Medicare Advantage Plans

Expanded Medicare Advantage cost share waivers effective May 1, 2020

  • CarePlus is waiving members' out-of-pocket costs for outpatient behavioral health (on an outpatient, non-facility basis) and telehealth visits through the end of 2020. While many members are successfully using telehealth, some are forgoing essential preventive and primary care services during this crisis. To reduce barriers,

  • CarePlus is waiving member costs for behavioral health (on an outpatient, non-facility basis) for in-network providers through the end of year. Behavioral health issues, like depression, may be intensified because of the pandemic and are important to flag and treat.

    In addition, we are extending telehealth cost share waivers for all telehealth visits—PCP and specialty, including behavioral health, for in-network providers through 2020. By eliminating these costs, we are supporting members to re-engage with their physicians for pressing primary care and behavioral health needs whether in-person or virtually, depending on their personal situation.

  • CarePlus is providing care kits to support visits to healthcare providers. For members who need to access the healthcare system or other essential services in the community, we want them to be as safe as possible. To assist in this effort, we are proactively sending a care kit to members’ homes throughout the summer, which includes 2 masks and instructions on how to care for the masks.

In addition, the following measures were announced on March 24, 2020:

  • Preauthorizations for COVID-19 care has been removed. CarePlus members who test positive for COVID-19 will not need to seek preauthorization to begin treatment immediately.
  • Early prescription refills allowed beginning March 10, 2020 through Oct. 23, 2020 – CarePlus is allowing early refills on prescription medicines so our members can prepare for extended supply needs—an extra 30 or 90-day supply as appropriate.
  • Home delivery of prescriptions may be available to members. Members should check with their current network pharmacies to see if they offer local prescription delivery to support patients in social isolation. As an alternative, members may use PrescribIT Rx*, CarePlus’ preferred cost-sharing mail order pharmacy, to have their prescription drugs delivered to them. Members can register for PrescribeIT Rx’s mail order delivery by calling 1-800-526-1490. Their hours of operation are Monday through Friday from 8 a.m. to 6 p.m., Eastern Time. Please keep in mind that first-time setup takes approximately five to ten days for processing and delivery after prescription orders are received. To see a list of our network mail-order pharmacies, please refer to our Provider Directories page located in our website at www.careplushealthplans.com/members/pharmacy-directories.

*Other pharmacies are available in our network.

If you suspect that you have been exposed to coronavirus or are experiencing symptoms, please call your healthcare provider to seek testing recommendations and treatment.

Everyone is encouraged to wash their hands frequently and thoroughly, avoid close contact with people who are sick, put distance between yourself and others, cover your mouth and nose with a cloth face cover when around others, clean and disinfect frequently touched surfaces daily and cover your mouth and nose when you cough or sneeze1. Here is an easy-to-follow illustration (PDFEnglish (PDF opens in new window) ) / (PDFSpanish (PDF opens in new window) ), of some steps you can take to help maintain your health.

More information on how to protect yourself is available from the Centers for Disease Control and Prevention(opens in new window). The CDC offers specific advice for people who are at higher risk(opens in new window), of serious illness, as well as a guide to steps everyone can take to help keep their home, workplace or school(opens in new window), safe.

Frequently asked questions

Updated May 5, 2020

  • Out-of-pocket cost waivers

    CarePlus is waiving member out-of-pocket costs for outpatient behavioral health and telehealth visits through December 31, 2020

    1. When is this new benefit effective?

      Effective May 1, 2020, CarePlus is waiving member copays for in-network behavioral health (on an outpatient, non-facility basis) and telehealth visits through the end of 2020.

    2. Why is CarePlus taking these additional steps?

      CarePlus’ goal is to make the healthcare experience better, more personal and more caring so that people can achieve their best health. Waiving member out-of-pocket costs for outpatient behavioral health visits and telehealth visits gives members flexibility to seek and receive care in the best way for them and according to their physician’s recommendations.

      We also hope the care kits will contribute to our members’ safety, and the safety of others, as our members access the healthcare system or other essential services in the community.

    3. Does the waiving of behavioral health and telehealth cost sharing require a COVID-19 diagnosis?

      No. CarePlus will be waiving member copays, coinsurance, and deductibles for all in-network outpatient behavioral health and telehealth visits through the end of 2020, regardless of diagnosis.

    4. Does the copay waiver apply only to in-network providers?

      Yes. Behavioral health and telehealth providers must be in-network.

    Behavioral Health

    1. Why include behavioral health?

      By including behavioral health, we aim to take a holistic approach to managing the very personal needs of our members. Proactive management of behavioral health conditions like depression or anxiety is important, especially at this time. With the strain of the pandemic and the social isolation that many are experiencing, we know that many of the most vulnerable in society are experiencing worsening of their conditions or new symptoms.1 We want to do our part to facilitate access to behavioral health treatment.

    2. Specifically what behavioral health services are covered by the waiver?

      CarePlus is waiving all out-of-pocket costs for members who visit in-network behavioral health providers on an outpatient, non-facility basis. Eligible visits include individual therapy, psychiatric medication consultations and group therapy on an outpatient, non-facility basis.

    Telehealth

    1. Is telehealth a safer option compared to visiting the doctor in person?

      We are encouraging members to continue to seek preventive care and are concerned about the health implications of deferring care, particularly for those with chronic conditions. With that in mind, we are waiving out-of-pocket costs for both telehealth and behavioral health visits so providers and their patients can determine the best care setting.

    2. What is CarePlus doing to expand telehealth services during the COVID-19 pandemic?

      CarePlus has extended telehealth cost share waivers for all telehealth visits, including those with in-network primary care physicians and specialists, including behavioral health providers, through the end of the 2020 calendar year.

      To encourage members to seek care safely while protecting the health care workforce, CarePlus is waiving member cost share for all telehealth services delivered by in-network providers. Both in-network primary care and specialty providers can deliver care using telehealth services, provided that CMS and state-specific guidelines are followed. This includes behavioral health services. For telehealth visits with a specialist, members are encouraged to work with their primary care physician to facilitate care coordination.

      Members can call the Member Services number on the back of their CarePlus ID card to get support with specific coronavirus questions and concerns, including assistance with accessing and connecting with telehealth providers.

    Notifying members and providers

    1. How will my doctor or healthcare provider know that you are taking these actions?

      CarePlus works closely with in-network doctors and healthcare providers. We have notified all our network providers of the actions we are taking through auto faxes and also through updated messaging on our network provider-facing COVID-19 website.

    2. How will members be notified of the changes?

      We will be sending a letter to all CarePlus members regarding the changes in benefits. We also have this information for members on CarePlusHealthPlans.com.

    Provider Information

    1. Where should I go to find a provider in my network?

      CarePlus has made it easy to find a doctor that is covered by your CarePlus plan. You can find a doctor by location, provider type, name or language. Simply use the online Find a Provider tool on www.careplushealthplans.com. If you are not able to access the tool, you can call the Member Services number on the back of your CarePlus ID card.

    2. What if my PCP is not currently seeing patients?

      If your PCP is not currently seeing patients, you can call the Member Services number on the back of your CarePlus ID card to obtain additional information or for assistance in choosing a new primary care physician.

    Specialists

    1. Why aren’t specialists included in the out-of-pocket cost waiver?

      CarePlus is taking this action to ensure that CarePlus members have access to the primary care they need to maintain their health, which is especially important for those with serious chronic conditions. The hallmark of primary care is its ability to broadly diagnose, treat and prevent a wide variety of conditions.

      Note that telehealth visits with specialists are included in the waiver of out-of-pocket costs.

    Billing

    1. What happens if my doctor tries to charge me for a copay when I go to the office or at the start of the telehealth visit?

      It is possible your doctor’s office forgot about the message as they typically see members from many different health plans. You can show your doctor the letter as a reminder. You can also ask your doctor to call CarePlus’ provider operations phone number or Member Services to confirm. (These numbers are on the back of your CarePlus ID card.) And, remember that this out-of-pocket cost waiver is in effect as of May 1, 2020, so if you went to the doctor before then, the requested copay does apply.

    2. I just got a bill OR my physician’s office charged my card on file for the copay after the visit. What should I do?

      If, after your visit, your doctor’s office sent you a bill or charged your credit card for a copay or coinsurance for a primary care visit, behavioral health visit or a telehealth visit, we will need to contact your doctor’s office to get this resolved. You can call your doctor directly or we can assist you with making this call. If you would like assistance, you may contact CarePlus Member Services number on the back of your CarePlus ID card.

    Miscellaneous

    1. How do these actions align around any re-opening guidance provided by federal, state, and local authorities?

      CarePlus’ actions are not connected to any specific re-opening guidance. Instead, these policies are intended to support member access to care through whatever channel they and their provider determine is best.

    Sources:

    1. Coping with Stress. (2020, June 12). Retrieved June 18, 2020, from Centers for Disease Control and Prevention, https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html (link opens in new window)
  • Care kits

    1. Who is going to be receiving care kits from CarePlus? What if my family members, who are not CarePlus members, need a mask? Can I get a care kit for them too?

      We are providing care kits to all CarePlus members. We are only currently able to supply our members with this care kit. The CDC’s directions for making your own mask can be found here (link opens in new window).

    2. What exactly will the care kit include?

      The care kit contains two washable facemasks, as well as instructions on how to care for the masks.

    3. When should I expect to receive my care kit?

      Care kits will be sent to members’ homes starting in June and throughout the summer.

    4. How can I get more care kits?

      We currently do not have additional supply. We will be monitoring the situation with our members to determine how we can continue to support them during this difficult time. The CDC’s directions for making your own mask can be found here (link opens in new window).

    5. How long do the masks last? Can they be washed? If so, how many times? Can I receive additional masks if needed?

      The masks can be washed 30 times. We currently do not have additional supply and will be monitoring the situation with our members to determine how we can continue to support them during this difficult time. The CDC’s directions for making your own mask can be found here (link opens in new window).

    6. How can I get help with food and groceries, securing prescription refills and solving routine medical issues to help avoid a trip to the doctor or ER?

      CarePlus is working to ensure members in need have access to basic necessities – including food, medication access and access to care. CarePlus is providing resources to members and connecting members with community organizations in their local areas. Members who are having difficulty obtaining these necessities can call the number on the back of their CarePlus ID card for support.

    7. What other policy changes related to COVID-19 has CarePlus previously announced?

      CarePlus previously announced that it is:

      • Waiving the out-of-pocket costs (copays, coinsurance and deductibles) associated with COVID-19 treatment and testing.
      • Allowing early prescription refills, so members can prepare for extended supply needs – an extra 30- or 90-day supply as appropriate.

    8. Who should NOT wear a mask?

      According to the CDC, cloth face coverings should not be placed on young children under age 2, anyone who has trouble breathing, or is unconscious, incapacitated or otherwise unable to remove the mask without assistance.2

    Sources:

    1. About Cloth Face Coverings. (2020, May 22). Retrieved June 18, 2020, from Centers for Disease Control and Prevention, https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/about-face-coverings.html (link opens in new window>
  • COVID Treatment

    Waiving out-of-pocket costs related to coronavirus testing and treatment

    1. Is CarePlus still waiving all member costs for treatment related to COVID-19?

      Yes. CarePlus is waiving member cost sharing for COVID-19 treatment and testing.

      Member copays, deductibles and coinsurance cost sharing will be waived for covered services for COVID-19 related tests and treatments regardless of where they take place. This could include telehealth, primary care physician visits, specialty physician visits, facility visits, labs, home health and ambulance services.

      We also intend to cover the cost of Food and Drug Administration (FDA) approved vaccines and medications when they become available.

    2. Does this require a confirmed coronavirus diagnosis?

      No. Given the limited availability of COVID-19 testing, we will waive member costs for testing and treatment claims for suspected or confirmed COVID-19 cases.

    3. When is this effective? Is it retroactive for members who might have already paid cost-sharing, etc.?

      This coverage decision is retroactive to February 4, 2020.

    4. When does this end?

      There is no current end date; we will reassess as circumstances change

    5. Will these costs be included in or apply to the member’s maximum out-of-pocket (MOOP)?

      Only a member’s cost share is applied to the maximum out-of-pocket (MOOP) calculation. Since the member cost share for COVID-19-related treatment is being waived, nothing will be applied to MOOP.

    6. Does this impact in- and out-of-network claims?

      CarePlus encourages members to continue to see or consult with the health care provider they already know. We will cover the member responsibility for member copays, deductibles or coinsurance costs for COVID-19-related services for in-network or out-of-network covered benefits during this time of crisis.

    Prescription and vaccine coverage

    1. Regarding COVID-19 treatment, what medications will CarePlus cover? Will CarePlus cover Remdesivir?

      CarePlus intends to cover the medical cost of treatment and Food and Drug Administration (FDA) approved vaccines and medications when they become available. If a member is prescribed non-FDA-approved medications for the treatment of COVID-19, he or she will be responsible for any cost sharing required per the plan design. Non-FDA approved drugs are excluded Part D drugs and ineligible for any Part D coverage.

      NOTE: As of June 15, 2020, the FDA has not approved Remdesivir for the treatment of COVID-19.

    2. Are any of the existing medications that could help treat COVID-19 covered (e.g., anti-RA drugs, HIV/malaria drugs)?

      We intend to cover member responsibility for medical cost of treatment and FDA-approved vaccines and medications when they become available. As of May 5, 2020, there are no FDA-approved vaccines or medications for the treatment of COVID-19.

    3. How can I ensure access to my prescription medications while practicing social distancing or sheltering in place?

      Members should check with their current network pharmacies to see if they offer local prescription delivery to support patients in social isolation. As an alternative, members may use PrescribeIT Rx*, CarePlus’ preferred cost-sharing mail order pharmacy, to have their prescription drugs delivered to them. Members can register for PrescribeIT Rx’s mail order delivery by calling 1-800-526-1490. Their hours of operation are Monday through Friday from 8 a.m. to 6 p.m., Eastern Time. Please keep in mind that first-time setup takes approximately five to ten days for processing and delivery after prescription orders are received. To find a list of participating pharmacies in our network, please refer to our Provider Directories page located in our website at www.careplushealthplans.com/members/pharmacy-directories.

      *Other pharmacies are available in our network

    4. Will CarePlus waive refill limits to ensure I have access to my regular medications?

      Yes. CarePlus is allowing early refills through July 25, 2020, on prescription medicines so members can prepare for extended supply needs—an extra 30- or 90-day supply, as appropriate. For specialty tier medications, we are waiving early refill limits for a 30-day supply.

    5. What if I need early prescription refills after July 25, 2020?

      CarePlus will continue to evaluate that end date by monitoring the situation, listening to your feedback and exploring ways we can support your health.

    6. I am concerned about shortages. Will PrescribeIT Rx have my medication and be able to fill and ship my medication to me?

      CarePlus is continually monitoring the drug supply chain. PrescribeIT Rx is currently working with its suppliers to ensure patients do not experience disruptions in receiving their prescriptions in the future. The Food and Drug Administration is closely monitoring supply chains and asking all manufacturers to report any disruptions.

    7. Can I get a vaccine and will CarePlus cover it?

      At present, there are no available vaccines for COVID-19; however, if one were to become available, CarePlus would cover that vaccine for its members.

  • In-home care

    1. Should I cancel my in-home care appointments because of COVID-19?

      Your care is important, and it is vital to maintain coordination with your healthcare providers. Call your Primary Care Provider to discuss and consult regarding your upcoming appointments, and the recommended methods for obtaining the care you need. If you have a history of recent travel and symptoms like fever, cough, or shortness of breath, please consult your healthcare provider. Call ahead before you request a home visit and tell the representative about your symptoms and any recent travel.

Additional Resources:

The latest from the CDC (link opens in new window)

  • Best practices to protect your health

    • What can you do?

      Take precautions as recommended by the CDC. There is no vaccine for the virus that causes COVID-19 at this time, although, many scientists are working around the clock on this.

      The CDC recommends washing your hands often to maintain your health, especially during these key times when you are likely to get or spread germs:3, 4

      • Before, during, and after preparing food
      • Before eating food
      • Before and after caring for someone at home who is sick with vomiting or diarrhea
      • Before and after treating a cut or wound
      • After using the toilet
      • After changing diapers or cleaning up a child who has used the toilet
      • After blowing your nose, coughing or sneezing
      • After touching an animal, animal feed or animal waste
      • After handling pet food or pet treats
      • After touching garbage

      The following hand washing procedures will help reduce your risk of infection:4

      • Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.
      • Lather your hands by rubbing them together with the soap. Lather the backs of your hands, between your fingers, and under your nails.
      • Scrub your hands for at least 20 seconds.
      • Rinse your hands well under clean, running water.
      • Dry your hands using a clean towel or air dry them.
      • If soap and water are not readily available, you can use an alcohol-based hand sanitizer that contains at least 60% alcohol
      • Avoid touching your eyes, nose or mouth with unwashed hands

      If you are sick with COVID-19 or think you might have COVID-19, follow the steps below to care for yourself and to help protect other people in your home and community.5

      • Stay at home except to get medical care
      • Separate yourself from other people
      • Monitor your symptoms and look for emergency warning signs for COVID-19. If you are showing any of the emergency warning signs, seek emergency medical care immediately.
      • Call ahead before visiting your doctor
      • If you are sick wear a cloth covering over your nose and mouth
      • Cover your mouth and nose with a tissue when you cough or sneeze, then throw the tissue in the trash and wash your hands
      • Clean your hands often
      • Avoid sharing personal household items
      • Clean all “high-touch” surfaces everyday

    Sources:

    1. How to Protect Yourself & Others. (2020, April 4). Retrieved April 7, 2020, from Centers for Disease Control and Prevention, https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html (link opens in new window)
    2. When and How To Wash Your Hands (2020, April 2). Retrieved April 7, 2020, from Centers for Disease Control and Prevention, https://www.cdc.gov/handwashing/when-how-handwashing.html (link opens in new window)
    3. What to Do if You Are Sick. (2020, May 8). Retrieved June 22, 2020, from Centers for Disease Control and Prevention, https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html (link opens in new window)
  • Protect yourself from COVID-19 scams

    • Don’t fall for coronavirus scams

      Here is some important information to help you recognize and protect yourself from scammers trying to take advantage of the ongoing coronavirus situation.

      What you should know:

      • If someone comes to your door: Some scammers are going door to door offering free medical services such as in-home COVID-19 test kits and reserving future COVID-19 vaccination appointments. These fraudsters are using these promises to access your home and gather your personal information.
      • If you receive a COVID-19-related call: Scammers claiming to represent a government agency, a public health agency or an insurance company are calling individuals to offer free COVID-19 test kits or reservations for future COVID-19 vaccination appointments. The scammers are requesting personal information like insurance numbers, Medicare IDs and credit card information, often claiming that government agencies are requiring that you provide this information. They may even tell you that you may have been exposed to the COVID-19 virus and that your personal information is needed for public health purposes.

      What you should do:

      • CarePlus will never send anyone to your door without first calling or emailing you to schedule an appointment. If someone you are not expecting comes to your home claiming to be a CarePlus representative, do NOT open your door.
      • If you receive a phone call from someone who says they’re from CarePlus and you are asked for your social security number, credit card or banking information, DO NOT provide this information. CarePlus will never ask you for this information over the phone.
      • If ANYONE calls you about the coronavirus, ask for the caller’s full name, job title and a call-back number before you give any information. Don’t feel rushed or intimidated! It is okay to end the call and contact the agency or company directly to verify that the call is valid.
      • If you suspect a scammer has contacted you by phone or in person, please let us know so we can help:
        • Call CarePlus Member Services at 1-800-794-5907 ; TTY: 711 to report any suspected fraudulent activity related to COVID-19. From October 1 - March 31, we are open 7 days a week; 8 a.m. to 8 p.m. From April 1 - September 30, we are open Monday - Friday, 8 a.m. to 8 p.m. You may always leave a voicemail message after hours, Saturdays, Sundays, and holidays and we will return your call within one business day.
        • You can also report any suspicious activity around COVID-19 fraud by calling the National Center for Disaster Fraud Hotline at 1 866 720 5721 or emailing disaster@leo.gov.

        And always, check back with www.careplushealthplans.com/coronavirus (link opens in new window) regularly for information you can trust.

        For more information, visit the Federal Trade Commission’s coronavirus scam alert (link opens in new window) site.

  • Tips to prepare for telehealth visit

    Ten helpful tips for making the most of your telehealth visit. A little preparation goes a long way.

    Making the move from in-person doctor visits to telehealth appointments—even temporarily—can be intimidating. Here is some practical advice to help get you started.

    1. Telehealth visits are scheduled just like in-person appointments. You will need to call your healthcare provider to set up a specific time for your phone call or video chat. If you do not have a regular doctor, or if your doctor does not offer telehealth visits, call the Member Services number on the back of your CarePlus member ID card. We will help you find a telehealth provider.
    2. To be able to see and hear your healthcare provider, you will need a smartphone, a tablet or a computer that is connected to the internet. If you are new to video chatting, consider a practice run with a friend or family member so you are comfortable with the equipment.
    3. Using headphones or ear buds instead of your device’s microphone and speaker will offer better sound clarity—and more privacy if there are other people in your household.
    4. Be prepared with a list of prescriptions, over-the-counter medicines or supplements you are currently taking. If you have a pharmacy, you like to use, have the name and address handy in case your healthcare provider suggests prescription medication.
    5. You will also want to have your CarePlus member ID card on hand. Although CarePlus is currently waiving member out-of-pocket cost for telehealth services, your healthcare provider will still need your plan information to submit a claim to CarePlus.
    6. While not required, if you have a thermometer, bathroom scale, or blood-pressure monitor at home, you may want to have them handy. Likewise, if you have diabetes and use a glucometer, you may want to keep that close by as well during your telehealth visit.
    7. It is a good idea to make some notes about your symptoms or concerns before your call begins so you do not forget to mention anything. Be ready to tell your doctor or nurse practitioner exactly what you are experiencing. (For routine issues like record requests or bill payment, a telehealth visit is not required. Simply call your provider’s office to get the help you need.)
    8. If you are dealing with an injury, rash or other visible issue, take a picture of it to share with your telehealth provider via email, if your telehealth provider requests it.
    9. Be punctual—ready to answer your provider’s call at the scheduled time. And start by asking what to do if you become disconnected during your visit.
    10. Always remember that in the event of a emergency like chest pain, breathing trouble or another major health event, call 911!