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DEVOTED GIVEBACK 008 TX (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED GIVEBACK 008 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 008 TX (HMO) in 2026, please refer to our full plan details page.
DEVOTED GIVEBACK 008 TX (HMO) is a HMO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in El Paso and Hudspeth Counties. This plan received an overall rating of 5 out of 5 stars in 2026.
It's important to know that DEVOTED GIVEBACK 008 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 008 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 008 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 $7550.00 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 TX (HMO) Medicare plan features an annual 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 for 1-month, 2-month, or 3-month supplies. This makes managing everyday prescriptions highly affordable with zero out-of-pocket costs for generic drugs. For higher-tier medications, the plan transitions to coinsurance costs instead of flat copays. You will pay a 24% coinsurance for Tier 3 (Preferred Brand) drugs and a 25% coinsurance for Tier 4 (Non-Preferred) drugs across standard pharmacy and mail order options. Tier 5 (Specialty) drugs are also covered with a 25% coinsurance for a 1-month supply.
Additional Benefits
The DEVOTED GIVEBACK 008 TX (HMO) plan offers robust medical coverage with no copay for primary care visits and a $45 copay for specialists, both with no coinsurance. For hospital stays, inpatient care requires a $375 daily copay for the first five days followed by no copay for days 6 through 90, while emergency room visits have a $115 copay. Outpatient services feature no coinsurance and range from no copay up to a $475 copay, helping you manage your healthcare expenses predictably. This plan also features valuable everyday benefits, including preventive dental care with no copay and comprehensive dental coverage up to $3,000 annually with 0% to 50% coinsurance. You will also benefit from a $400 annual allowance for eyewear with no copay, affordable hearing aid options, and a $200 allowance every three months for over-the-counter items. Additionally, home health services and routine preventive care are fully covered with no copay and no coinsurance.
Inpatient Hospital See details
DEVOTED GIVEBACK 008 TX (HMO) covers inpatient hospital care with prior authorization and no coinsurance, requiring a $375 daily copay for days 1 through 5 and no copay for days 6 through 90 for acute and psychiatric stays. Unlimited additional days are covered for acute care, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
DEVOTED GIVEBACK 008 TX (HMO) covers outpatient services with no coinsurance, featuring a $0 to $475 copay for outpatient hospital services and a $375 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $45 copay.
Partial Hospitalization See details
DEVOTED GIVEBACK 008 TX (HMO) covers partial hospitalization benefits with a $60.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
DEVOTED GIVEBACK 008 TX (HMO) covers ground ambulance services with a copay of no copay to $315 and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are not covered under this plan, as trips to plan-approved or any other health-related locations are excluded.
Emergency Services See details
Emergency Services are covered by DEVOTED GIVEBACK 008 TX (HMO) with a $115 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 $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 $315 copay plus 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED GIVEBACK 008 TX (HMO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $45 copay and no coinsurance. Other covered benefits include occupational therapy for a $35 copay, physical and speech therapy for a $45 to $50 copay, and mental health services for a $45 copay, all with no coinsurance, while podiatry and routine chiropractic services are not covered.
Preventive Services See details
DEVOTED GIVEBACK 008 TX (HMO) provides coverage for preventive services with no copay and no coinsurance, including annual physical exams, fitness benefits, and kidney disease education. However, these benefits are only partially covered, as services such as in-home safety assessments, personal emergency response systems, therapeutic massage, and in-home support are not covered.
Hearing Services See details
Hearing services covered by DEVOTED GIVEBACK 008 TX (HMO) include annual routine exams and fitting evaluations for a $45 copay, no coinsurance, and no deductible. Prescription hearing aids are partially covered with no coinsurance and copays ranging from no copay to $299, but OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
DEVOTED GIVEBACK 008 TX (HMO) provides partially covered vision services with no deductibles, offering one annual routine eye exam 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, providing up to a $400 annual limit for contacts, eyeglasses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by DEVOTED GIVEBACK 008 TX (HMO) up to an annual maximum of $3,000, offering no copay and no coinsurance for preventive care, and no copay with 0% to 50% coinsurance for comprehensive services. Medicare-covered dental services require a $45 copay and no coinsurance, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED GIVEBACK 008 TX (HMO) covers Home Infusion bundled Services with no copay and no coinsurance, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs carry no copay and 0% to 20% coinsurance, while Part B insulin has a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by DEVOTED GIVEBACK 008 TX (HMO) with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
DEVOTED GIVEBACK 008 TX (HMO) covers medical equipment with no copays, featuring a 20% coinsurance for durable medical equipment and a coinsurance ranging from no coinsurance to 20% for prosthetics, medical supplies, and diabetic supplies. Diabetic therapeutic shoes and inserts are not covered, and prior authorization is required.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED GIVEBACK 008 TX (HMO) with prior authorization required. Lab services and outpatient X-rays feature no copay, diagnostic procedures range from a $0 to $95 copay with no coinsurance, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
The DEVOTED GIVEBACK 008 TX (HMO) plan covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
DEVOTED GIVEBACK 008 TX (HMO) covers some cardiac rehabilitation services with no copay and no coinsurance, though prior authorization is required. However, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
DEVOTED GIVEBACK 008 TX (HMO) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization and no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and 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 008 TX (HMO) covers select other services with no copay and no coinsurance, including additional preventive services and up to $200 every three months for over-the-counter (OTC) items. Acupuncture and meal benefits are not covered under this plan.
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