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Devoted LIBERTY Arizona (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Devoted LIBERTY Arizona (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Devoted LIBERTY Arizona (HMO) in 2025, please refer to our full plan details page.
Devoted LIBERTY Arizona (HMO) is a HMO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Maricopa and Pinal Counties. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Devoted LIBERTY Arizona (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Devoted LIBERTY Arizona (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 LIBERTY Arizona (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 $140.00. 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $5900.00 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
Prescription drugs are not covered by Devoted LIBERTY Arizona (HMO).
Additional Benefits
The Devoted LIBERTY Arizona (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $425 copay for the first four days, with no copay for the rest of the stay, while outpatient services have copays from $0 to $525. Emergency services have a $125 copay, and primary care visits cost $45. The plan also covers preventive, hearing, vision, and dental services, with specific copays and coverage limits. Hearing exams cost $45, and prescription hearing aids are covered with a copay between $599 and $899. Vision services include routine eye exams for a $45 copay and eyewear up to $1000 annually. Dental services are covered up to $1,000 per year.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric, are covered with prior authorization. For Inpatient Hospital-Acute, you will pay a $425 copay for days 1-4, and no copay for days 5-90. For Inpatient Hospital Psychiatric, you will pay a $425 copay for days 1-4, and no copay for days 5-90. Additional days for Inpatient Hospital-Acute are covered, while non-Medicare-covered stay and upgrades for Inpatient Hospital-Acute are not covered, and additional days and non-Medicare-covered stay for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered, with copays ranging from $0 to $525; observation services have a $425 copay, and ambulatory surgical center services have no copay. Individual and group sessions for outpatient substance abuse services have a $45 copay, and outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Devoted LIBERTY Arizona (HMO) plan, with a $70 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services. Ground ambulance services have a copay of $0 - $350, while air ambulance services have a 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the Devoted LIBERTY Arizona (HMO) plan, with a $125 copay, and no coinsurance. Urgently Needed Services have a copay between $0 and $55, with no coinsurance. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are also covered, with a $125 copay for the first two, and a $350 copay and 20% coinsurance for Worldwide Emergency Transportation.
Primary Care See details
The Devoted LIBERTY Arizona (HMO) plan covers primary care physician services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services are partially covered, but routine chiropractic care is not covered, and podiatry services are not covered. Primary care physician services, physician specialist services, individual and group sessions for mental health and psychiatric services, and opioid treatment program services have a $45 copay, while occupational therapy services have a $45 copay, and physical therapy and speech-language pathology services have a $45-$50 copay. Other health care professional services have a $0-$45 copay, and additional telehealth benefits have a $0-$45 copay.
Preventive Services See details
The Devoted LIBERTY Arizona (HMO) plan covers preventive services, including annual physical exams, health education, weight management programs, alternative therapies, nutritional/dietary benefits, fitness benefits, home and bathroom safety devices and modifications, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visits. However, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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, additional sessions of smoking and tobacco cessation counseling, counseling services, enhanced disease management, telemonitoring services, and remote access technologies are not covered.
Hearing Services See details
Hearing services include hearing exams with a $45 copay, routine hearing exams (1 per year), and fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered with a copay between $599 and $899 for 2 hearing aids every year, however, Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The Devoted LIBERTY Arizona (HMO) plan covers vision services, including routine eye exams with a $45 copay. Eyewear is covered up to a combined maximum of $1000 every year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Devoted LIBERTY Arizona (HMO) covers dental services with a $1,000 annual maximum, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery. Medicare dental services have a $45 copay, and orthodontic services are covered under diagnostic and preventive dental. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, you will pay a $35 copay and 20% coinsurance, while for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, you will pay between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Devoted LIBERTY Arizona (HMO) plan. The plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical Equipment is covered by the Devoted LIBERTY Arizona (HMO) plan. Durable Medical Equipment (DME) has a coinsurance between 20% and 25%, while Prosthetic Devices have a coinsurance between 0% and 20%, and Medical Supplies have a 20% coinsurance; however, 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 are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay ranging from $0 to $95, while Lab Services have no copay. Diagnostic Radiological Services have a copay that can be up to $300, and Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Devoted LIBERTY Arizona (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but none of the sub-services are covered. This means that you will not receive any benefits for this service.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Devoted LIBERTY Arizona (HMO) plan. There is no copay for days 1-20, and a $214 copay for days 21-100.
Other Services See details
Other Services include $0 preventive services, but acupuncture, over-the-counter items, meal benefits, 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 are not covered. There is no coinsurance or deductible for these services.
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