinsurance. Emergency room visits have a $130 copay that is waived if admitted, while urgent care and routine preventive services are available with no copay. Supplemental benefits include dental coverage up to $1,250 annually with no copay for many services, alongside a $350 yearly allowance for eyewear and contacts. Hearing care is partially covered with a $45 routine exam copay and prescription hearing aid benefits. Members also benefit from a $95 over-the-counter allowance every three months and home health services with no copay or coinsurance.
Inpatient Hospital See details
DEVOTED GIVEBACK 014 FL (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, though prior authorization is required. For acute stays, there is a $395 daily copay for days 1-6 and no copay for days 7-90, while psychiatric stays require a $395 daily copay for days 1-5 and no copay for days 6-90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services covered by DEVOTED GIVEBACK 014 FL (HMO) feature no coinsurance, with copays ranging from $0 to $395 for outpatient hospital services and a $395 copay per stay for observation services. Ambulatory surgical center and outpatient blood services require no copay and no coinsurance, while outpatient substance abuse sessions have a $45 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by DEVOTED GIVEBACK 014 FL (HMO) with a $55.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services under DEVOTED GIVEBACK 014 FL (HMO) require prior authorization for ambulance transport, which features a copay ranging from no copay to $340 (and no coinsurance) for ground services, and a 20% coinsurance (and no copay) for air services. Some transportation services are covered, but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
DEVOTED GIVEBACK 014 FL (HMO) covers emergency services with a $130 copay—waived if admitted within 24 hours—and no coinsurance, alongside urgently needed services with a copay ranging from no copay to $50 and no coinsurance. Worldwide emergency and urgent services are covered up to a $25,000 maximum with a $130 copay and no coinsurance, while worldwide emergency transportation requires a $340 copay and 20% coinsurance.
Primary Care See details
DEVOTED GIVEBACK 014 FL (HMO) provides primary care physician services with no copay and no coinsurance, while specialist visits require a $45 copay and no coinsurance. Physical, occupational, and speech therapy services range from a $45 to $65 copay with no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
DEVOTED GIVEBACK 014 FL (HMO) offers partially covered preventive services with no copay and no coinsurance for covered options like annual physicals, fitness benefits, and kidney education. However, several additional preventive sub-services are not covered, including in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs for chemotherapy hair loss, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, additional smoking cessation sessions, enhanced disease management, telemonitoring, remote access technologies, and counseling services.
Hearing Services See details
DEVOTED GIVEBACK 014 FL (HMO) hearing services are partially covered, offering annual routine exams with a $45 copay and no coinsurance, and up to two prescription hearing aids per year with no coinsurance and a $599 to $899 copay. OTC hearing aids, as well as inner ear, outer ear, and over-the-ear prescription hearing aids, are not covered.
Vision Services See details
DEVOTED GIVEBACK 014 FL (HMO) partially covers vision services, offering one routine eye exam per year with a $0 to $45 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, up to a combined maximum of $350 per year for contacts, eyeglasses, and upgrades.
Dental Services See details
DEVOTED GIVEBACK 014 FL (HMO) partially covers dental services up to $1,250 annually, offering Medicare-covered dental with a $45 copay and no coinsurance, and other covered dental services with no copay and 0% to 50% coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by DEVOTED GIVEBACK 014 FL (HMO) with no copay, though prior authorization is required and step therapy applies. Covered Medicare Part B chemotherapy, radiation, and other drugs require 0% to 20% coinsurance, while Part B insulin drugs have a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
DEVOTED GIVEBACK 014 FL (HMO) covers Dialysis Services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
DEVOTED GIVEBACK 014 FL (HMO) partially covers medical equipment with no copay, requiring 20% to 50% coinsurance for durable medical equipment, no coinsurance to 20% coinsurance for prosthetics and medical supplies, and no coinsurance to 50% coinsurance for diabetic supplies. Prior authorization is required for these covered services, and diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED GIVEBACK 014 FL (HMO) covers diagnostic and radiological services with no copay for lab services and outpatient X-rays, and no coinsurance for diagnostic procedures. Diagnostic procedures and tests have copays ranging from $0 to $125, diagnostic radiological services feature copays starting at $0, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by DEVOTED GIVEBACK 014 FL (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by DEVOTED GIVEBACK 014 FL (HMO) with no coinsurance and require prior authorization. While some services are covered, standard cardiac ($40 copay), intensive cardiac ($40 copay), pulmonary ($35 copay), and SET for PAD ($25 copay) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by DEVOTED GIVEBACK 014 FL (HMO) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and additional days beyond the standard 100-day Medicare limit are not covered.
Other Services See details
Other Services are partially covered by DEVOTED GIVEBACK 014 FL (HMO), which offers additional preventive services and over-the-counter (OTC) items up to $95 every three months with no copay and no coinsurance. Acupuncture, meal benefits, and dual-eligible SNP services are not covered under this plan.
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