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DEVOTED GIVEBACK 035 IA (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED GIVEBACK 035 IA (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED GIVEBACK 035 IA (HMO) in 2026, please refer to our full plan details page.
DEVOTED GIVEBACK 035 IA (HMO) is a HMO plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Iowa. This plan received an overall rating of 5 out of 5 stars in 2026.
It's important to know that DEVOTED GIVEBACK 035 IA (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 035 IA (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 035 IA (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 $159.70. 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 $7000.00 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 035 IA (HMO) prescription drug plan features an annual drug deductible of $605. Under this plan, you will enjoy no copay for Tier 1 preferred generic drugs filled at standard pharmacies or through standard mail order. Tier 2 generic drugs are also highly affordable, requiring only a $3.00 copay for a one-month supply at standard pharmacies and mail order. For higher-tier medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 21% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty medications carry a 25% coinsurance for a one-month supply. This straightforward structure helps you easily project your out-of-pocket costs for prescription medications under the DEVOTED GIVEBACK 035 IA (HMO) plan.
Additional Benefits
The DEVOTED GIVEBACK 035 IA (HMO) plan offers comprehensive coverage for essential medical services, featuring no copay and no coinsurance for primary care visits and preventive care. Specialist visits require a $55 copay, while inpatient hospital stays have a $475 daily copay for the first three days and no copay for days four through 90. Emergency care is available with a $115 copay, and urgent care services range from no copay to a $40 copay. For supplemental care, the plan includes dental benefits with no copay up to a $250 yearly limit, and eyewear coverage up to a $200 annual maximum. Routine hearing exams require a $55 copay, while covered prescription hearing aids carry a copay between $599 and $899. Additionally, home health services and the first 20 days of skilled nursing facility stays are covered with no copay.
Inpatient Hospital See details
DEVOTED GIVEBACK 035 IA (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $475 daily copay for days 1 through 3 and no copay for days 4 through 90. This benefit is partially covered as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED GIVEBACK 035 IA (HMO) covers outpatient services with no coinsurance, featuring a $0 to $575 copay for hospital services, a $475 copay per stay for observation services, and a $50 copay for substance abuse sessions. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, and prior authorization is required for most services.
Partial Hospitalization See details
DEVOTED GIVEBACK 035 IA (HMO) covers partial hospitalization services with an $80.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
DEVOTED GIVEBACK 035 IA (HMO) covers prior-authorized ground ambulance services with a copay of up to $315 and air ambulance services with a 20% coinsurance. While some transportation services are covered, routine trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
DEVOTED GIVEBACK 035 IA (HMO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, and urgently needed services with a $0 to $40 copay and no coinsurance. Worldwide emergency and urgent care are covered up to $25,000 with a $115 copay and no coinsurance, while worldwide emergency transportation requires a $315 copay and 20% coinsurance.
Primary Care See details
DEVOTED GIVEBACK 035 IA (HMO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $55 copay and no coinsurance. Therapy services, including physical ($55 copay), occupational ($35 copay), and mental health ($50 copay), are covered with no coinsurance, though podiatry and routine chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by DEVOTED GIVEBACK 035 IA (HMO) with no copay and no coinsurance for annual physicals, kidney disease education, and glaucoma screenings. This benefit is partially covered, excluding services such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, and caregiver support.
Hearing Services See details
Hearing services are partially covered by DEVOTED GIVEBACK 035 IA (HMO), as OTC hearing aids and inner, outer, or over-the-ear prescription hearing aids are not covered. Routine hearing exams require a $55 copay and no coinsurance, while covered prescription hearing aids have a copay of $599 to $899 and no coinsurance.
Vision Services See details
Vision services are partially covered by DEVOTED GIVEBACK 035 IA (HMO) with no deductibles, featuring eye exams with a $0 to $55 copay and no coinsurance, though other eye exam services are not covered. Eyewear 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 035 IA (HMO), with Medicare-covered dental requiring a $55 copay and no coinsurance, and other covered preventive and comprehensive services requiring no copay and no coinsurance up to a $250 yearly maximum. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED GIVEBACK 035 IA (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs require 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 035 IA (HMO) with no copay and a 20% coinsurance, and prior authorization is required.
Medical Equipment See details
Medical equipment is covered by DEVOTED GIVEBACK 035 IA (HMO) with no copays, though prior authorization is required. Durable medical equipment carries a 19% coinsurance, while prosthetics, medical supplies, and diabetic supplies range from no coinsurance to 20% coinsurance. Diabetic equipment is only partially covered, as diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED GIVEBACK 035 IA (HMO) covers diagnostic and radiological services with prior authorization required. Diagnostic tests and procedures feature no coinsurance and a copay of $0 to $95, while lab services and outpatient X-rays have no copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered under the DEVOTED GIVEBACK 035 IA (HMO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by DEVOTED GIVEBACK 035 IA (HMO) with no coinsurance and require prior authorization. While some services are covered, specific programs such as Cardiac Rehabilitation (with a $30 copay), Intensive Cardiac Rehabilitation ($30 copay), Pulmonary Rehabilitation ($25 copay), and Supervised Exercise Therapy for Symptomatic Peripheral Artery Disease ($20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
DEVOTED GIVEBACK 035 IA (HMO) covers skilled nursing facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a three-day prior hospital stay is not necessary, additional days beyond the standard 100-day limit are not covered.
Other Services See details
DEVOTED GIVEBACK 035 IA (HMO) partially covers other services, providing additional preventive services not covered by Medicare with no copay and no coinsurance. However, acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
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