Are you turning 65? Or are you on Medicare and losing coverage or moving?
See if you qualify for an enrollment period to sign up for a plan

Devoted GIVEBACK Missouri (HMO)

Health Insurance Company: Devoted Health

Medicare Advantage Plan Details

Devoted Health
$0 /mo
monthly premium
Devoted GIVEBACK Missouri (HMO)
Additional Coverage
Overall Star Rating (2025)
  • Rx
  • Dental
  • Vision
  • Hearing
(coming soon)

General Plan Details

Medical Deductible
$0
Out-of-Pocket Maximum
$7000
Rx Drug Coverage
Yes
Rx Deductible
$590
Primary Doctor Office Visit
$0 copay
Specialist Office Visit
$45 copay per visit

Additional Benefits

Dental Coverage
Yes
Vision Coverage
Yes
Mental Health Coverage
Yes
Transportation for non-emergency
No
Fitness Benefits
Yes
Worldwide emergency
Yes
Telehealth
Yes
Part B Give Back
No

Doctor & Hospital Coverage

Primary Doctor Office Visit
$0 copay
Specialist Office Visit
$45 copay per visit
Periodic Exam Coverage
$0 copay

Emergency Room

$110 copay per visit (always covered)

Ambulance Coverage

$0-300 copay

Lab, X-Ray, Radiology Coverage

Outpatient diag procs/tests/lab services:
Medicare-covered diagnostic procedures/tests: $0-95 copay
Medicare-covered lab services: $0-40 copay
Outpatient diag/therapeutic rad services:
Medicare-covered diagnostic radiological services (e.g., CT, MRI, etc): $0-300 copay
Medicare-covered x-ray services: $0-75 copay

Outpatient Surgery Coverage

Outpatient hospital:
Medicare-covered outpatient hospital services: $0-575 copay per visit

Hospitalization Coverage

Inpatient hospital-acute:
$475 per day for days 1 through 3
$0 per day for days 4 through 90
Inpatient hospital psychiatric:
$475 per day for days 1 through 3
$0 per day for days 4 through 90

Rehabilitation Coverage

Occupational therapy services:
$35 copay
Physical therapy and speech and language therapy services:
$45-50 copay

Urgent Care Coverage

$0-45 copay per visit (always covered)

Skilled Nursing Facility (SNF)

$0 per day for days 1 through 20
$214 per day for days 21 through 100

Mental Health Coverage

Medicare-covered individual sessions: $45 copay
Medicare-covered group sessions: $45 copay

Dental, Vision, Hearing Benefits

Dental Services

Oral exams:
In-network: $0 copay
Out-of-network: $0 copay
Prophylaxis (cleaning):
In-network: $0 copay
Out-of-network: $0 copay
Dental x-rays:
In-network: $0 copay
Out-of-network: $0 copay

Vision Benefits

Eye exams:
Routine eye exams: $0 copay
Eyewear:
Contact Lenses: $0 copay
Eyeglasses: $0 copay

Hearing Benefits

Hearing exams:
Routine hearing exams: $45 copay
Hearing aids:
Hearing aids (all types): $599-899 copay

Rx Drug Coverage - Standard Retail Cost

Tier 1: Preferred Generic

$0.00 copay (30-day supply)
$0.00 copay (90-day supply)

Tier 2: Generic

$10.00 copay (30-day supply)
$30.00 copay (90-day supply)

Tier 3: Preferred Brand

25% coinsurance (30-day supply)
25% coinsurance (90-day supply)

Tier 4: Non-Preferred Drug

25% coinsurance (30-day supply)
25% coinsurance (90-day supply)

Tier 5: Specialty Tier

25% coinsurance (30-day supply)

Tier 1: Preferred Generic

$0.00 copay (30-day supply)
$0.00 copay (90-day supply)

Tier 2: Generic

$10.00 copay (30-day supply)
$25.00 copay (90-day supply)

Tier 3: Preferred Brand

25% coinsurance (30-day supply)
25% coinsurance (90-day supply)

Tier 4: Non-Preferred Drug

25% coinsurance (30-day supply)
25% coinsurance (90-day supply)

Tier 5: Specialty Tier

25% coinsurance (30-day supply)

More Additional Benefits

Annual physical exams
Yes
Chiropractic Coverage
No
Acupuncture
No
Massage Therapy
No
Health Education
Yes
Counseling Services
No
Support for Caregivers of Enrollees
No
Personal Emergency Response System (PERS)
No
In-home support services
No
Home and bathroom safety devices
Yes
Meals for short duration
No

Plan Links

Ready to Enroll Online?

Or call and get free advice from licensed insurance agents

TTY 711
Mon-Fri: 8am-9pm, Sat: 8am-8pm ET
No Obligation to Enroll

Looking for other plans in your area?

Where This Plan is Available

State:
View all plans in your Missouri County

Additional Plan Info

Plan Year:
2025
Insurance Company Website:
Devoted Health

Health Insurance Companies Offering Plans

Medicare Advantage and Part D plans and benefits offered by the following insurance companies:

  • Aetna Medicare
  • Anthem Blue Cross Blue Shield
  • Anthem Blue Cross
  • Anthem Blue Cross and Blue Shield
  • Aspire Health Plan
  • Baylor Scott & White Health Plan
  • Capital Blue Cross
  • Cigna Healthcare
  • Dean Health Plan
  • Devoted Health
  • Florida Blue Medicare
  • Freedom Health
  • GlobalHealth
  • Health Care Service Corporation
  • Healthy Blue
  • HealthSun
  • Humana
  • Molina Healthcare
  • Mutual of Omaha
  • Medica Central Health Plan
  • Optimum HealthCare
  • Premera Blue Cross
  • SCAN Health Plan
  • Simply
  • UnitedHealthcareⓇ
  • Wellcare
  • WellPoint