DEVOTED GIVEBACK 006 NM (HMO) Medicare Advantage Plan H9977-006 • 2026 • Luna County, NM

DEVOTED GIVEBACK 006 NM Overview

Plan Details for DEVOTED GIVEBACK 006 NM

With a monthly premium of $0.00, DEVOTED GIVEBACK 006 NM is a Medicare Advantage HMO plan that includes hospital, medical, and prescription drug coverage under Medicare Parts A and B. Services are generally covered when received from in-network providers, except in emergency situations. The annual Part D deductible is $605.00.

Primary care visits have a $0 copay, specialist visits come with a $55 copay, urgent care services carry a $0-$40 copay, and ambulance transportation is $0-$315 copay. These costs apply toward the maximum out-of-pocket (MOOP) limit of $7000.00. Once this limit is reached, in-network services are fully covered for the remainder of the year.

This plan is listed by CMS under Plan ID H9977-006. Cost-sharing details are provided below.

Cost-Sharing Overview

DEVOTED GIVEBACK 006 NM has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The table below details the most common in-network out-of-pocket expenses for plan H9977-006.

Certain preventive services are covered 100% by DEVOTED GIVEBACK 006 NM as a Part B benefit.

Prescription Drug Coverage

DEVOTED GIVEBACK 006 NM includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.

This plan includes an enhanced benefit Medicare Part D plan (PDP), providing coverage beyond the standard CMS-defined minimum.

Prescription Drug Plan Premium

The Part D prescription drug plan premium is included in the overall Medicare Special Needs Plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.

For more details, visit the Social Security Extra Help program .

Prescription Drug Plan Deductible

This plan has a $605.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Devoted Health starts contributing towards your prescription costs.

Prescription Drug Plan Out-of-Pocket Costs

Beyond premiums and deductibles, DEVOTED GIVEBACK 006 NM may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.

CMS Star Ratings

The Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (Part C) and Part D prescription drug plans each year using a 5-star system. These ratings measure plan performance in areas such as preventive care, management of chronic conditions, and member experience.