Enter your ZIP code to learn about the CarePlus Medicare Advantage plans in your area, or call us at 1-855-605-6171; TTY: 711.
We know that changing plans can be confusing. CarePlus wants to make sure that you, as a new or existing member, safely transition into the new plan year. If you are not able to get your prescription drug because it is not in the current Prescription Drug Guide or it requires prior authorization because of quantity limits, step therapy requirements, or confirmation of your clinical history, we can help. To learn more about the transition process, please review our Transition Policy.
You can mail your request for prescription drug payment reimbursement along with any bills, receipts, and/or medical record documentation directly to us. To make sure you are giving us all the information we need to make a decision on your request for payment, please fill out our Prescription Drug Claim Form provided below or call Member Services and ask for a form to be mailed to you. Call 1-800-794-5907 (TTY: 711). 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 after-hours, Saturdays, Sundays, and holidays and we will return your call within one business day. Using this form will help us process your request faster.
Send the completed Prescription Drug Claim Form or signed reimbursement request to:
CarePlus Health Plans, Inc.
Attention: Member Services department
11430 NW 20th Street, Suite 300
Miami, FL 33172
You also can find detailed information about requesting a prescription drug payment reimbursement in our Evidence of Coverage, under Chapter 7, Section 2.1, or by reviewing our Prescription Drug Direct Member Reimbursement Policy below:
1CareNeeds PLUS (D-SNP): This plan is available to anyone receiving both Medicare and Medicaid: Qualified Medicare Beneficiaries (QMB/QMB+), Specified Low-Income Medicare Beneficiaries (SLMB/SLMB+), Qualifying Individuals (QI), Qualified Disabled and Working Individuals (QDWI) and other Full Benefit Dual Eligibles (FBDE) CareNeeds PLUS (HMO D-SNP) is sponsored by CarePlus Health Plans, Inc. and the State of Florida, Agency for Health Care Administration.
2CareComplete (C-SNP): This plan is available to anyone enrolled in Medicare with a diagnosis of diabetes, cardiovascular disorders or chronic heart failure.
3CareBreeze (C-SNP): This plan is available to anyone enrolled in Medicare with a diagnosis of chronic lung disorders.
4CareOne PLUS (HMO-POS): This plan covers certain out-of-network services for members while visiting Puerto Rico. Except in emergency or urgent situations, non-contracted providers may deny care.
5CareOne PLATINUM (HMO-POS): This plan covers certain services received from out-of-network providers in Brevard and Indian River counties in Florida. Except in emergency or urgent situations, non-contracted providers may deny care. You will pay a higher copay for services received by non-contracted providers
Out-of-network/non- contracted providers are under no obligation to treat CarePlus members, except in emergency situations. Please call our Member Services number or see your Evidence of Coverage for more information, including the cost- sharing that applies to out-of-network services