DEVOTED GIVEBACK 015 FL (HMO) Medicare Advantage Plan H1290-015 • 2027
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $400
- Maximum Out-of-Pocket
- $7150.00In-network
- Part B Giveback
- −$202.00 reduction
- Prescription Coverage
- Enhanced, $650.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- See List
- Total Enrollment
- 1,607 beneficiaries
DEVOTED GIVEBACK 015 FL (HMO) Introduction
DEVOTED GIVEBACK 015 FL is a Medicare Advantage HMO plan offered by Devoted Health. It uses a Health Maintenance Organization (HMO) provider network and comes with prescription drug coverage. For the 2027 plan year it has a $0.00 monthly premium, $400 medical deductible, and $7150.00 in-network maximum out-of-pocket. CMS Plan ID H1290-015 identifies this plan. The 2027 Part D prescription drug deductible is $650.00.
Plan Benefits
DEVOTED GIVEBACK 015 FL has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H1290-015.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: $0 copay | In-network: $0 copay |
| Specialist | In-network: $10-$45 copay | In-network: $45 copay |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | In-network: $0 copay | In-network: $0 copay |
| Telehealth benefit | In-network: $0-$50 copay | In-network: $0-$50 copay |
| Routine chiropractic | Not covered | Not covered |
| Fitness benefits | Coming soon | In-network: $0 copay |
| Health education | In-network: $0 copay | In-network: $0 copay |
| Counseling services | Not covered | Not covered |
| Over-the-counter drug benefits | In-network: $0 copay | In-network: $0 copay |
| Health transportation (non-emergency) | Coming soon | Not covered |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | In-network: $25-$300 copay | In-network: $0-$300 copay |
| Lab services | In-network: $0-$45 copay, 20% coinsurance | In-network: $0-$40 copay |
| Outpatient x-rays | In-network: $0-$75 copay | In-network: $0-$75 copay |
| Diagnostic tests and procedures | In-network: $0-$125 copay | In-network: $0-$125 copay |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | $130 copay | $130 copay |
| Worldwide emergency care | Coming soon | $130 copay |
| Urgent care | $0-$50 copay | $0-$50 copay |
| Inpatient hospital care | Tier 1 $395 per day for days 1-6 $0 per day for days 7-90 $0 per stay |
Tier 1 $395 per day for days 1-6 $0 per day for days 7-90 $0 per stay |
| Skilled Nursing Facility | Tier 1 $10 per day for days 1-20 $221 per day for days 21-100 |
Tier 1 $0 per day for days 1-20 $218 per day for days 21-100 |
| Ground ambulance | In-network: $0-$350 copay | In-network: $0-$350 copay |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | In-network: $45 copay | In-network: $45 copay |
| Outpatient group therapy | In-network: $45 copay | In-network: $45 copay |
| Inpatient psychiatric hospital care | Tier 1 $395 per day for days 1-6 $0 per day for days 7-90 $0 per stay |
Tier 1 $395 per day for days 1-6 $0 per day for days 7-90 $0 per stay |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: $45-$50 copay | In-network: $45-$65 copay |
| Occupational therapy | In-network: $45-$50 copay | In-network: $45-$50 copay |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | In-network: $0 copay | In-network: 0%-50% coinsurance |
| Durable medical equipment | In-network: 20%-50% coinsurance | In-network: 20%-50% coinsurance |
| Prosthetics | In-network: 0%-20% coinsurance | In-network: 0%-20% coinsurance |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | In-network: 0%-20% coinsurance | In-network: 0%-20% coinsurance |
| Other Part B drugs (Medicare-covered) | In-network: 0%-20% coinsurance | In-network: 0%-20% coinsurance |
Dental Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Oral exam | In-network: $0 copay | In-network: $0 copay |
| Dental x-rays | In-network: $0 copay | In-network: $0 copay |
| Cleaning | In-network: $0 copay | In-network: $0 copay |
| Periodontics | In-network: 50% coinsurance | In-network: $0 copay |
| Endodontics | In-network: 50% coinsurance | In-network: 0%-50% coinsurance |
| Restorative services | In-network: 50% coinsurance | In-network: 0%-50% coinsurance |
| Implant services | In-network: 50% coinsurance | Not covered |
| Orthodontics | Not covered | Not covered |
| Oral/Maxillofacial surgery | In-network: 50% coinsurance | In-network: $0 copay |
Vision Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Routine eye exam | In-network: $0 copay | In-network: $0 copay |
| Contact lenses | In-network: $0 copay | In-network: $0 copay |
| Eyeglass frames only | In-network: $0 copay | In-network: $0 copay |
| Eyeglass lenses only | In-network: $0 copay | In-network: $0 copay |
| Eyeglasses (frames & lenses) | In-network: $0 copay | In-network: $0 copay |
| Upgrades | In-network: $0 copay | In-network: $0 copay |
Hearing Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Hearing exam | In-network: $0 copay | In-network: $0 copay |
| Fitting/evaluation | In-network: $0 copay | In-network: $0 copay |
| Prescription hearing aids | In-network: $599-$899 copay | In-network: $599-$899 copay |
| OTC hearing aids | Not covered | Not covered |
Additional and Special Needs Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Adult day health services | Not covered | Not covered |
| Home-based palliative care | Not covered | Not covered |
| Personal emergency response system | Coming soon | Not covered |
| Weight management programs | In-network: $0 copay | In-network: $0 copay |
| Wigs for chemotherapy-related hair loss | Coming soon | Not covered |
| Alternative therapies | In-network: $0 copay | In-network: $0 copay |
| Massage therapy | Not covered | Not covered |
| Home/bathroom safety devices | In-network: $0 copay | In-network: $0 copay |
Certain preventive services are covered 100% by DEVOTED GIVEBACK 015 FL as a Part B benefit.
Prescription Drug Coverage
DEVOTED GIVEBACK 015 FL 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 Advantage 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.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | ($45.30) |
| Supplemental Part D Premium: | $$45.30 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | $7.28 |
| Low-Income Premium Subsidy Paid by CMS: | $0.00 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $650.00 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 015 FL may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | $0.00 copay | Coming soon |
| Preferred Brand | 21% coinsurance | Coming soon |
| Non-Preferred Drug | 25% coinsurance | Coming soon |
| Specialty Tier | 26% coinsurance | Coming soon |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H1290)
Medicare Advantage (Part C) and Part D plans are rated each year by CMS on a 5-star scale. Ratings summarize plan performance across clinical care and member experience measures.
| CMS Measure | Star Rating |
|---|---|
| 2027 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Contact Information for Devoted Health
- Website
- Devoted Health Plan Page
- Providers
- Devoted Health Providers Page
- Formulary
- Devoted Health Formulary Page
- Pharmacy
- Devoted Health Pharmacy Page
- New Member Health Plan Help
- (844)978-2770
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (844)978-2770
- New Member Part D TTY Users
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Plan Availability
DEVOTED GIVEBACK 015 FL (H1290-015-0) is available in the following locations:
Florida Counties Served
Frequently Asked Questions
Here are some of the most frequently asked questions about this plan (click to open).
Frequently Asked Questions About DEVOTED GIVEBACK 015 FL (HMO)
How much does plan H1290-015 cost per month?
The plan’s monthly premium is $0.00 for 2027. The Part B premium is not included.
What is the annual out-of-pocket maximum (MOOP) for this plan?
The annual in-network MOOP is $7150.00 for 2027. After this limit is reached, covered in-network services are fully paid.
What is the CMS star rating for DEVOTED GIVEBACK 015 FL?
The 2027 CMS star rating for DEVOTED GIVEBACK 015 FL is ★4.5 out of 5.
How many beneficiaries are enrolled in this plan?
CMS reports 1,607 beneficiaries enrolled in this plan.
What is the prescription drug deductible for 2027?
For 2027, the prescription drug deductible is $650.00.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | CMS Version |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | CY2027 Landscape (202609.1) |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | 2027 Star Ratings Data Tables |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | PBP Benefits-2027 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | 2026-09 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Devoted Health (official source) | http://www.Devoted.com | October 4, 2026 |
| Medicare.gov | Understanding Medicare Advantage Plans | 25 May, 2025 |
| NCOA.org | 5 Steps to Choosing the Right Medicare Plan for You | 25 May, 2025 |
| Medicare.gov | Explore your Medicare coverage options | 25 May, 2025 |
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