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Devoted GIVEBACK Oregon (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Devoted GIVEBACK Oregon (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Devoted GIVEBACK Oregon (HMO) in 2025, please refer to our full plan details page.
Devoted GIVEBACK Oregon (HMO) is a HMO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Oregon. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Devoted GIVEBACK Oregon (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 Oregon (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 Oregon (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 $137.60. 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 $7900.00 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 Oregon (HMO) plan has an enhanced alternative drug benefit. The plan has a deductible of $590. After you meet the deductible, you will pay the costs for your drugs in each tier until your total drug costs reach $2,000. For generic drugs at a standard pharmacy, you will pay a $10 copay for preferred generics and 25% coinsurance for standard generics. For brand name and non-preferred drugs, you will pay 25% coinsurance. Once your yearly out-of-pocket drug costs reach $2,000, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Devoted GIVEBACK Oregon (HMO) plan offers a range of benefits with varying costs. Hospital stays have a copay for the first few days, with no copay for most of the stay. Outpatient services have copays that vary depending on the service, and emergency services have a $110 copay. The plan covers primary care, preventive, hearing, vision, and dental services with copays or coinsurance. It also includes coverage for home health, and skilled nursing facilities, with no copay for home health services. There are also several other services, such as acupuncture, that are covered with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization. For days 1-5, there is a $375 copay, and for days 6-90, there is no copay. Additional days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient services are covered by the Devoted GIVEBACK Oregon (HMO) plan, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $475, observation services have a $385 copay, and ambulatory surgical center services have no copay. Individual and group sessions for outpatient substance abuse have a copay of $45.00.
Partial Hospitalization See details
Partial Hospitalization is covered by the Devoted GIVEBACK Oregon (HMO) plan with a $70 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Devoted GIVEBACK Oregon (HMO). 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 under the Devoted GIVEBACK Oregon (HMO) plan. Emergency Services have a $110 copay, and Urgently Needed Services have a copay between $0 and $45. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $110 copay, while Worldwide Emergency Transportation has a $350 copay and 20% coinsurance.
Primary Care See details
The Devoted GIVEBACK Oregon (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. Chiropractic Services has a $15 copay, Occupational Therapy Services has a $35 copay, Physician Specialist Services has a $50 copay, Individual and Group Mental Health and Psychiatric sessions have a $45 copay, and Physical Therapy and Speech-Language Pathology Services has a $50 copay.
Preventive Services See details
The Devoted GIVEBACK Oregon (HMO) plan covers preventive services, including annual physical exams, health education, weight management programs, alternative therapies, therapeutic massage, 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 EKGs with no copay. However, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss, adult day health services, home-based palliative care, in-home support services, support for caregivers, additional sessions of smoking cessation, enhanced disease management, telemonitoring services, remote access technologies, and counseling services are not covered.
Hearing Services See details
Hearing Services include routine hearing exams with a $50 copay, and fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered, with a copay between $599 and $899, but prescription hearing aids for the inner, outer, or over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for eye exams with a $20 copay, as well as coverage for eyewear. Eyewear has a combined maximum benefit of $250 every year and includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames and upgrades.
Dental Services See details
The Devoted GIVEBACK Oregon (HMO) plan covers 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. Medicare Dental Services have a $50 copay, and there is a $250 maximum benefit per year for other dental services. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, you will pay a $35 copay and 20% coinsurance. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, you will pay between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Devoted GIVEBACK Oregon (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits with the Devoted GIVEBACK Oregon (HMO) plan include Durable Medical Equipment (DME) with a 15% coinsurance, Prosthetic Devices with a 0-20% coinsurance, and Medical Supplies with a 15% coinsurance, but Durable Medical Equipment for use outside the home and Diabetic Supplies/Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a copay between $0 and $95, and Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $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 Oregon (HMO) plan with no copay or coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but not covered in practice. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Devoted GIVEBACK Oregon (HMO) plan with prior authorization. For days 1-20 and 61-100, there is no copay, while days 21-60 have a $170 copay. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes acupuncture and other services, but does not cover over-the-counter items, meal benefits, 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. Acupuncture is covered with no copay.
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