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DEVOTED GIVEBACK 008 TN (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED GIVEBACK 008 TN (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED GIVEBACK 008 TN (HMO) in 2026, please refer to our full plan details page.
DEVOTED GIVEBACK 008 TN (HMO) is a HMO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Nashville. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that DEVOTED GIVEBACK 008 TN (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 008 TN (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 008 TN (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 $123.30. 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 $8500.00 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 008 TN (HMO) Medicare plan features an annual prescription drug deductible of $605. You will pay no copay for Tier 1 preferred generic drugs filled at standard pharmacies or through standard mail order for up to a 3-month supply. Tier 2 generic drugs are also highly affordable, with copays starting at $3 for a 1-month supply and capping at $9 for a 3-month retail supply or $7.50 for a 3-month mail order. Higher-tier medications under this plan are subject to coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs carry a 25% coinsurance. These coinsurance rates apply to both standard pharmacy and standard mail-order services, with specialty drugs limited to a 1-month supply.
Additional Benefits
The DEVOTED GIVEBACK 008 TN (HMO) plan offers robust coverage for essential medical services with predictable out-of-pocket costs, featuring no copay and no coinsurance for primary care visits, preventive services, and home health care. For specialist visits, physical therapy, and mental health services, members will pay a copay between $35 and $50 with no coinsurance. Inpatient hospital stays require a $425 daily copay for the first few days and no copay thereafter, while emergency room visits carry a $115 copay that is waived if admitted. Ancillary benefits include routine dental and vision care with no copay and no coinsurance up to specific annual limits, though routine hearing exams and hearing aids require fixed copays. Diagnostic services such as lab tests, X-rays, and home health visits are available with no copay, whereas durable medical equipment and dialysis services generally require a 20% coinsurance. Skilled nursing facility stays are also covered with no copay for the first 20 days, followed by a daily copay of $218 for days 21 through 100.
Inpatient Hospital See details
DEVOTED GIVEBACK 008 TN (HMO) covers inpatient hospital services with no coinsurance, requiring a $425 daily copay for days 1 to 5 of acute stays and days 1 to 4 of psychiatric stays, with no copay for subsequent days. This benefit is partially covered because non-Medicare-covered stays, hospital upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by DEVOTED GIVEBACK 008 TN (HMO) with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $525, observation services carry a $425 copay per stay, and outpatient substance abuse sessions have a $50 copay, with prior authorization required for most services.
Partial Hospitalization See details
DEVOTED GIVEBACK 008 TN (HMO) covers partial hospitalization services with a $65.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
DEVOTED GIVEBACK 008 TN (HMO) covers ground ambulance services with a copay ranging from no copay to $315 and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Prior authorization is required for ambulance services, and transportation services to health-related locations are not covered.
Emergency Services See details
DEVOTED GIVEBACK 008 TN (HMO) covers emergency services with a $115 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgently needed services with no copay to a $40 copay and no coinsurance. Worldwide emergency and urgent services are also covered up to a $25,000 limit with a $115 copay and no coinsurance, while worldwide emergency transportation costs a $315 copay and 20% coinsurance.
Primary Care See details
DEVOTED GIVEBACK 008 TN (HMO) provides primary care physician services with no copay and no coinsurance, while telehealth benefits range from no copay to a $50 copay with no coinsurance. Specialist visits, physical and occupational therapy, mental health, psychiatric, and opioid treatment services require copays between $35 and $50 with no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by DEVOTED GIVEBACK 008 TN (HMO) with no copay and no coinsurance, including annual physical exams, kidney disease education, and select fitness and nutritional benefits. However, additional preventive benefits are only partially covered, excluding in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, therapeutic massage, adult day health, home palliative care, in-home support, caregiver support, extra smoking cessation, enhanced disease management, telemonitoring, remote access, and counseling services.
Hearing Services See details
DEVOTED GIVEBACK 008 TN (HMO) partially covers hearing services, providing routine hearing exams for a $50 copay and no coinsurance, and prescription hearing aids with copays from $599 to $899 and no coinsurance. Over-the-counter (OTC) hearing aids, as well as inner ear, outer ear, and over-the-ear prescription hearing aids, are not covered under this plan.
Vision Services See details
DEVOTED GIVEBACK 008 TN (HMO) offers partially covered vision services, featuring one routine eye exam per year with no copay to a $50 copay and no coinsurance, while other eye exam services are not covered. Eyewear, including contacts, lenses, frames, and upgrades, is covered with no copay and no coinsurance up to a $200 annual maximum.
Dental Services See details
Dental services are partially covered by DEVOTED GIVEBACK 008 TN (HMO), offering most preventive and comprehensive services with no copay and no coinsurance up to a $250 annual limit. Medicare-covered dental services require a $50 copay and no coinsurance, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED GIVEBACK 008 TN (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B drugs, such as chemotherapy and insulin, carry a coinsurance ranging from no coinsurance up to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered by the DEVOTED GIVEBACK 008 TN (HMO) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Medical equipment is partially covered by DEVOTED GIVEBACK 008 TN (HMO) with no copays and prior authorization required. Durable medical equipment has a 20% coinsurance, while prosthetics, medical supplies, and diabetic supplies range from no coinsurance to 20% coinsurance, though diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED GIVEBACK 008 TN (HMO) covers diagnostic and radiological services with prior authorization, offering no coinsurance and a copay ranging from no copay to $95 for diagnostic tests and procedures. Lab services, outpatient X-rays, and diagnostic radiological services feature no copay, while therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the DEVOTED GIVEBACK 008 TN (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the DEVOTED GIVEBACK 008 TN (HMO) plan. This includes standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) rehabilitation services, which are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
DEVOTED GIVEBACK 008 TN (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day hospital stay required, though prior authorization is necessary. There is no copay for days 1 through 20, and a $218 daily copay for days 21 through 100, while additional days beyond the standard Medicare benefit are not covered.
Other Services See details
DEVOTED GIVEBACK 008 TN (HMO) provides partial coverage for Other Services, offering additional preventive services not covered by Medicare with no copay and no coinsurance. However, other sub-services such as acupuncture, over-the-counter (OTC) items, and meal benefits are not covered under this plan.
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