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DEVOTED GIVEBACK 048 TX (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED GIVEBACK 048 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 048 TX (HMO) in 2026, please refer to our full plan details page.
DEVOTED GIVEBACK 048 TX (HMO) is a HMO plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Austin. This plan received an overall rating of 5 out of 5 stars in 2026.
It's important to know that DEVOTED GIVEBACK 048 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 048 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 048 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 048 TX (HMO) Medicare plan features an annual drug deductible of $605. For Tier 1 (Preferred Generic) and Tier 2 (Generic) medications, members enjoy no copay for 1-month, 2-month, or 3-month supplies filled through standard pharmacies or standard mail order. This ensures affordable access to essential everyday prescriptions right from the start. For higher-tier prescriptions, cost-sharing is based on coinsurance rather than flat copayments. Tier 3 (Preferred Brand) drugs require a 24% coinsurance, while Tier 4 (Non-Preferred Drug) and Tier 5 (Specialty Tier) medications carry a 25% coinsurance through standard pharmacies and standard mail order services. Specialty Tier coverage under this plan is limited to a 1-month supply.
Additional Benefits
The DEVOTED GIVEBACK 048 TX (HMO) plan offers affordable access to essential medical care, featuring no copay and no coinsurance for primary care visits, annual physicals, and home health services. For specialized care and hospital stays, members can expect a $55 copay for specialist visits, a $115 copay for emergency services, and a $350 daily copay for the first few days of inpatient stays. Diagnostic lab services and outpatient X-rays are also available with no copay, helping to keep routine healthcare costs highly manageable. In addition to core medical coverage, this plan provides valuable supplemental benefits, including preventive and comprehensive dental care with no copay up to a $250 annual limit. Members also benefit from routine vision exams with no copay to a $55 copay, a $200 yearly eyewear allowance, and up to $99 every three months for over-the-counter items. While routine hearing exams require a $55 copay, prescription hearing aids are covered with copays ranging from $599 to $899.
Inpatient Hospital See details
DEVOTED GIVEBACK 048 TX (HMO) covers inpatient hospital services with no coinsurance, requiring prior authorization and a daily copay of $350 for days 1 to 5 of acute stays and days 1 to 4 of psychiatric stays, followed by no copay for subsequent days up to day 90. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by DEVOTED GIVEBACK 048 TX (HMO) with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay ranging from $0 to $450, observation services carry a $350 copay per stay, and outpatient substance abuse sessions have a $50 copay.
Partial Hospitalization See details
Partial hospitalization services are covered by DEVOTED GIVEBACK 048 TX (HMO) with a $60.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by DEVOTED GIVEBACK 048 TX (HMO), with ground ambulance services requiring no coinsurance and a copay ranging from no copay to $350, and air ambulance services requiring a 20% coinsurance and no copay. Prior authorization is required for ambulance services, and transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
DEVOTED GIVEBACK 048 TX (HMO) covers emergency services with a $115 copay and no coinsurance (waived if admitted within 24 hours), and urgently needed services with no copay to a $40 copay and no coinsurance. Worldwide emergency services are covered up to a $25,000 limit, with a $115 copay and no coinsurance for emergency or urgent care, and a $350 copay plus 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED GIVEBACK 048 TX (HMO) covers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, and speech therapy require a $55 copay and no coinsurance. Occupational therapy has a $35 copay, mental health and psychiatric services require a $50 copay, and telehealth ranges from a $0 to $55 copay, all with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by DEVOTED GIVEBACK 048 TX (HMO) with no copay and no coinsurance for annual physicals, kidney disease education, and diabetes self-management. Additional preventive benefits are partially covered, including fitness benefits and nutritional counseling, while services such as in-home support, personal emergency response systems, therapeutic massage, and medical nutrition therapy are not covered.
Hearing Services See details
DEVOTED GIVEBACK 048 TX (HMO) covers hearing services, featuring routine hearing exams for a $55 copay and no coinsurance, plus unlimited fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $599 to $899 for up to two aids per year, though inner ear, outer ear, over-the-ear, and OTC hearing aids are not covered.
Vision Services See details
DEVOTED GIVEBACK 048 TX (HMO) partially covers vision services, offering one routine eye exam per year with a $0 to $55 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay or coinsurance up to a $200 annual maximum for contacts, frames, lenses, and upgrades.
Dental Services See details
DEVOTED GIVEBACK 048 TX (HMO) partially covers dental services, offering Medicare-covered dental for a $55 copay and no coinsurance, and other preventive and comprehensive dental services with no copay and no coinsurance up to a $250 yearly maximum. Maxillofacial prosthetics, implant services, and orthodontics are not covered under these benefits.
Home Infusion bundled Services See details
Home infusion bundled services are covered by DEVOTED GIVEBACK 048 TX (HMO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance, while Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the DEVOTED GIVEBACK 048 TX (HMO) plan with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Medical equipment is covered by DEVOTED GIVEBACK 048 TX (HMO) with no copays, featuring a 16% coinsurance for durable medical equipment (DME) and no coinsurance to 19% coinsurance for prosthetics and medical supplies. Diabetic equipment is partially covered with no copay and no coinsurance to 16% coinsurance for diabetic supplies, while diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED GIVEBACK 048 TX (HMO) covers diagnostic and radiological services, with prior authorization required for both. Diagnostic services require no coinsurance, offering no copay for lab services and a copay of up to $95 for diagnostic tests, while radiological services feature no copay for outpatient X-rays and a 20% coinsurance for therapeutic services.
Home Health Services See details
Home Health Services are covered by DEVOTED GIVEBACK 048 TX (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the DEVOTED GIVEBACK 048 TX (HMO) plan with no coinsurance, though prior authorization is required. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by DEVOTED GIVEBACK 048 TX (HMO) with no coinsurance and does not require a prior three-day hospital stay, though prior authorization is required. You will pay no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, with no coverage provided for additional days beyond the Medicare-covered limit.
Other Services See details
Other services are partially covered by DEVOTED GIVEBACK 048 TX (HMO) with no copay and no coinsurance, including additional preventive services and up to $99 every three months for over-the-counter items. Acupuncture and meal benefits are not covered under this plan.
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