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DEVOTED GIVEBACK 006 TX (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED GIVEBACK 006 TX (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED GIVEBACK 006 TX (HMO) in 2026, please refer to our full plan details page.
DEVOTED GIVEBACK 006 TX (HMO) is a HMO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Houston. This plan received an overall rating of 5 out of 5 stars in 2026.
It's important to know that DEVOTED GIVEBACK 006 TX (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 006 TX (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 006 TX (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 $7200.00 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 006 TX (HMO) Medicare plan features an annual prescription drug deductible of $605. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 2 generic medications filled at standard pharmacies or through standard mail-order services. This cost-free coverage applies to one-month, two-month, and three-month supplies of these generic drugs. For brand-name and specialty prescriptions, costs are calculated as a percentage of the drug price. You can expect a 24% coinsurance for Tier 3 preferred brand drugs and a 25% coinsurance for Tier 4 non-preferred drugs. Tier 5 specialty medications also carry a 25% coinsurance, which is limited to a one-month supply at standard pharmacies and mail-order services.
Additional Benefits
The DEVOTED GIVEBACK 006 TX (HMO) plan offers robust medical coverage with no copay for primary care visits, home health services, and preventive care. For specialist visits, emergency care, and diagnostic services, you will generally pay predictable copays with no coinsurance, such as a $115 copay for emergency room visits and up to a $50 copay for specialists. Inpatient hospital stays require a $425 daily copay for the first few days, after which there is no copay, while outpatient hospital services carry copays ranging from no copay up to $525. This plan also includes key supplemental benefits to lower your out-of-pocket costs, featuring no copay for preventive dental up to a $250 annual limit and a $400 annual allowance for eyewear with no copay. Hearing exams and prescription hearing aids are covered with no deductible and low copays, and you receive up to a $200 allowance every three months for over-the-counter items with no copay. For medical equipment and dialysis, you will pay no copay and coinsurance ranging up to 20 percent.
Inpatient Hospital See details
DEVOTED GIVEBACK 006 TX (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 remaining days. Unlimited additional days are covered for acute stays, though upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
DEVOTED GIVEBACK 006 TX (HMO) covers outpatient services with no coinsurance, offering ambulatory surgical center and blood services with no copay. Outpatient hospital services require a copay of $0 to $525, observation services have a $425 copay per stay, and outpatient substance abuse sessions have a $45 copay.
Partial Hospitalization See details
Partial hospitalization is covered under the DEVOTED GIVEBACK 006 TX (HMO) plan with a $60.00 copay and no coinsurance. Prior authorization is required for this service.
Ambulance and Transportation Services See details
DEVOTED GIVEBACK 006 TX (HMO) covers ground ambulance services with a copay ranging from no copay to $375 and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Prior authorization is required for all ambulance services, and transportation services are not covered.
Emergency Services See details
DEVOTED GIVEBACK 006 TX (HMO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are 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 and no coinsurance for emergency or urgent care, and a $375 copay plus 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED GIVEBACK 006 TX (HMO) covers primary care physician visits with no copay and no coinsurance, while other services like specialist visits, mental health care, and physical therapy require copays ranging from $0 to $50 with no coinsurance. Chiropractic and podiatry services are not covered under this plan.
Preventive Services See details
Preventive services are covered under the DEVOTED GIVEBACK 006 TX (HMO) plan with no copay and no coinsurance for services like annual physicals and fitness benefits. This benefit is partially covered, as it excludes in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access technologies, and counseling.
Hearing Services See details
Hearing services are covered by DEVOTED GIVEBACK 006 TX (HMO) with no deductible, featuring routine exams for a $45 copay and fitting evaluations with no copay, both with no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from no copay to $299, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
DEVOTED GIVEBACK 006 TX (HMO) partially covers vision services, offering one routine eye exam per year with a $0 to $45 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $400 annual maximum for contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
DEVOTED GIVEBACK 006 TX (HMO) covers dental services with a $45 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for preventive and comprehensive services up to a $250 annual maximum. These dental benefits are partially covered, as maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED GIVEBACK 006 TX (HMO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization and step therapy are required. Associated Medicare Part B drugs, including chemotherapy and radiation, require no copay and no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by DEVOTED GIVEBACK 006 TX (HMO) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
DEVOTED GIVEBACK 006 TX (HMO) covers medical equipment with no copay, though prior authorization is required and coinsurance ranges from 0% (no coinsurance) to 20% depending on the item. While durable medical equipment, prosthetics, and diabetic supplies are covered, diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED GIVEBACK 006 TX (HMO) covers diagnostic and radiological services, though prior authorization is required. Lab services and outpatient X-rays have no copay, diagnostic procedures have no coinsurance with copays ranging from $0 to $150, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the DEVOTED GIVEBACK 006 TX (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
DEVOTED GIVEBACK 006 TX (HMO) partially covers Cardiac Rehabilitation Services with no coinsurance, though prior authorization is required. Standard cardiac rehabilitation (which has a $30 copay), intensive cardiac rehabilitation ($30 copay), pulmonary rehabilitation ($25 copay), and supervised exercise therapy for PAD ($20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by DEVOTED GIVEBACK 006 TX (HMO) with no coinsurance and prior authorization required, allowing admission without a prior three-day hospital stay. There is no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
DEVOTED GIVEBACK 006 TX (HMO) partially covers other services, including over-the-counter (OTC) items and additional preventive services with no copay and no coinsurance. The OTC benefit provides up to $200 every three months for covered items, while acupuncture and meal benefits are not covered.
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