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Devoted EXTRA Greater Houston (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Devoted EXTRA Greater Houston (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Devoted EXTRA Greater Houston (HMO) in 2025, please refer to our full plan details page.
Devoted EXTRA Greater Houston (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 4.5 out of 5 stars in 2025.
It's important to know that Devoted EXTRA Greater Houston (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 EXTRA Greater Houston (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 EXTRA Greater Houston (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.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $4900.00 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 EXTRA Greater Houston (HMO) plan has an enhanced alternative drug benefit. The plan has a deductible of $590.00. During the initial coverage phase, after you meet your deductible, you will pay either a copay or coinsurance depending on the drug tier and pharmacy you use. For example, you will have no copay for preferred generic drugs from a standard pharmacy or standard mail order. For standard generic, preferred brand, and non-preferred drugs, you will pay 25% coinsurance. Once your total drug costs reach $2000.00, you will enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs.
Additional Benefits
The Devoted EXTRA Greater Houston (HMO) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays depending on the specific service. This plan also provides coverage for ambulance, emergency, and primary care services, with some services requiring prior authorization. Additional benefits include hearing, vision, and dental services with set copays and annual maximums, as well as home infusion, dialysis, medical equipment, and diagnostic services. This plan also covers home health, and skilled nursing facility services.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $325 copay for days 1-5 and no copay for days 6-90, and for Inpatient Hospital Psychiatric, you will pay a $425 copay for days 1-5 and no copay for days 6-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and additional days and non-Medicare-covered stays 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 $425, observation services with a $325 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $30 copay for both individual and group sessions, and outpatient blood services. Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, and Outpatient Substance Abuse Services require prior authorization.
Partial Hospitalization See details
Partial Hospitalization is covered with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Devoted EXTRA Greater Houston (HMO) plan. Ground ambulance services have a copay between $0 and $325, while air ambulance services have a 20% coinsurance, and 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 by Devoted EXTRA Greater Houston (HMO). Emergency Services have a $125 copay, and Urgently Needed Services have a copay between $0 and $45. Worldwide Emergency Transportation has a $325 copay and 20% coinsurance, while Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay.
Primary Care See details
The Devoted EXTRA Greater Houston (HMO) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay, Occupational Therapy Services with a copay between $30 and $45, Physician Specialist Services with a $30 copay, and Mental Health Specialty Services with a $30 copay for individual and group sessions. Also covered are Other Health Care Professional services with a copay between $0 and $30, and Psychiatric Services with a $30 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services are covered with a copay between $0 and $50, and Additional Telehealth Benefits are covered with a copay between $0 and $30. Opioid Treatment Program Services are covered with a copay between $30 and $30. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive Services are covered by the Devoted EXTRA Greater Houston (HMO) plan, including Medicare-covered services, annual physical exams, health education, weight management programs, alternative therapies, nutritional/dietary benefits, fitness benefits, home and bathroom safety devices, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs. 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 include routine hearing exams with a $30 copay, and fitting/evaluation for hearing aids. Prescription hearing aids are covered with a copay between $399 and $699, but inner ear, outer ear, and over the ear prescription hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a $30 copay, and eyewear with a combined maximum benefit of $1000 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $30 copay, as well as other services like oral exams, dental x-rays, and more. This plan has a maximum annual benefit of $1000 for other dental services, but does not cover maxillofacial prosthetics, implant services, or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and 20% coinsurance; for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Devoted EXTRA Greater Houston (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Devoted EXTRA Greater Houston (HMO) plan, including Durable Medical Equipment (DME) with a coinsurance between 0% and 25% and Prosthetic Devices with a coinsurance between 0% and 20%, but does not cover Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts. Medical Supplies have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $150, lab services with no copay, diagnostic radiological services with a copay up to $200, 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 EXTRA Greater Houston (HMO) plan, with no copay or coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Devoted EXTRA Greater Houston (HMO), but the specific services of Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD Services are not covered. The plan has a copay for some services, but the specific amount is not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Devoted EXTRA Greater Houston (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Devoted EXTRA Greater Houston (HMO) plan does not cover acupuncture, over-the-counter items, meal benefits, 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 Services and Other 2 include $0 preventive services.
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