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DEVOTED GIVEBACK 002 AL (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED GIVEBACK 002 AL (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED GIVEBACK 002 AL (HMO) in 2026, please refer to our full plan details page.
DEVOTED GIVEBACK 002 AL (HMO) is a HMO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Alabama. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that DEVOTED GIVEBACK 002 AL (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 002 AL (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 002 AL (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 $135.50. 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 002 AL (HMO) plan features an Enhanced Alternative drug benefit with an annual prescription drug deductible of $605. After meeting this deductible, you enter the initial coverage phase, where Tier 1 preferred generic drugs require a $3 copay at standard pharmacies and standard mail. During this phase, you will pay a 22% coinsurance for Tier 2 standard generics, and a 25% coinsurance for Tier 3 preferred brands and Tier 4 non-preferred drugs. Once your annual out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and will have no copay for covered Part D prescriptions. Additionally, if you qualify for the low-income subsidy, also known as Extra Help, you will have no copay for your Part D costs.
Additional Benefits
The DEVOTED GIVEBACK 002 AL (HMO) plan offers essential medical coverage, featuring no copay for preventive services, annual physicals, and lab work, with primary care copays ranging from no copay up to $50. For inpatient hospital stays, members pay a daily copay of $445 for the first five days and no copay for days six through 90. Outpatient surgical services are covered with no copay, while other outpatient hospital services may require copays ranging from no copay to $545. This plan also provides specialty benefits, including vision exams with no copay to a $45 copay, a $100 annual eyewear allowance, and dental coverage up to a $250 annual limit. Routine hearing exams require a $45 copay, while prescription hearing aids are covered with copays ranging from $599 to $899. Additionally, durable medical equipment is available with no copay and a 20% to 50% coinsurance.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by DEVOTED GIVEBACK 002 AL (HMO) with a daily copay of $445 for days 1 through 5 and no copay or coinsurance for days 6 through 90. Non-Medicare-covered stays, acute hospital upgrades, and additional days for psychiatric stays are not covered under this plan.
Outpatient Services See details
Outpatient services are covered by DEVOTED GIVEBACK 002 AL (HMO) with no coinsurance, featuring no copay for ambulatory surgical center services and a copay ranging from $0 to $545 for outpatient hospital services. Patients will also pay a $445 copay per stay for observation services, a $45 copay for outpatient substance abuse sessions, and no deductible for outpatient blood services.
Partial Hospitalization See details
DEVOTED GIVEBACK 002 AL (HMO) covers partial hospitalization benefits with a $70.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by DEVOTED GIVEBACK 002 AL (HMO), as transportation services to plan-approved or any health-related locations are not covered. Covered ground ambulance services require a copay ranging from no copay to $350 plus a coinsurance, while air ambulance services require a 20% coinsurance and a copay.
Emergency Services See details
Emergency services are covered by DEVOTED GIVEBACK 002 AL (HMO) with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require no copay to a $45 copay and no coinsurance, while worldwide emergency services are covered up to $25,000 with copays up to $350 and 20% coinsurance for worldwide transportation.
Primary Care See details
Primary Care benefits are partially covered by DEVOTED GIVEBACK 002 AL (HMO), featuring no coinsurance and copays ranging from no copay up to $50 for covered services. Podiatry services and routine chiropractic care are not covered under this plan.
Preventive Services See details
Preventive services are covered by DEVOTED GIVEBACK 002 AL (HMO) with no copay and no coinsurance for Medicare-covered zero-dollar services and annual physical exams. Additional benefits are partially covered, excluding in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, therapeutic massage, adult day health, palliative care, in-home support, caregiver support, extra smoking cessation sessions, disease management, telemonitoring, remote access, and counseling. Covered additional services include fitness, alternative therapies, weight management, and home safety devices.
Hearing Services See details
Hearing services are partially covered by DEVOTED GIVEBACK 002 AL (HMO), featuring a $45 copay and no coinsurance for routine hearing exams, and a $599 to $899 copay and no coinsurance for prescription hearing aids. OTC hearing aids, as well as prescription hearing aids for the inner ear, outer ear, and over the ear, are not covered.
Vision Services See details
DEVOTED GIVEBACK 002 AL (HMO) covers vision services, offering eye exams with copays ranging from no copay to $45 and no coinsurance. The plan also includes a combined $100 annual maximum allowance for eyewear, including contacts and eyeglasses, with no copays or coinsurance.
Dental Services See details
DEVOTED GIVEBACK 002 AL (HMO) provides partially covered dental services, which include Medicare-covered dental care for a $45 copay and no coinsurance. Other covered dental services are limited to a $250 annual maximum, though maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED GIVEBACK 002 AL (HMO) covers Home Infusion bundled Services with prior authorization, requiring no coinsurance to 20% coinsurance and no copay for chemotherapy, radiation, and other Part B drugs. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by DEVOTED GIVEBACK 002 AL (HMO) with a 20% coinsurance and no copay. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment is covered by DEVOTED GIVEBACK 002 AL (HMO) with no copays, featuring a 20% to 50% coinsurance for durable medical equipment and no coinsurance to 20% coinsurance for prosthetics and medical supplies. Diabetic equipment is partially covered, offering diabetic supplies with no copay and no coinsurance to 50% coinsurance, while diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED GIVEBACK 002 AL (HMO) covers diagnostic and radiological services with prior authorization required. Lab services and outpatient X-rays have no copay, diagnostic tests carry a $0 to $95 copay, diagnostic radiology ranges from a $0 to $300 copay, and therapeutic radiology requires 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the DEVOTED GIVEBACK 002 AL (HMO) plan, with prior authorization required to receive these services.
Cardiac Rehabilitation Services See details
DEVOTED GIVEBACK 002 AL (HMO) does not cover Cardiac Rehabilitation Services, meaning members are responsible for the full cost of these services. All sub-services, including intensive cardiac, pulmonary, and SET for PAD rehabilitation, are excluded from coverage.
Skilled Nursing Facility (SNF) See details
DEVOTED GIVEBACK 002 AL (HMO) partially covers Skilled Nursing Facility (SNF) services, with prior authorization required and additional days beyond Medicare-covered days not covered. For covered stays, there is no copay and no coinsurance for days 1 through 20, and a $218 daily copay with no coinsurance for days 21 through 100.
Other Services See details
Other Services are partially covered by DEVOTED GIVEBACK 002 AL (HMO), which covers additional preventive services not covered by Medicare with no maximum benefit limit and no specified copay or coinsurance. However, acupuncture, over-the-counter (OTC) items, meal benefits, and dual eligible SNPs with highly integrated services are not covered.
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