DEVOTED GIVEBACK 001 HI (HMO)
Available to residents of Honolulu County, HI for 2026. Contract H5397, plan 001, segment 0.
Plan details
| Monthly drug premium | $0.00 |
|---|---|
| Drug deductible | $605.00Tier 1 and 2 exempt |
| Plan type | Medicare Advantage |
| Contract / plan | H5397-001-0 |
| Offered by | Devoted Health |
| Parent organization | Devoted Health, Inc. |
| Formulary drugs | 3,377 |
CMS star ratings
- Overall
- —
- Health plan (Part C)
- —
- Drug plan (Part D)
- —
Published per contract — every plan under contract H5397 shares this rating.
Drug tiers — preferred pharmacy, initial coverage
| Tier | Cost-sharing |
|---|---|
| Tier 1 | $0.00 |
| Tier 2 | $1.00 |
| Tier 3 | 24% |
| Tier 4 | 25% |
| Tier 5 | 25% |
Plan facts come from the CMS quarterly prescription drug plan public use files.