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DEVOTED GIVEBACK 015 FL (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED GIVEBACK 015 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 015 FL (HMO) in 2026, please refer to our full plan details page.
DEVOTED GIVEBACK 015 FL (HMO) is a HMO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Palm Beach County. This plan received an overall rating of 5 out of 5 stars in 2026.
It's important to know that DEVOTED GIVEBACK 015 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 015 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 015 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 015 FL (HMO) Medicare plan features an annual prescription drug deductible of $605. Under this plan, Tier 1 preferred generic drugs have no copay for 1-month, 2-month, and 3-month supplies at standard pharmacies and standard mail-order services. Tier 2 generic drugs are also highly affordable, requiring a $5.00 copay for a 1-month supply and up to a $15.00 copay for a 3-month supply. For brand-name and specialty medications, costs are based on coinsurance rather than flat copays. 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 at standard pharmacies and standard mail order. This straightforward cost structure helps beneficiaries clearly calculate their potential out-of-pocket expenses.
Additional Benefits
The DEVOTED GIVEBACK 015 FL (HMO) plan offers robust coverage with low out-of-pocket costs, featuring no copays for primary care visits, preventive care, routine eye exams, and home health services. For specialized care, members pay predictable flat fees, including a $45 copay for specialist visits and a $130 copay for emergency room services. Inpatient hospital stays require a $395 daily copay for the first few days followed by no copay, while skilled nursing facility stays are covered with no copay for the first 20 days. This plan also includes valuable supplemental benefits, such as dental coverage up to a $1,250 yearly limit with no copay for preventive care and a $350 annual allowance for eyewear. Additionally, members receive a $62 quarterly over-the-counter allowance and enjoy no copays on laboratory tests and outpatient X-rays. Standard medical equipment and dialysis services are covered with coinsurance ranging up to 50% and 20% respectively, with no copays required.
Inpatient Hospital See details
Inpatient hospital services are covered by DEVOTED GIVEBACK 015 FL (HMO) with no coinsurance, requiring a $395 daily copay for days 1 through 6 for acute stays and days 1 through 5 for psychiatric stays, followed by no copay for the remaining days of your stay. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED GIVEBACK 015 FL (HMO) covers outpatient services with no coinsurance, including no copays for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay of $0 to $395, observation services carry a $395 copay per stay, and outpatient substance abuse sessions have a $45 copay.
Partial Hospitalization See details
Partial hospitalization services are covered by DEVOTED GIVEBACK 015 FL (HMO) with a $55.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services under DEVOTED GIVEBACK 015 FL (HMO) cover ground ambulance services with a $0 to $350 copay plus coinsurance, and air ambulance services with a 20% coinsurance plus a copay, both requiring prior authorization. Transportation services to plan-approved or health-related locations are not covered.
Emergency Services See details
DEVOTED GIVEBACK 015 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, and urgently needed services with a copay ranging from no copay up to $50 and no coinsurance. Worldwide emergency and urgent services are covered with a $130 copay and no coinsurance, while worldwide emergency transportation has a $350 copay and 20% coinsurance, up to a $25,000 maximum plan benefit limit.
Primary Care See details
DEVOTED GIVEBACK 015 FL (HMO) provides primary care physician services with no copay and no coinsurance, and specialist visits for a $45 copay and no coinsurance. Physical, occupational, and speech therapies require copays of $45 to $65 and no coinsurance, while podiatry is not covered, and chiropractic services cover some services with a $15 copay and no coinsurance, though routine and other chiropractic services are not covered.
Preventive Services See details
DEVOTED GIVEBACK 015 FL (HMO) provides partial coverage for preventive services with no copay and no coinsurance for all covered options, including annual physical exams, fitness benefits, and dietary services. However, several additional benefits are not covered, such as in-home support, personal emergency response systems (PERS), caregiver support, and therapeutic massages.
Hearing Services See details
DEVOTED GIVEBACK 015 FL (HMO) covers hearing exams with a $45 copay and no coinsurance, including one routine exam yearly and unlimited fitting evaluations. Prescription hearing aids are partially covered with a $599 to $899 copay and no coinsurance for up to two devices per year, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by DEVOTED GIVEBACK 015 FL (HMO), offering one routine eye exam per year with no copay and no coinsurance, though other eye exam services are not covered. Covered eyewear, including contacts, eyeglasses, and upgrades, has no copay and no coinsurance up to a $350 annual maximum.
Dental Services See details
DEVOTED GIVEBACK 015 FL (HMO) dental services are partially covered up to a $1,250 yearly maximum, featuring no copay and no coinsurance for preventive care, periodontics, and oral surgery. Medicare-covered dental services require a $45 copay and no coinsurance, and comprehensive services carry no copay with 0% to 50% coinsurance, though maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by DEVOTED GIVEBACK 015 FL (HMO) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, insulin, and other drugs have no minimum coinsurance and up to 20% coinsurance, with Part B insulin drugs also carrying a $35 copay.
Dialysis Services See details
Dialysis Services are covered by DEVOTED GIVEBACK 015 FL (HMO) with no copay and a 20% coinsurance, subject to prior authorization requirements.
Medical Equipment See details
DEVOTED GIVEBACK 015 FL (HMO) covers durable medical equipment, prosthetics, and medical supplies with no copays and coinsurance ranging from no coinsurance up to 50%, depending on the service. Diabetic equipment is partially covered under this plan, offering diabetic supplies with no copay and up to 50% coinsurance, though diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED GIVEBACK 015 FL (HMO) with no copay for lab services and outpatient X-rays, and no coinsurance for diagnostic tests. Diagnostic procedures and tests have a copay ranging from $0 to $125, while diagnostic radiological services have a $0 minimum copay and therapeutic radiological services require a 20% coinsurance. Prior authorization is required for these covered services.
Home Health Services See details
Home Health Services are covered under the DEVOTED GIVEBACK 015 FL (HMO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by DEVOTED GIVEBACK 015 FL (HMO) with no coinsurance, though some services are covered while cardiac ($40 copay), intensive cardiac ($40 copay), pulmonary ($35 copay), and SET for PAD ($25 copay) services are not covered.
Skilled Nursing Facility (SNF) See details
DEVOTED GIVEBACK 015 FL (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare benefit are not covered.
Other Services See details
DEVOTED GIVEBACK 015 FL (HMO) partially covers other services, providing additional preventive services and over-the-counter (OTC) items with no copay and no coinsurance. While members receive a maximum OTC benefit of $62 every three months, acupuncture and meal benefits are not covered under this plan.
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