About Medicare Enrollment

Welcome CarePlus Members

As a member of CarePlus, this page is just for you. Here you can find the information and forms you need to help manage your healthcare decisions and provide us with feedback.

We want to make it easier for you to help stay in control of your health care. As one of our 115,000* members, you are the reason why we work hard to provide you with improved benefits, value and convenience each year. We have always believed that good healthcare starts with prevention. That is why we focus on giving you the benefits you need to help you stay satisfied and happy.

CMS Star Ratings

The Overall Star Rating gives you a single summary score that makes it easier for you to compare plans based on quality and performance. The information provided below is an overall star rating for CarePlus’ performance. In addition, you can visit www.medicare.gov (link opens in new window)  to see detailed ratings and find out more about the differences between plans.

Summary of the Florida Patient's Bill of Rights and Responsibilities

CarePlus' Summary of the Florida Patient's Bill of Rights and Responsibilities

Florida law requires that your healthcare provider or healthcare facility recognize your rights while you are receiving medical care and that you respect the healthcare providers’ or healthcare facility’s right to expect certain behavior on the part of patients.

PDFSummary of the Florida Patients Bill of Rights and Responsibilities - English(PDF opens in new window) 

PDFSummary of the Florida Patients Bill of Rights and Responsibilities - Spanish(PDF opens in new window) 

Grievance and Appeal Information

You or your authorized representative may file a grievance request either verbally or in writing. For important information on how to file a grievance and/or appeal, please click one of the options below.

PDFHow to File a Grievance or Appeal - English(PDF opens in new window) 

PDFHow to File a Grievance or Appeal - Spanish(PDF opens in new window) 

For important information and forms about coverage determinations, redeterminations and how to appoint a representative, please click here.

How to File a Grievance and/or Appeal

To file a grievance or appeal, you can contact CarePlus in one of these ways:

By phone– 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 message after hours, Saturdays, Sundays, and holidays and we will return your call within 1 business day. Fax or mail the form – If you prefer, you can download a copy of the form below and fax or mail it to CarePlus.

Grievance and Appeals Request Form

PDFGrievance/Appeal Request Form - English(PDF opens in new window) 

PDFGrievance/Appeal Request Form - Spanish(PDF opens in new window) 

Fax number: 1-800-956-4288

Mailing address:

CarePlus Health Plans
Grievance and Appeals department
11430 NW 20th Street, Suite 300
Miami, FL 33172

You may submit feedback online directly to the Centers for Medicare & Medicaid Services. Fill out the Medicare Complaint Form (link opens in new window)  with your personal information and concern.

Contact numbers for members and physicians who have questions and need to inquire about the status of the grievance, coverage determination, and appeal processes

Members:

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 message after hours, Saturdays, Sundays, and holidays and we will return your call within 1 business day. Our fax number is 1-800-956-4288.

Provider/Physicians:

Please contact the CarePlus Pharmacy Coverage Determination Review Team at 1-866-315-7587, The Pharmacy Coverage Determination Review Team hours of operations are Monday - Friday, from 8 a.m. to 8 p.m. TTY users should call 711. Our fax number is 1-800-310-9071.

How to obtain an aggregate number of grievances, appeals and exceptions filed with CarePlus.

PDFHow to Obtain an Aggregate Number of Grievances, Appeals and Exceptions - English(PDF opens in new window) 

PDFHow to Obtain an Aggregate Number of Grievances, Appeals and Exceptions - Spanish(PDF opens in new window) 

You can also find detailed information in Chapter 9 of the CarePlus Evidence of Coverage (EOC) with regard to grievances, coverage determinations (including exceptions), and the appeals process. Links to the EOC can be found on the 2018 CarePlus Medicare Advantage Plan Information page and 2019 CarePlus Medicare Advantage plan Information.

How and Where to Send us your Request for Payment:

You can submit your requests for payment reimbursement, along with proof of payment (bills, receipts) and/or a copy of the medical record documentation, if available, with your request. To make sure you are giving us all the information we need to make a decision, you can either download a copy of the below Reimbursement Request 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 message after-hours, Saturdays, Sundays, and holidays and we will return your call within 1 business day. If you don’t want to use the form, you can also send us a cover letter with all the needed documentation listed above. The Reimbursement Request Form or signed reimbursement request must be sent in writing.

PDFReimbursement Request Form - English(PDF opens in new window) 

PDFReimbursement Request Form - Spanish(PDF opens in new window) 

Mail your request for payment together with any bills, receipts, and/or medical record documentation to us at the address mentioned below:

CarePlus Health Plans
11430 NW 20th Street, Suite 300
Miami, FL 33172
Attention: Member Services department

Over-The-Counter (OTC) Products

No matter which CarePlus benefit plan you are enrolled in, you can take advantage of a set monthly allowance that you can use to order approved over-the-counter (OTC) products. This includes products like cough medicine, pain relievers, and first aid items. These products can be mailed directly to your home through our easy-to-use OTC mail-order service. Please allow 10 to 14 calendar days from the time our network mail-order pharmacy Humana-owned PrescribeIT Rx receives your order to the time of delivery. If you don't receive your order within the estimated timeframe, please call PrescribeIT Rx at 1-800-526-1490. TTY users should call 711. Hours of operation are Monday through Friday from 8 a.m. to 6 p.m. This information is not a complete description of benefits. Call 1-800-794-5907 (TTY: 711) for more information.

PDF2018 PrescribeIT Rx OTC English Form(PDF opens in new window) 

PDF2018 PrescribeIT Rx OTC Spanish Form(PDF opens in new window) 

PDF2019 PrescribeIT Rx OTC English Form(PDF opens in new window) 

PDF2019 PrescribeIT Rx OTC Spanish Form(PDF opens in new window) 

For more information about PrescribeIT Rx OTC mail-order service please click on the link below.

https://www.prescribeitrx.com/otc (link opens in new window)

National Coverage Determinations (NCD)

From time-to-time CMS makes changes to the services that are covered by Medicare. These changes are updated via National Coverage Determinations. You can access the NCD information by using the link below.

National Coverage Determinations

Quality Improvement (QI) Program

CarePlus’ Quality Improvement Program includes clinical care, preventive care and member services. For information about our Quality Improvement Program and progress toward our goals, please review the document below:

PDFCarePlus Quality Improvement Program Description Overview (English) (PDF opens in new window) 

PDF CarePlus Quality Improvement Program Description Overview (Spanish) (PDF opens in new window) 

Members may also obtain a written Quality Improvement (QI) Program description by calling the Quality Operations, Compliance and Accreditation department at (305) 626-5195 between 8:30 a.m. to 5:00 p.m., Monday - Friday; TTY users should call 711. We welcome members’ input regarding our QI program. Feedback can be provided by writing to the following address: CarePlus Health Plans, Quality Operations, Compliance & Accreditation department, 3501 SW 160th Ave, Bldg. B, 1st Floor Miramar, FL 33027.

Care Management Member Satisfaction Surveys

CarePlus conducts annual surveys to assess our members’ levels of satisfaction with the care and interventions they receive from CarePlus’ care management programs. The goal of these programs is to provide health education and wellness promotion services to members with an assigned care manager serving as their advocate. The results of the satisfaction surveys are reviewed, analyzed and incorporated into quality improvement activities in an effort to enhance CarePlus’ care management programs and provide our members with high-quality service. If you have questions or would like to receive a copy of these survey results, please call the CarePlus Care Management Department at 1-866-657-5625. We are available Monday through Friday from 8 a.m. to 4 p.m. Eastern time.

SNP MOC Quality Improvement Evaluation (QIE)

CarePlus Health Plans conducts an annual evaluation of its Model of Care (MOC). If you would like details related to this evaluation 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 message after hours, Saturdays, Sundays, and holidays and we will return your call within 1 business day.

CarePlus is an HMO plan with a Medicare contract. Enrollment in CarePlus depends on contract renewal. CareNeeds (HMO SNP) and CareNeeds PLUS (HMO SNP) are sponsored by CarePlus Health Plans, Inc. and the State of Florida, Agency for Health Care Administration.

CareNeeds (HMO SNP) and CareNeeds PLUS (HMO SNP), have been approved by the National Committee for Quality Assurance (NCQA) to operate as a Special Needs Plan (SNP) until December 31 2020 based on a review of CareNeeds' and CareNeeds PLUS' Model of Care.