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Devoted GIVEBACK El Paso (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Devoted GIVEBACK El Paso (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Devoted GIVEBACK El Paso (HMO) in 2025, please refer to our full plan details page.
Devoted GIVEBACK El Paso (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 4.5 out of 5 stars in 2025.
It's important to know that Devoted GIVEBACK El Paso (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 El Paso (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 El Paso (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 $174.70. 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 $590.00 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 El Paso (HMO) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay for your drugs based on the drug tier and pharmacy type. For drugs in the initial coverage phase, you may pay a copay or coinsurance depending on the specific drug and pharmacy. For example, for preferred generic drugs, there is no copay when using a standard or mail-order pharmacy. For standard generic drugs, you'll pay 18% coinsurance, and 25% coinsurance for preferred brand and non-preferred drugs. After your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs.
Additional Benefits
The Devoted GIVEBACK El Paso (HMO) plan offers a range of benefits, including inpatient hospital stays with a copay, outpatient services with varying copays, and coverage for emergency services. The plan also covers primary care visits, preventive services with no copay, and services for hearing, vision, and dental care with copays or coinsurance. Additional benefits include ambulance services, home health services with no copay, and coverage for home infusion and dialysis services. The plan also includes coverage for diagnostic and radiological services and skilled nursing facility stays with copays. However, it's important to note that certain services like acupuncture, over-the-counter items, and private duty nursing are not covered by this plan.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For days 1-5, the copay is $375, and for days 6-90, there is no copay; there is no coinsurance. Additional Days for Inpatient Hospital-Acute are covered with no copay or coinsurance, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and both Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $475, observation services with a $375 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services, including individual and group sessions, have a copay of $45. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Devoted GIVEBACK El Paso (HMO) plan with a $60 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Devoted GIVEBACK El Paso (HMO) plan. Ground ambulance services have a copay of $0-$275, while air ambulance services have a 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. For Emergency Services, there is a $110 copay, and no coinsurance. For Urgently Needed Services, there is a copay between $0 and $45, and no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $110 copay, and no coinsurance, while Worldwide Emergency Transportation has a $275 copay and 20% coinsurance.
Primary Care See details
The Devoted GIVEBACK El Paso (HMO) plan covers primary care, including primary care physician services, with no copay, and chiropractic services with a $15 copay. Occupational therapy services have a $35 copay, while physician specialist services require a referral and have a $45 copay. Mental health specialty services, including individual and group sessions, have a $45 copay. Physical therapy and speech-language pathology services have a copay between $45 and $50, and additional telehealth benefits range from no copay to a $45 copay. Opioid Treatment Program Services have a $45 copay.
Preventive Services See details
Preventive Services, including Medicare-covered services, annual physical exams, and other preventive services are covered by the Devoted GIVEBACK El Paso (HMO) plan. Additional services like Health Education, Weight Management Programs, Alternative Therapies, Nutritional/Dietary Benefit, Fitness Benefit, and Home and Bathroom Safety Devices and Modifications are covered. However, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, and Counseling Services are not covered.
Hearing Services See details
Hearing Services includes routine hearing exams with a $45 copay, and the fitting/evaluation for hearing aids is covered. Prescription hearing aids are covered with a copay between $0 and $299, but inner ear, outer ear, and over the ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a $45 copay, eyewear with a combined maximum benefit of $750 per year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Routine eye exams are covered once per year.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $45 copay, and other dental services with a $750 annual maximum. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatments, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and 20% coinsurance, and for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and no copay, Prosthetic Devices with a 0-20% coinsurance and no copay, and Medical Supplies with a 20% coinsurance and no copay. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services includes coverage for all diagnostic services, diagnostic procedures/tests with a copay between $0 and $95, lab services with no copay, diagnostic radiological services with a maximum copay of $300, therapeutic radiological services with a coinsurance of at least 20%, and outpatient X-ray services with no copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Devoted GIVEBACK El Paso (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Devoted GIVEBACK El Paso (HMO) plan, but the specific services of Medicare-covered Intensive Cardiac Rehabilitation, Medicare-covered Pulmonary Rehabilitation, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD), and Additional Cardiac Rehabilitation Services are not covered. There is a copay for some services, but the specific amount is not listed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Devoted GIVEBACK El Paso (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services are not covered for Acupuncture, Over-the-Counter (OTC) Items, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services. Other 2 benefits are covered, including $0 preventive services.
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