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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 Clay, Duval, Nassau, and St. Johns 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 the deductible is met, you will pay for your prescriptions based on the drug tier and pharmacy. For the initial coverage phase, you may pay a $1 copay for preferred generic drugs at standard and mail order pharmacies. Standard generic drugs, preferred brand drugs, and non-preferred drugs have a 25% coinsurance. After your yearly out-of-pocket drug costs reach $2000, you will enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Devoted GIVEBACK Florida (HMO) plan offers a wide range of benefits. This plan covers inpatient hospital stays with a copay, outpatient services with copays up to $395, and emergency services with a $125 copay. The plan also includes coverage for primary care with no copay, hearing services with a $45 copay for exams, and vision services with a $45 copay for eye exams and coverage for eyewear up to $1100 per year. Dental services are covered with a maximum plan benefit of $1,100 per year, and there is also coverage for home health and skilled nursing facility services.
Inpatient Hospital See details
Inpatient Hospital services are covered. For Inpatient Hospital-Acute, you pay a $395 copay for days 1-6, and no copay for days 7-90. Inpatient Hospital Psychiatric has 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, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services with the Devoted GIVEBACK Florida (HMO) plan covers all outpatient hospital services, with copays ranging from $0 to $395 for outpatient hospital services, and a $395 copay for observation services. Ambulatory Surgical Center (ASC) Services have no copay, while Individual and Group Sessions for Outpatient Substance Abuse have a copay of $45. Outpatient Blood Services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Devoted GIVEBACK Florida (HMO) plan, requiring prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Devoted GIVEBACK Florida (HMO) plan, with a copay of $0-$350 for ground ambulance services and 20% coinsurance for air ambulance services. 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. Emergency Services have a $125 copay with no coinsurance. Urgently Needed Services have a copay between $0 and $55 with no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, and Worldwide Emergency Transportation has a $350 copay and 20% coinsurance.
Primary Care See details
The Devoted GIVEBACK Florida (HMO) plan covers primary care services, including primary care physician services, with no copay. Chiropractic services have a $20 copay. Occupational therapy services have a copay ranging from $0-$45, and physician specialist services have a $45 copay. Mental health and psychiatric individual and group sessions have a $45 copay. Physical therapy and speech-language pathology services have a copay ranging from $0-$65. Additional telehealth benefits have a copay ranging from $0-$45, and opioid treatment program services have a $45 copay.
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 services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit. In-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission 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 hearing exams with a $45 copay. Prescription hearing aids are covered with a copay between $199 and $499, and the plan does not cover prescription hearing aids for the inner ear, outer ear, and over the ear.
Vision Services See details
Vision services include eye exams with a $45 copay, as well as coverage for eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. This plan offers a combined maximum of $1100 for eyewear per year.
Dental Services See details
The Devoted GIVEBACK Florida (HMO) plan covers dental services, including oral exams with a $45 copay, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery. This plan does not cover maxillofacial prosthetics, implant services, or orthodontics. There is a maximum plan benefit of $1,100 per year for other dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Devoted GIVEBACK Florida (HMO) plan, requiring prior authorization. Medicare Part B Insulin Drugs have a $35 copay and 20% coinsurance, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Devoted GIVEBACK Florida (HMO) plan. The coinsurance for Dialysis Services is between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered by the Devoted GIVEBACK Florida (HMO) plan. Durable Medical Equipment (DME) has a coinsurance between 0% and 40%, while Prosthetic Devices have a coinsurance between 0% and 20%, and Medical Supplies have a 20% coinsurance; there is no copay for any of these services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Devoted GIVEBACK Florida (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $125, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $300, and Therapeutic Radiological Services have a 20% coinsurance. 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 and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Devoted GIVEBACK Florida (HMO) plan. This includes Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Devoted GIVEBACK Florida (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services are not covered, including acupuncture, over-the-counter items, and meal benefits. Some additional services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and Private Duty Nursing Services are also not covered.
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