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DEVOTED GIVEBACK 009 VA (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED GIVEBACK 009 VA (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED GIVEBACK 009 VA (HMO) in 2026, please refer to our full plan details page.
DEVOTED GIVEBACK 009 VA (HMO) is a HMO plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Greater Richmond Area. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED GIVEBACK 009 VA (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 009 VA (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 009 VA (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 $184.70. 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 $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 $7000.00 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 009 VA (HMO) prescription drug plan features an annual drug deductible of $605. Under this plan, Tier 1 preferred generic drugs have no copay for both standard pharmacy and standard mail-order fills across all supply durations. Tier 2 generic drugs are also highly affordable, with a copay starting at $3.00 for a one-month supply at standard retail pharmacies or through mail order. For brand-name and specialty medications, cost-sharing is based on coinsurance during the initial coverage phase. You will pay a 21% coinsurance for Tier 3 preferred brand drugs, while Tier 4 non-preferred drugs carry a 25% coinsurance. Tier 5 specialty drugs also require a 25% coinsurance for a one-month supply at standard pharmacies and mail-order services.
Additional Benefits
The DEVOTED GIVEBACK 009 VA (HMO) plan offers affordable medical coverage with no copay and no coinsurance for primary care doctor visits, though specialist visits require a $55 copay. For inpatient hospital stays, members pay no coinsurance and a $475 daily copay for days one through three, followed by no copay for days four through ninety. Emergency room visits carry a $115 copay, which is waived if you are admitted to the hospital within 24 hours. This plan also includes key supplemental benefits to help manage your everyday health costs, such as no copay for preventive and comprehensive dental services up to a $250 annual maximum. Vision care features eye exams with no copay to a $55 copay, alongside eyewear coverage with no copay up to a $200 annual limit. Additionally, members receive an over-the-counter allowance of up to $88 every three months to purchase health-related items.
Inpatient Hospital See details
DEVOTED GIVEBACK 009 VA (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $475 daily copay for days 1 through 3 and no copay for days 4 through 90. While unlimited additional acute days are covered, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
DEVOTED GIVEBACK 009 VA (HMO) covers outpatient services with no coinsurance, featuring ambulatory surgical center and blood services with no copay. Outpatient hospital services have a copay of $0 to $575, observation services require a $475 copay per stay, and substance abuse sessions carry a $50 copay.
Partial Hospitalization See details
Partial hospitalization is covered under the DEVOTED GIVEBACK 009 VA (HMO) plan with an $80 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
DEVOTED GIVEBACK 009 VA (HMO) partially covers Ambulance and Transportation Services, as ambulance services are covered under prior authorization but transportation services to health-related locations are not covered. Medicare-covered ground ambulance services require a copay of $0 to $315 and no coinsurance, while air ambulance services require a 20% coinsurance and no copay.
Emergency Services See details
DEVOTED GIVEBACK 009 VA (HMO) covers emergency services with a $115 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours. Urgently needed services feature no copay to a $40 copay with no coinsurance, while worldwide emergency services are covered up to $25,000 with a $115 copay for medical care and a $315 copay plus 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED GIVEBACK 009 VA (HMO) offers primary care physician services with no copay and no coinsurance, while specialist visits require a $55 copay and no coinsurance. Other covered benefits, including physical, occupational, and mental health therapies, feature copays ranging from $35 to $55 with no coinsurance, though chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered under the DEVOTED GIVEBACK 009 VA (HMO) with no copay and no coinsurance. While annual physical exams, fitness benefits, and kidney disease education are covered, several sub-services such as in-home safety assessments, personal emergency response systems (PERS), and therapeutic massages are not covered.
Hearing Services See details
Hearing services are partially covered by DEVOTED GIVEBACK 009 VA (HMO), featuring a $55 copay and no coinsurance for hearing exams, and a copay ranging from $599 to $899 with no coinsurance for prescription hearing aids. OTC hearing aids, as well as inner ear, outer ear, and over-the-ear prescription hearing aids, are not covered.
Vision Services See details
DEVOTED GIVEBACK 009 VA (HMO) vision services are partially covered with no deductibles, offering eye exams with a $0 to $55 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay or coinsurance up to a $200 annual limit for contacts, lenses, frames, and upgrades.
Dental Services See details
DEVOTED GIVEBACK 009 VA (HMO) partially covers dental services, with no coverage for maxillofacial prosthetics, implant services, and orthodontics. Medicare-covered dental services require a $55 copay and no coinsurance, while other covered preventive and comprehensive dental services have no copay and no coinsurance up to a $250 annual maximum.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by DEVOTED GIVEBACK 009 VA (HMO) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs require a coinsurance ranging from no coinsurance to 20% with no copay, while Part B insulin drugs require a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by the DEVOTED GIVEBACK 009 VA (HMO) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
DEVOTED GIVEBACK 009 VA (HMO) partially covers medical equipment with no copays, though prior authorization is required. Durable medical equipment carries a 17% coinsurance, diabetic supplies range from no coinsurance to 17% coinsurance, and prosthetics range from no coinsurance to 20% coinsurance, but diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED GIVEBACK 009 VA (HMO) covers diagnostic and radiological services with prior authorization required. Lab services are available with no copay and no coinsurance, diagnostic tests have a copay of $0 to $95 with no coinsurance, and therapeutic radiological services require a minimum 20% coinsurance plus a copay.
Home Health Services See details
DEVOTED GIVEBACK 009 VA (HMO) covers Home Health Services with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
DEVOTED GIVEBACK 009 VA (HMO) covers Cardiac Rehabilitation Services with no coinsurance, though prior authorization is required. While some services are covered, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by DEVOTED GIVEBACK 009 VA (HMO) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the standard 100-day limit are not covered.
Other Services See details
DEVOTED GIVEBACK 009 VA (HMO) partially covers other services, providing over-the-counter (OTC) items up to $88 every three months and additional preventive services with no copay and no coinsurance. Acupuncture, meal benefits, and other miscellaneous services are not covered under this plan.
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