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Medicare Advocates
Medicare Advantage · HMO · Plan ID H3515-022-000

DEVOTED GIVEBACK EXTRAS 022 WA (HMO)

The DEVOTED GIVEBACK EXTRAS 022 WA (HMO) is a 2027 HMO Medicare Advantage plan from Devoted Health with a $0 monthly premium. It may include allowances for vision, otc / flex allowance, and part b giveback. It's available in 4 counties across 1 state.

Reviewed by the Medicare Advocates team · 2027 plan year · sourced from CMS data

Offered in 4 counties across 1 state

2027 plan at a glance
  • Monthly premium$0
  • In-network max out-of-pocket$8,300
Yearly benefit allowances
  • Vision$400
  • OTC / Flex allowance$564
  • Part B giveback$900

2027 plan-year figures (premium, star rating, MOOP) from the CMS Landscape file; allowance amounts from CMS PBP data. Amounts vary by plan; not all plans offer all benefits.

About this plan

DEVOTED GIVEBACK EXTRAS 022 WA (HMO), plan H3515-022-000, is a 2027 Medicare Advantage plan from Devoted Health, sold in Washington. It pairs a $0 plan premium with a Part B giveback worth $900 a year.

How the network works

This is an HMO plan, so it pays for your care when you use a provider in its network. Outside the network you generally pay the full cost yourself, and the exceptions are emergency care and urgently needed services, which are covered anywhere in the country. You pick a primary care provider from the network, and that doctor coordinates the rest of your care.

You need a referral from your primary care provider before you see a specialist.

Who can enroll

To join, you need Medicare Part A and Part B and you have to live in the plan's service area, which covers 4 counties in Washington for 2027. You keep paying your Part B premium to Medicare.

Counties in the service area include King, Pierce, Snohomish and Thurston.

Premium and giveback

This plan reduces your Part B premium, which people call a giveback. It is worth $900 over a year, about $75 a month, and it shows up as a lower Part B deduction rather than a payment to you.

A $0 plan premium is not the same as $0 total cost. You still pay a copay or coinsurance when you get care, up to the plan's yearly out-of-pocket limit.

What the DEVOTED GIVEBACK EXTRAS 022 WA (HMO) plan may include

  • Vision: up to $400 per year in plan allowance (2027).
  • OTC / Flex allowance: up to $564 per year in plan allowance (2027).
  • Part B giveback: up to $900 per year in plan allowance (2027).

Costs & coverage detail

Annual Part D drug deductible: $700 (2027).

Doctor visits

  • Specialist visit$45 copay
  • Telehealth$0–$45 copay
  • Chiropractic (Medicare-covered)$15 copay
  • Podiatry (Medicare-covered)$45 copay

Emergency & urgent care

  • Emergency room$115 copay
  • Urgent care$0–$40 copay

Tests, labs & imaging

  • Lab services$0–$45 copay
  • Diagnostic tests & procedures$0–$95 copay
  • X-rays$0–$75 copay
  • Diagnostic radiology (CT/MRI/PET)$25–$300 copay

Outpatient hospital & surgery

  • Outpatient hospital services$0–$555 copay
  • Ambulatory surgical center$0–$455 copay
  • Outpatient substance abuse (individual)$45 copay

Medical equipment & supplies

  • Durable medical equipment (DME)20% coinsurance
  • Medical supplies (Medicare-covered)0–20% coinsurance
  • Part B drugs (other)0–20% coinsurance
  • Part B chemotherapy drugs0–20% coinsurance

Ambulance

  • Ground ambulance$0–$330 copay

Dental

  • Comprehensive dental (restorative)50% coinsurance

Vision

  • Routine eye exam$0–$45 copay

Hearing

  • Routine hearing exam$45 copay
  • Hearing aids$599–$899 copay

Mental health

  • Mental health visit (individual)$45 copay
  • Mental health visit (group)$45 copay
  • Psychiatric services (individual)$45 copay
  • Inpatient psychiatric hospital$455/day, days 1–4; $0/day, days 5–90

Therapy

  • Occupational therapy visit$35 copay

Hospital stays

  • Inpatient hospital$490/day, days 1–5; $0/day, days 6–90
  • Skilled nursing facility (SNF)$0/day, days 1–20; $221/day, days 21–100

In-network, Medicare-covered cost sharing for the 2027 plan year (CMS PBP data). Costs vary by service and setting; see the Summary of Benefits for full detail.

Extra benefit allowances

  • Eyewear allowance$400 per year
  • Over-the-counter (OTC) allowance$141 per quarter

What everyday care costs

In network, a specialist visit is $45, the emergency room is $115 and urgent care is $0 to $40. Emergency care and urgently needed services are covered whether or not the provider is in the plan's network, which matters when you are away from home.

An individual mental health visit is $45 and occupational therapy is $35.

Physical therapy and speech therapy are covered too, at cost shares the plan lists in its Summary of Benefits rather than in the CMS benefit files, so check those two there.

Preventive care and vaccines

You pay $0 for the preventive services Original Medicare covers when you use a provider in the plan's network. That includes your annual wellness visit, the recommended screenings for your age, and most vaccines. Preventive care is the easiest value to collect from any Medicare Advantage plan, so book the wellness visit early in the year.

Dental, vision and hearing

Beyond what Original Medicare covers, this plan includes $400 toward glasses or contacts and $141 a year for over-the-counter health items. These allowances almost always have to be used with providers and suppliers the plan works with, so check that before you buy, particularly for hearing aids where the plan usually names its own vendor.

The eyewear allowance covers eyeglasses or contact lenses, and it resets each plan year rather than rolling over, so an unused allowance is lost at the end of December.

Prescription drug coverage

Part D prescription drug coverage is included, so you do not need a separate drug plan. Check the plan's formulary, which is its list of covered drugs, for every medicine you take before you enroll.

For 2027, the drug deductible is $700 and your own drug costs are capped at $2,400 for the year.

If a medicine you take is not on the formulary, your prescriber can ask the plan for an exception, and if your income is limited, Extra Help can cut what you pay for drugs regardless of which plan you choose.

Prior authorization

Some care on this plan needs prior authorization, which means Devoted Health has to approve it before you get it. Specialist services are among those that do. Your doctor's office usually files the request, but the plan may not pay if the approval is skipped, so confirm it is in hand before a scheduled procedure. The plan's evidence of coverage lists every service that needs it.

How this plan compares in Pierce County

Here is how DEVOTED GIVEBACK EXTRAS 022 WA (HMO) sits against other plans sold in Pierce County for 2027.

UHC Care Advantage WA-E001 (PPO I-SNP) has a lower in-network limit at $4,000.

Who this plan may fit

This plan may fit people in the service area who want a $0 plan premium and are comfortable with a $8,300 ceiling on in-network costs. It suits you less well if you want to use doctors outside the network, because this type of plan generally will not pay for that.

Like any Medicare Advantage plan, it changes how your Medicare claims are paid. If you travel often, or you want to use any doctor who accepts Medicare without checking a network, compare it against Original Medicare with a Medicare Supplement and a separate drug plan before you decide.

Questions to ask before you enroll

A licensed insurance agent can check all of these against your own doctors and prescriptions at no cost.

  • Are my doctors in the plan's network, and what would an out-of-network visit cost me?
  • Are all of my prescriptions on the plan's drug list, and at which tier?
  • Which of the services I use regularly need prior authorization?
  • Do I need a referral from my primary care provider before I see a specialist?
  • When does the Part B giveback start, and how will I see it?
  • What counts toward the $8,300 out-of-pocket limit, and what does not?

Common questions

What is the DEVOTED GIVEBACK EXTRAS 022 WA (HMO) plan?
It is a Medicare Advantage plan (CMS plan ID H3515-022-000) offered by Devoted Health for the 2027 plan year. Medicare Advantage plans bundle your Part A and Part B coverage, and most include extra benefits Original Medicare does not.
What extra benefits could this plan include?
Depending on the plan, supplemental benefits may include allowances toward vision, otc / flex allowance, part b giveback. Amounts shown are for the 2027 plan year and vary by plan and area. A licensed agent can confirm what is available to you.
Where is this plan available?
For 2027, this plan is offered in 4 counties across 1 state. Availability and benefits depend on your specific ZIP code.
How do I enroll or compare plans?
Call to speak with a licensed insurance agent who can review this plan alongside the other options in your area at no cost. There is no obligation to enroll, and enrollment may be limited to certain times of year unless you qualify for a Special Enrollment Period.

Counties served

Washington (4 counties)

King, Pierce, Snohomish, Thurston

Ready when you are.

No cost. No pressure. There is no obligation to enroll.One licensed insurance agent, for as long as you’re on Medicare.