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DEVOTED GIVEBACK 006 NM (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED GIVEBACK 006 NM (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED GIVEBACK 006 NM (HMO) in 2026, please refer to our full plan details page.
DEVOTED GIVEBACK 006 NM (HMO) is a HMO plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Southern New Mexico. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED GIVEBACK 006 NM (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 006 NM (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 006 NM (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 $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 006 NM (HMO) Medicare plan features an annual drug deductible of $605. Under this plan, you will enjoy no copay for Tier 1 preferred generic drugs filled through standard pharmacies or standard mail order for up to a three-month supply. For Tier 2 generic drugs, copays are as low as $3.00 for a one-month supply, with standard mail order offering a reduced copay of $7.50 for a three-month supply. For brand-name and specialty medications, this HMO plan utilizes coinsurance during the initial coverage phase. Tier 3 preferred brand drugs require a 21% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs incur a 25% coinsurance for standard fills. This clear cost-sharing structure helps you easily project your out-of-pocket costs for prescription medications.
Additional Benefits
The DEVOTED GIVEBACK 006 NM (HMO) plan offers comprehensive medical coverage with no copay for primary care visits, preventive services, and home health care. For specialist visits, copays range from $15 to $55, while inpatient hospital stays require a $475 daily copay for the first three days followed by no copay for days 4 through 90. Outpatient hospital services generally feature no coinsurance, with copays ranging from no copay up to $475. This plan also includes supplemental dental, vision, and hearing benefits to help reduce your out-of-pocket costs. Vision exams feature a low copay of $0 to $20 with a $200 annual allowance for eyewear, while eligible over-the-counter items are covered with no copay up to $94 every three months. Additionally, most diagnostic lab work and x-rays require no copay, though durable medical equipment carries a 15% coinsurance.
Inpatient Hospital See details
DEVOTED GIVEBACK 006 NM (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance and a copay of $475 per day for days 1 through 3, followed by no copay for days 4 through 90. While unlimited additional days are covered for acute stays, prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services under DEVOTED GIVEBACK 006 NM (HMO) are covered with no coinsurance, featuring a $0 to $475 copay for hospital services and a $475 copay per stay for observation services. Ambulatory surgical center and blood services require no copay and no coinsurance, while outpatient substance abuse sessions have a $50 copay, with prior authorization required for most services.
Partial Hospitalization See details
DEVOTED GIVEBACK 006 NM (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
Ambulance and transportation services are covered by DEVOTED GIVEBACK 006 NM (HMO), featuring a copay of $0 to $315 for ground ambulance services and a 20% coinsurance for air ambulance services, with prior authorization required. While some transportation services are covered, trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
DEVOTED GIVEBACK 006 NM (HMO) covers emergency services with a $115 copay (waived if admitted within 24 hours) and no coinsurance, while urgently needed services range from no copay to $40 with no coinsurance. Worldwide emergency and urgent services are covered up to a $25,000 limit with a $115 copay and no coinsurance, except for worldwide emergency transportation which requires a $315 copay and 20% coinsurance.
Primary Care See details
DEVOTED GIVEBACK 006 NM (HMO) offers primary care physician services with no copay and no coinsurance, though the broader benefit is only partially covered because podiatry, routine chiropractic, and other chiropractic services are not covered. Other covered services, including specialist visits, physical therapy, and mental health services, feature copays ranging from $15 to $55 and no coinsurance.
Preventive Services See details
DEVOTED GIVEBACK 006 NM (HMO) covers preventive services with no copay and no coinsurance, though the benefit is only partially covered. Uncovered sub-services include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, additional tobacco cessation counseling, enhanced disease management, telemonitoring, remote access technologies, and counseling.
Hearing Services See details
DEVOTED GIVEBACK 006 NM (HMO) covers hearing services with no deductible, offering annual routine hearing exams for a $55 copay and no coinsurance, subject to prior authorization. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $599 to $899, but OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
DEVOTED GIVEBACK 006 NM (HMO) partially covers vision services, offering one routine eye exam per year with a $0 to $20 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance, providing a combined maximum benefit of $200 per year for contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
DEVOTED GIVEBACK 006 NM (HMO) partially covers dental services, featuring a $55 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered services up to a $250 annual maximum. While preventive and most comprehensive treatments are included, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED GIVEBACK 006 NM (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs incur between no coinsurance and 20% coinsurance, while Part B insulin requires a $35.00 copay and between no coinsurance and 20% coinsurance.
Dialysis Services See details
DEVOTED GIVEBACK 006 NM (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
DEVOTED GIVEBACK 006 NM (HMO) covers durable medical equipment with no copay and 15% coinsurance, and prosthetics and medical supplies with no copay and no coinsurance to 20% coinsurance. Diabetic equipment is partially covered with no copay and no coinsurance to 15% coinsurance for diabetic supplies, but diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED GIVEBACK 006 NM (HMO) covers diagnostic and radiological services with prior authorization required. Lab services and outpatient X-rays have no copay, diagnostic procedures and tests range from a $0 to $95 copay with no coinsurance, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the DEVOTED GIVEBACK 006 NM (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
DEVOTED GIVEBACK 006 NM (HMO) covers some Cardiac Rehabilitation Services with no coinsurance and required prior authorization, though several sub-services are not covered. Specifically, cardiac rehabilitation and intensive cardiac rehabilitation (each with a $30 copay), pulmonary rehabilitation (with a $25 copay), and supervised exercise therapy for symptomatic peripheral artery disease (with a $20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) care is partially covered by DEVOTED GIVEBACK 006 NM (HMO) with no coinsurance, though additional days beyond the Medicare-covered limit are not covered. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and prior authorization is required.
Other Services See details
DEVOTED GIVEBACK 006 NM (HMO) partially covers other services, offering additional preventive services and over-the-counter (OTC) items with no copay and no coinsurance. While acupuncture, meal benefits, and other services are not covered, the plan provides up to $94 every three months for eligible OTC items.
Get Personalized Help from a licensed insurance agent
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