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Medicare Advantage Plans

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CarePlus Medicare Advantage Plans: Overview

Understanding How CarePlus Plans Work

At CarePlus, we believe that prevention is the best medicine. That’s why all CarePlus plans include Medicare-covered preventive services and screenings at no additional cost to you.

When you become a CarePlus member, you’ll choose a primary care physician (PCP) (also known as a general practitioner) from our network of providers. Your PCP is a healthcare professional who is trained to give you basic medical care. Your PCP will provide your routine or basic care and coordinate the rest of the covered services you need. In most cases, you must see your PCP to get a referral before you see any other healthcare provider.

Most CarePlus Medicare Advantage plans have a $0 monthly plan premium1.

All CarePlus Medicare Advantage plans include:

  • Preventive dental benefits
  • SilverSneakers® (link opens in new window) fitness program
  • Coverage for inpatient hospital stays
  • Deliver Fresh Meal program available within 30 days of discharge from an inpatient stay from an inpatient hospital stay
  • Over-the-Counter (OTC) allowances
  • Our CarePlus Rewards program for preventive care
  • Transportation to plan-approved locations
  • Telehealth services2
  • Routine Vision benefits
  • Routine Hearing benefits

Most CarePlus Medicare Advantage plans also include:

  • Prescription drug coverage with no deductible
  • Access to a preferred cost-sharing mail-order pharmacy with no shipping fees
  • Coverage for certain erectile dysfunction drugs and prescription vitamins

When can I enroll in a Medicare Advantage (MA) plan?

If you recently became eligible for Medicare, through age or disability, you generally have the option to apply for coverage in a Medicare Advantage plan close to the date when your Medicare Part A and Part B coverage starts.

Your Medicare Advantage plan cannot start before both your Part A and Part B coverage begins. However, you generally have a period of seven months to apply for Medicare Advantage plan coverage.

This means you can apply for a Medicare Advantage plan three months before, the month of, or three months after your Medicare Part A and Part B coverage starts. You must be enrolled in Medicare Part A and in Medicare Part B. This period is known as the Initial Coverage Election Period (ICEP).

Already enrolled in Medicare?

If you did not recently become eligible for Medicare, your enrollment options are different and may be limited to certain times during the year.

Annual Enrollment Period (AEP): October 15 - December 7

During this time, you may change or enroll in a Medicare Advantage (MA), Medicare Advantage Prescription Drug (MAPD), or Prescription Drug Plan (PDP), or return to Original Medicare. Changes made during this period will take effect on January 1 of the following year.

Open Enrollment Period (OEP): January 1 - March 31

If you enrolled in a Medicare Advantage (MA) or Medicare Advantage Prescription Drug (MAPD) plan, you may be able to switch plans or return to Original Medicare during this time. You can change plans only one time during this enrollment period.

Special Enrollment Period (SEP)

In certain situations, outside of the ICEP or AEP, Medicare beneficiaries may be able to join, switch, or leave a Medicare Advantage plan or a prescription drug plan during a Special Enrollment Period (SEP).

Some examples of special enrollment situations are:

  • Your current plan is not renewing its contract with the Centers for Medicare & Medicaid Services (CMS).
  • You are turning 65.
  • You recently moved to the plan coverage area.
  • You have a qualifying medical condition.
  • You have Medicare and Medicaid.
  • You are disenrolling from an Employer’s or Union’s health coverage.
  • You want to enroll in a plan that received a 5-star rating from Medicare for that plan year.
  • You enter, reside in, or leave a long-term care facility.
  • You qualify for Extra Help.
  • You involuntarily lost creditable prescription drug coverage.
  • Other exceptional conditions may exist, as determined by CMS.

1Most CarePlus plans do not have a premium. If you qualify for and enroll in a CareNeeds Plus plan for enrollees who have both Medicare and Medicaid (dual eligibles), your premium will likely be paid in full by Medicare’s Extra Help/Low Income Subsidy Program. For some members, the premium is reduced. The premium you pay, if any, is determined by your income and resources. To get the information necessary to apply for assistance visit our Extra Help page.

2This benefit may not be offered by all in-network plan providers. Check directly with your provider about the availability of telehealth services, or you can also visit our ”Find a Doctor” tool to access our searchable directory online.

Most CarePlus plans require members to use network providers except in emergency or urgent care situations (or if a plan has a Point of Service (POS) option. Emergency or urgently needed services can always be obtained in or out of the service area from the nearest available provider. When in the service area, you must use plan providers for urgent care. In addition, when out of the service area, you can obtain dialysis treatment from any qualified dialysis provider. If you obtain routine care from out-of-network providers, neither Medicare nor CarePlus will be responsible for the costs.

For more information, please 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.

Additional Disclaimers:

2023 Disclaimers

CareNeeds 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).

CareComplete (HMO C-SNP): This plan is available to anyone enrolled in Medicare with a diagnosis of diabetes, cardiovascular disorders or chronic heart failure.

CareBreeze (HMO C-SNP): This plan is available to anyone enrolled in Medicare with a diagnosis of chronic lung disorders.

(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.

(110-CareOne PLATINUM (HMO-POS); 141-CareComplete Platinum (HMO-POS C-SNP);142-CareBreeze Platinum (HMO-POS C-SNP); 143-CareSalute (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.