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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 Manatee. 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. Once you meet the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For Tier 1 drugs, you will pay a $5 copay at a standard pharmacy or through mail order. For other tiers, you will pay 25% coinsurance. After 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 comprehensive coverage with a variety of benefits. Inpatient hospital stays have a copay, but outpatient services and ambulatory surgical centers have no copay. Emergency services have a copay, and primary care, including specialist visits, have varying copays. The plan also includes coverage for hearing, vision, and dental services, with copays for exams and services. Medical equipment, home health, and skilled nursing facilities are covered with varying cost-sharing. Many other services are also covered, and some services require prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $395 copay for days 1-6, and no copay for days 7-90. For Inpatient Hospital Psychiatric, you will pay a $395 copay for days 1-5, and no copay for days 6-90.
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. Outpatient substance abuse services have a $45 copay for both individual and group sessions, and outpatient blood services are also covered.
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, with prior authorization required for all ambulance services. Ground Ambulance Services have a copay of $0-$350, while Air Ambulance Services have a 20% coinsurance, and 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, and the copay is waived if admitted to the hospital within 24 hours. Urgently Needed Services have a copay between $0 and $55 with no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage each have a $125 copay, while Worldwide Emergency Transportation has a $350 copay and 20% coinsurance.
Primary Care See details
The Devoted GIVEBACK Florida (HMO) plan covers Primary Care Physician Services, Chiropractic Services (with a $20 copay), Occupational Therapy Services (with a $0-$45 copay), Physician Specialist Services (with a $0-$45 copay), Mental Health Specialty Services (minimum $45 copay), Other Health Care Professional (with a $0-$45 copay), Psychiatric Services (minimum $45 copay), Physical Therapy and Speech-Language Pathology Services (with a $0-$65 copay), Additional Telehealth Benefits (with a $0-$45 copay), and Opioid Treatment Program Services (minimum $45 copay). Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive Services are covered, including Medicare-covered zero dollar preventive services, annual physical exams, and additional preventive services. Some services such as In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), and Counseling Services are not covered.
Hearing Services See details
Hearing services include routine hearing exams with a $45 copay and prescription hearing aids with a copay between $599 and $899 for all types, but prescription hearing aids for the inner, outer, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The Devoted GIVEBACK Florida (HMO) plan covers vision services including routine eye exams with a $45 copay, eyewear with a combined maximum benefit of $500 per year, and contact lenses. The plan also covers eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
The Devoted GIVEBACK Florida (HMO) plan covers Medicare Dental Services with a $45 copay, and other dental services including oral exams, 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. The plan does not cover maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 20% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Devoted GIVEBACK Florida (HMO) plan. The coinsurance for these services is between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 30%, and Prosthetics/Medical Supplies with no copay and coinsurance for Medicare-covered services. Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
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, and Lab Services have no copay. Diagnostic Radiological Services have a maximum copay of $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, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Devoted GIVEBACK Florida (HMO) plan. While some services are listed as having a copay, the plan does not cover any of the listed sub-services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered under 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 per day; additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services are not covered for 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. Other Services, including preventive services, are covered with no copay.
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