Plan year 2027 · Medicare AdvantageCMS files of Sept. 22 and Oct. 1, 2026

Devoted Giveback 012 VA, 2027

H6994Contract012Plan

HMO · 16 counties in Virginia

Run by Devoted Health Plan of Virginia Inc (contract H6994), sold as Devoted Health, owned by Devoted Health, Inc.

Renews for 2027

2026 star rating, contract H6994: not rated (too new)

Devoted Giveback 012 VA (H6994-012) costs $0 a month in 2027, the same as in 2026, with an in-network out-of-pocket limit of $8,250 ($7,000 in 2026).

What changes from 2026 to 2027?

The changed lines are marked and come first. In-network amounts; members keep paying the Part B premium unless the plan reduces it.
What you pay or get	2026	2027	Change
In-network out-of-pocket limit	$7,000	$8,250	up $1,250
Drug deductible	$605	$461	down $144
Hospital stay, in network	$475 a day for days 1–3, then $0 a day for days 4–90	$475 a day for days 1–5, then $0 a day for days 6–90	up $950for a 5-day stay
Skilled nursing facility, in network	$0 a day for days 1–20, then $218 a day for days 21–100	$0 a day for days 1–20, then $221 a day for days 21–100	up $30for a 30-day stay
Counties served	10	16	up 6
Drug tier 2, generic	$3	$0	down $3
Drug tier 3, preferred brand	21% of the cost	15% of the cost	down 6 points
Drug tier 5, specialty tier	25% of the cost	26% of the cost	up 1 point
13 lines do not change
Monthly premium	$0	$0	no change
Part B premium reduction, monthly	$184.70	$184.70	no change
Primary care visit	$0 copay	$0 copay	no change
Specialist visit	$55 copay	$55 copay	no change
Emergency room	$115 copay	$115 copay	no change
Medical deductible, in network	none	none	no change
Ground ambulance, in network	$0 copay	$0 copay	no change
Comprehensive dental, yearly limit	not offered	not offered	no change
Eyewear, yearly limit	$200 a year	$200 a year	no change
Hearing aids, yearly limit for both ears	not offered	not offered	no change
Over-the-counter items, yearly	$372 a year	$372 a year	no change
Drug tier 1, preferred generic	$0	$0	no change
Drug tier 4, non-preferred drug	25% of the cost	25% of the cost	no change

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS plan benefit package files, 2027 and 2026; CMS plan crosswalk from 2026 to 2027 (Oct. 1, 2026). Plan details can change during the year; confirm on Medicare Plan Finder.

What will prescriptions cost?

Your share for a 30-day supply at a retail pharmacy, as filed with CMS; tiers whose share changes are marked
Tier	What the tier holds	2026	2027
Tier 1	Preferred Generic	$0	$0
Tier 2	Generic	$3	$0
Tier 3	Preferred Brand	21% of the cost	15% of the cost
Tier 4	Non-Preferred Drug	25% of the cost	25% of the cost
Tier 5	Specialty Tier	25% of the cost	26% of the cost

Source: CMS plan benefit package files, 2027 and 2026. Insulin is capped at $35 a month by law. A drug's tier is set by the plan's formulary.

How does it compare with plans sold where it is?

In the counties it serves, 48 plans open to everyone are sold for 2027, this one included. Against the others, 21 plans have a lower out-of-pocket limit, 26 a higher one. On the premium, 36 the same, 11 a higher one.

Out-of-pocket limits of the 48 plans open to everyone

$0 to under $2,0000 plans

$2,000 to under $4,0002 plans

$4,000 to under $6,0007 plans

$6,000 to under $8,00012 plans

$8,000 to $10,000 (this plan)27 plans

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).

Where is it sold, and what does it cost there?

The premium and the out-of-pocket limit are the same in all 16 counties: $0 a month and $8,250.

Virginia

Bath Botetourt Brunswick Buckingham Craig Danville City Emporia City Floyd Franklin Giles Greensville Halifax Henry Lunenburg Nottoway Pulaski

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).

Who runs this plan?

Plan ID: H6994-012
Legal name of the contract: Devoted Health Plan of Virginia Inc
Sold as: Devoted Health
Parent company: Devoted Health, Inc.
Plan type: HMO
2026 star rating of the contract: not rated (too new) overall; health plan not rated, drug plan not rated
Members, September 2026: 150
Plan website, as filed with CMS: www.devoted.com

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS 2026 Star Ratings (October 2025); CMS monthly enrollment by plan and by county, September 2026 (CMS hides counts under 11). CMS publishes the 2027 Star Ratings in October 2026.

What else should you check?

Other 2027 plans in Henry, VAWhere most of its members live; premiums and limits side by side
Every Devoted Health plan for 2027Its contracts, counties and plans that end
The other 15 plans of contract H6994Same company, same contract
Is your prescription covered?Coverage share and tier for 2,259 drugs

Data, not advice. These are the plan's filed amounts, not a quote for you; confirm on Medicare Plan Finder or call the plan before you enroll.