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.
Most CarePlus plans include prescription drug coverage. This coverage may vary depending on the plan you select. To find out if your prescription drugs are covered, please refer to the comprehensive Prescription Drug Guides (also known as formularies) below. These guides are updated on our website monthly. Only the current formulary for each plan will display.
The comprehensive formularies include a list of covered drugs selected by CarePlus. We work with a team of doctors and pharmacists to make a formulary that represents the prescription drugs we think you need for a quality treatment program. CarePlus will generally cover the drugs listed in our formularies as long as the drug is medically necessary, the prescription is filled at a CarePlus network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage, which you can view by clicking here.
You may also request that a printed Prescription Drug Guide be mailed to you. Please fill out and submit this form or call Member Services at 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.
If you are not a CarePlus member, please fill out this form to request a Prescription Drug Guide be mailed to you.
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.
PDFPrescription Drug Claim Form – English (opens in new window)
PDFPrescription Drug Claim Form – Spanish (opens in new window)
Send the completed Prescription Drug Claim Form or signed reimbursement request to:
CarePlus Health Plans
Attention: Member Services department
PO Box 277810 Miramar, FL 33027
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:
PDFPart D Direct Member Reimbursement Policy – English (opens in new window)
PDFPart D Direct Member Reimbursement Policy – Spanish (opens in new window)
CarePlus Medicare plans with prescription drug coverage may have additional benefits in 2023 that are not currently displayed.
Important Message About What You Pay for Vaccines - Our 2023 Medicare Advantage Prescription Drug plans cover most Part D vaccines* at no additional cost to you, even if your plan has a deductible and you haven’t paid it.
Important Message About What You Pay for Insulin - You won’t pay more than $35 for a one-month (up to 30-day) supply of each Part D insulin product covered by the plan, no matter what cost-sharing tier it’s on, even if your plan has a deductible and you haven’t paid it.
Interested in a CarePlus plan? Our licensed CarePlus sales agents are available to help you select the coverage that best meets your needs, including plans with enhanced insulin and vaccine benefits call 1-855-605-6171; TTY: 711
Are you a current member? If you are a CarePlus member and have any questions about these enhanced benefits, please contact CarePlus Member Services at the number on the back of your Member ID card for more information.
To learn more, visit CarePlusHealthPlans.com/IRA
*Applies to Part D vaccines listed on the Advisory Committee on Immunization Practices (ACIP) list. Restrictions based on age and vaccine availability may apply. Visit the Centers for Disease Control and Prevention’s ACIP vaccine recommendations webpage (opens in new window) for more information.
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 (HMO C-SNP): This plan is available to anyone enrolled in Medicare with a diagnosis of diabetes, cardiovascular disorders or chronic heart failure.
3CareBreeze (HMO C-SNP): This plan is available to anyone enrolled in Medicare with a diagnosis of chronic lung disorders.
4(057-CareOne 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.
6CareComplete Platinum (HMO-POS C-SNP) This plan covers certain services received from out-of-network providers located within the plan's service area. 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.
7CareBreeze Platinum (HMO-POS C-SNP) This plan covers certain services received from out-of-network providers located within the plan's service area. 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.
8CareSalute (HMO-POS): This plan covers certain services received from out-of-network providers located within the plan's service area. 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.
