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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 Brevard, Indian River, Martin, St. Lucie 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'll pay a copay or coinsurance for your medications. For Tier 1 preferred generic drugs, you'll pay a $5 copay at standard and mail order pharmacies. For other tiers, you'll pay 25% coinsurance at standard and mail order pharmacies. After your total drug costs reach $2000, you will enter the catastrophic coverage phase, where you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Devoted GIVEBACK Florida (HMO) plan offers a wide range of benefits with varying costs. Inpatient hospital stays require a copay, with costs varying based on the type of care. Outpatient services have copays ranging from $0 to $395, and primary care services have copays between $0 and $65. The plan also includes coverage for preventive services with no copay, hearing and vision services, and dental services with a $45 copay for exams. Ambulance, emergency, and home health services are covered, with some requiring copays or coinsurance. However, the plan does not cover certain services like cardiac rehabilitation, and some "other services".
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; additional days are covered with no copay. For Inpatient Hospital Psychiatric, you pay a $395 copay for days 1-5 and no copay for days 6-90; additional days are not covered.
Outpatient Services See details
Outpatient Services for the Devoted GIVEBACK Florida (HMO) plan includes coverage for outpatient hospital services with a copay ranging from $0 to $395, and observation services with a $395 copay. Ambulatory Surgical Center (ASC) Services have no copay, and Outpatient Substance Abuse Services, including individual and group sessions, have a copay of $45. Outpatient Blood Services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Devoted GIVEBACK Florida (HMO) plan, with a $60 copay. 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; however, 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 under the Devoted GIVEBACK Florida (HMO) plan. Emergency Services has a $125 copay and no coinsurance, while Urgently Needed Services has a copay between $0 and $55, and no coinsurance. Worldwide Emergency Services includes Worldwide Emergency Coverage with a $125 copay and no coinsurance, Worldwide Urgent Coverage with a $125 copay and no coinsurance, and Worldwide Emergency Transportation with a $350 copay and 20% coinsurance.
Primary Care See details
The Devoted GIVEBACK Florida (HMO) plan covers primary care physician services, chiropractic services, occupational therapy, physician specialist services, mental health services, other health care professionals, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment services. Chiropractic services have a $20 copay, while occupational therapy has a copay between $0 and $45. Physician specialist services, and additional telehealth benefits have a copay between $0 and $45. Mental health individual and group sessions, psychiatric individual and group sessions, and opioid treatment services have a $45 copay. Physical therapy and speech-language pathology services have a copay between $0 and $65.
Preventive Services See details
The Devoted GIVEBACK Florida (HMO) plan covers preventive services, including an annual physical exam, with no copay, as well as 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 an EKG following a welcome visit. However, in-home safety assessments, personal emergency response systems (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, 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 include hearing exams with a $45 copay, and routine hearing exams covered once per year with no copay. Prescription hearing aids are covered with a copay between $0 and $299, but inner ear, outer ear, and over the ear 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 $45 copay, eyewear with a combined maximum benefit of $1000 per year, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Routine eye exams are covered once 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 with no copay. Orthodontic services are covered under Diagnostic and Preventive Dental. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and 20% coinsurance. 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 these services is between 20% and 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME) and Prosthetics/Medical Supplies, is covered by the Devoted GIVEBACK Florida (HMO) plan. DME has a coinsurance between 0% and 30%, and Prosthetic Devices have a coinsurance between 0% and 20%, while Medical Supplies have a 20% coinsurance; there is no copay for any of these services. However, Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
The Devoted GIVEBACK Florida (HMO) plan covers diagnostic and radiological services, including diagnostic procedures/tests with a copay between $0 and $125, and lab services with no copay. Radiological services are covered, with a copay for diagnostic services up to $300, no copay for outpatient X-rays, and 20% coinsurance for therapeutic services.
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. The plan does not cover any cardiac rehabilitation services, including 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. You will have no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services are not covered, including acupuncture, over-the-counter items, and meal benefits. Additionally, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), and several other services are not covered.
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