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Devoted GIVEBACK Florida (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Devoted GIVEBACK Florida (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Devoted GIVEBACK Florida (HMO) in 2025, please refer to our full plan details page.
Devoted GIVEBACK Florida (HMO) is a HMO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Osceola, Seminole, and Orange Counties. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Devoted GIVEBACK Florida (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 Florida (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 Florida (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 $174.70. 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 $590.00 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 Florida (HMO) plan has a $590 deductible for prescription drugs. After meeting the deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy used. For example, in the initial coverage phase, you may pay a $5 copay for preferred generic drugs at a standard or mail-order pharmacy. For standard generic, preferred brand, and non-preferred drugs, you will pay 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Devoted GIVEBACK Florida (HMO) plan offers a wide range of benefits, including inpatient and outpatient hospital services, with varying copays depending on the service. The plan also covers primary care, preventive, hearing, vision, and dental services, with copays ranging from $0 to $45 for many services, and a $1,000 maximum benefit for eyewear and dental services. Additionally, the plan provides coverage for ambulance, emergency, and home health services, and covers home infusion and dialysis services with a copay or coinsurance.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $395 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you pay a $395 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $395, observation services with a $395 copay, and ambulatory surgical center services with no copay. This plan also covers outpatient substance abuse services with a $45 copay for both individual and group sessions, as well as outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Devoted GIVEBACK Florida (HMO) plan with a $55 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Devoted GIVEBACK Florida (HMO) plan. Ground ambulance services have a copay between $0 and $350, and air ambulance services have a 20% coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Devoted GIVEBACK Florida (HMO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a copay between $0 and $55. Worldwide Emergency Transportation has a $350 copay and 20% coinsurance, while Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay.
Primary Care See details
The Devoted GIVEBACK Florida (HMO) plan covers Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Chiropractic services have a $20 copay, Physician Specialist Services and Additional Telehealth Benefits have a copay between $0-$45, Occupational Therapy Services, Individual and Group Sessions for Mental Health Specialty Services, and Individual and Group Sessions for Psychiatric Services have a $45 copay, Physical Therapy and Speech-Language Pathology Services have a copay between $45-$65, and Opioid Treatment Program Services have a $45 copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
The Devoted GIVEBACK Florida (HMO) plan covers preventive services, including annual physical exams, health education, weight management programs, alternative therapies, nutritional/dietary benefits, fitness benefits, home and bathroom safety devices and modifications, kidney disease education, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit. However, in-home safety assessment, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, therapeutic massage, adult day health services, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, and counseling services are not covered.
Hearing Services See details
Hearing Services are covered by the Devoted GIVEBACK Florida (HMO) plan, including routine hearing exams with a $35 copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered; Prescription Hearing Aids (all types) are covered with a copay between $0 - $299, while other types of prescription hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Devoted GIVEBACK Florida (HMO) plan covers vision services including eye exams with a $35 copay. The plan also covers eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. The plan has a combined maximum benefit of $1000 for all eyewear every year.
Dental Services See details
Devoted GIVEBACK Florida (HMO) covers dental services, with a $45 copay for Medicare dental services. Other dental services, including oral exams, dental x-rays, and more, are covered with a $1,000 maximum benefit per year. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, but require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a 20% coinsurance. For Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Devoted GIVEBACK Florida (HMO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance of 0% to 20%, Prosthetics/Medical Supplies with a coinsurance for Medicare-covered services, and Diabetic Equipment. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, and outpatient X-ray services, are covered. Diagnostic Procedures/Tests have a copay between $0 and $125, while Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $300. Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Devoted GIVEBACK Florida (HMO) plan with no copay or coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Devoted GIVEBACK Florida (HMO) plan. Despite the general coverage, the plan does not cover any of the sub-services including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services are covered, but acupuncture, over-the-counter items, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered. Other 2 benefits are covered, and preventive services have no copay.
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