Medicare Advantage Plans

CarePlus Medicare Advantage Plans: Overview

Understanding How CarePlus Plans Work

CarePlus has a holistic view of health care. We believe that prevention is the best medicine, and that health solutions come about when we work closely with our providers and members. We cover all Medicare-covered preventive services and screenings at no additional cost to you.

When you become a CarePlus member, you must choose a primary care provider (PCP) (also known as a general practitioner) from our network of providers. Your PCP is a healthcare professional, usually a physician, who meets state requirements and is trained to give you basic medical care. You will get your routine or basic care from your PCP. Your PCP also can 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.

CarePlus Medicare Advantage plans include:

  • Mail-order pharmacy with no delivery fees
  • Dental benefits
  • Fitness & exercise classes
  • Inpatient hospitalization coverage
  • Over-the-counter allowance
  • Prescription drug coverage
  • Preventive care rewards program
  • Transportation benefits
  • Telehealth services
  • Vision benefits

Most CarePlus Medicare Advantage plans also include:

  • $0 monthly plan premiums for most members *
  • Hearing benefits
  • Meal program after hospital discharge

*Our CareExtra plan in Miami-Dade County requires an affordable monthly premium; however, if you receive Extra Help from Medicare, you may qualify to pay a lower premium or no premium at all. Extra Help and Florida Medicaid help lower or completely cover the premiums for members who qualify for these types of assistance.

CarePlus plans require members to use network providers except in emergency or urgent care situations. 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:

2020

CareNeeds (HMO D-SNP) and CareNeeds PLUS (HMO D-SNP) are sponsored by CarePlus Health Plans, Inc. and the State of Florida, Agency for Health Care Administration.

CareNeeds PLUS (HMO D-SNP) plan is available to anyone receiving both Medicare and Medicaid-covered services: Qualified Medicare Beneficiaries (QMB+), Specified Low-Income Medicare Beneficiaries (SLMB+), and other Full Benefit Dual Eligible (FBDE). * The plan premium is fully funded by Medicare’s Extra Help program for anyone who qualifies to join this plan

CareNeeds (HMO D-SNP) plan is available to anyone receiving both Medicare and some level of financial assistance from Medicaid: Qualified Medicare Beneficiaries (QMB), Specified Low-Income Medicare Beneficiaries (SLMB), Qualifying Individuals (QI), and Qualified Disabled and Working Individuals (QDWI). ** Your premium depends on the amount of Extra Help you get. You must continue to pay your Medicare Part B premium. The Part B premium may be covered through your State Medicaid Program.

2021

CareNeeds PLUS (HMO D-SNP) is sponsored by CarePlus Health Plans, Inc. and the State of Florida, Agency for Health Care Administration.

CareNeeds PLUS (HMO 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). Your premium depends on the amount of “Extra Help” you get. You must continue to pay your Medicare Part B premium. The Part B premium may be covered through your State Medicaid Program.

CareComplete (HMO C-SNP): This plan is available to anyone with Medicare who has been diagnosed with diabetes, cardiovascular disorders or chronic heart failure.

(057-CareOne PLUS (HMO-POS) Orlando): 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) Space Coast): 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.