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DEVOTED GIVEBACK 018 FL (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED GIVEBACK 018 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 018 FL (HMO) in 2026, please refer to our full plan details page.
DEVOTED GIVEBACK 018 FL (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 5 out of 5 stars in 2026.
It's important to know that DEVOTED GIVEBACK 018 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 018 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 018 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 018 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 3-month supply through standard pharmacies and standard mail order. 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 standard pharmacy supply. For brand-name and specialty medications, costs are structured as coinsurance. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs carry a 25% coinsurance at standard pharmacies and mail order. These percentages apply across 1-month, 2-month, and 3-month fills, with specialty tier coverage limited to a 1-month supply.
Additional Benefits
The DEVOTED GIVEBACK 018 FL (HMO) plan offers robust coverage for essential medical needs with no copays for primary care visits, home health services, and routine lab tests or X-rays. Specialist visits require a $45 copay, while inpatient hospital stays cost a daily copay of $395 for the first several days before transitioning to no copay. Emergency room visits carry a $130 copay, which is waived if you are admitted, and urgent care costs range from no copay up to $50. This plan also features valuable supplemental benefits, including up to $1,250 annually for dental care and a $350 yearly allowance for eyewear with no copay. Routine hearing exams require a $45 copay, and prescription hearing aids are covered with copays ranging from $599 to $899. Additionally, members receive a $41 quarterly allowance for over-the-counter items, though medical equipment and dialysis services generally require coinsurance of up to 50% and 20% respectively.
Inpatient Hospital See details
DEVOTED GIVEBACK 018 FL (HMO) covers inpatient hospital services with no coinsurance, requiring a daily copay of $395 for days 1 to 6 for acute stays and days 1 to 5 for psychiatric stays, followed by no copay for subsequent days up to day 90. Prior authorization is required, and while unlimited additional acute days are covered, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED GIVEBACK 018 FL (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and outpatient blood services at no copay. Outpatient hospital services carry a copay ranging from $0 to $395, observation services require a $395 copay per stay, and outpatient substance abuse sessions have a $45 copay.
Partial Hospitalization See details
DEVOTED GIVEBACK 018 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 018 FL (HMO) covers ambulance services with prior authorization, featuring a copay of $0 to $350 and no coinsurance for ground ambulance services, and a 20% coinsurance with no copay for air ambulance services. Transportation services are not covered under this plan.
Emergency Services See details
DEVOTED GIVEBACK 018 FL (HMO) covers emergency services with a $130 copay (waived if admitted within 24 hours) and no coinsurance, and urgently needed services with no coinsurance and a copay ranging from no copay to $50. Worldwide emergency services are covered up to $25,000, requiring a $130 copay and no coinsurance for emergency or urgent care, and a $350 copay with 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED GIVEBACK 018 FL (HMO) covers primary care physician services with no copay and no coinsurance, while specialist visits require a $45 copay and no coinsurance. Physical, occupational, speech, and mental health therapies are covered with copays ranging from $0 to $65 and no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by DEVOTED GIVEBACK 018 FL (HMO) with no copay and no coinsurance for covered care like annual physicals, fitness benefits, and kidney disease education. However, several additional services are not covered, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, therapeutic massages, and in-home support.
Hearing Services See details
Hearing services are covered by DEVOTED GIVEBACK 018 FL (HMO), including routine hearing exams for a $45 copay and no coinsurance. Prescription hearing aids are partially covered with a copay of $599 to $899 and no coinsurance, but OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
DEVOTED GIVEBACK 018 FL (HMO) partially covers vision services with no deductibles, offering one annual routine eye exam with a copay of $0 to $45, no coinsurance, and required prior authorization, while other eye exam services are not covered. Eyewear is covered with no copay or coinsurance up to a $350 yearly maximum for contacts, frames, lenses, and upgrades.
Dental Services See details
DEVOTED GIVEBACK 018 FL (HMO) dental services are partially covered up to a $1,250 annual maximum, featuring a $45 copay and no coinsurance for Medicare-covered dental care. Other covered preventive and comprehensive services have no copay and 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 018 FL (HMO) with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other Part B drugs feature no copay and no coinsurance to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by DEVOTED GIVEBACK 018 FL (HMO) with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Medical Equipment See details
DEVOTED GIVEBACK 018 FL (HMO) covers medical equipment with no copays, though prior authorization is required and coinsurance applies. Durable medical equipment requires 20% to 50% coinsurance, prosthetics and medical supplies range from no coinsurance to 20% coinsurance, and diabetic equipment is partially covered with diabetic supplies requiring no coinsurance to 50% coinsurance while therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED GIVEBACK 018 FL (HMO) with prior authorization required, featuring no copay for lab services and outpatient X-rays. Diagnostic procedures and tests have a copay of $0 to $125 with no coinsurance, diagnostic radiological services have a copay starting at $0, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the DEVOTED GIVEBACK 018 FL (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by DEVOTED GIVEBACK 018 FL (HMO) with no copay and no coinsurance, though prior authorization is required. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by DEVOTED GIVEBACK 018 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, prior hospital stays of less than 3 days are allowed, and additional days beyond the standard 100 days are not covered.
Other Services See details
DEVOTED GIVEBACK 018 FL (HMO) provides partial coverage for other services, featuring over-the-counter (OTC) items up to $41 every three months and additional preventive services with no copay and no coinsurance. Acupuncture, meal benefits, and dual-eligible SNP services are not covered.
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