DEVOTED GIVEBACK 004 MO (HMO)
Available to residents of Andrew County, MO for 2026. Contract H2041, plan 004, segment 0.
Plan details
| Monthly drug premium | $0.00 |
|---|---|
| Drug deductible | $605.00Tier 1 and 2 exempt |
| Plan type | Medicare Advantage |
| Contract / plan | H2041-004-0 |
| 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 H2041 shares this rating.
Drug tiers — preferred pharmacy, initial coverage
| Tier | Cost-sharing |
|---|---|
| Tier 1 | $0.00 |
| Tier 2 | $3.00 |
| Tier 3 | 21% |
| Tier 4 | 25% |
| Tier 5 | 25% |
Also available in 17 other MO counties
Plan facts come from the CMS quarterly prescription drug plan public use files.