About Medicare Enrollment

Welcome CarePlus Members

We want to make it easier for you to help stay in control of your health care. As one of our 145,852 * members, you are the reason why we work hard to provide you with improved benefits, value, and convenience each year. We believe that good healthcare starts with prevention, which is why we focus on giving you the benefits you need to help you stay satisfied and happy.

On this page you will find the information and forms you need to help manage your healthcare decisions, and to provide us with feedback.

*The Centers for Medicare & Medicaid Services (CMS) Medicare Advantage (MA) Membership Reports August 2019.

CMS Star Ratings

The Centers for Medicare & Medicaid Services (CMS) created its Five-Star Quality Rating System to help consumers, their families, and caregivers compare Medicare health and prescription drug plans. The below information is the overall Star Rating CarePlus received for 2019. CMS makes information available about all rated Medicare health and prescription drug plans at www.medicare.gov (link opens in new window) .

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.

PDFCarePlus Summary of the Florida Patient’s Bill of Rights and Responsibilities — English(PDF opens in new window) 

PDFCarePlus Summary of the Florida Patient’s Bill of Rights and Responsibilities — Spanish(PDF opens in new window) 

How to File a Grievance 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.

By fax or by mail– Download a copy of the form below and fax or mail it to CarePlus.

Grievance or Appeal Request Form

PDFGrievance or Appeal Request Form — English(PDF opens in new window) 

PDFGrievance or Appeal Request Form — Spanish(PDF opens in new window) 

Fax number: 1-800-956-4288

Mailing address:

CarePlus Health Plans
Grievance and Appeals
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 grievance and appeal data.

PDFHow to Obtain Grievance and Appeal Data — English(PDF opens in new window) 

PDFHow to Obtain Grievance and Appeal Data — Spanish(PDF opens in new window) 

You can 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. You will find links to the EOC on the CarePlus Medicare Advantage Plan Information pages.

How and Where to Send Us Your Request for Payment

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, either download, print, and complete a copy of the below Reimbursement Request Form. If you don’t want to use the form, send us a cover letter with all the needed documentation listed above.

If you need help completing the form, or information about what you need to send us, 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. You must send the Reimbursement Request Form or signed reimbursement request 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 with any bills, receipts, and/or medical record documentation to us at:

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

National Coverage Determinations

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

The CarePlus Quality Improvement Program includes clinical care, preventive care, and member services. See below for information about our Quality Improvement Program and progress toward our goals:

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 also can obtain a written Quality Improvement (QI) Program description by calling the Quality Operations, Compliance and Accreditation department at 1-305-626-5195 Monday - Friday, 8:30 a.m. to 5:00 p.m.; TTY users should call 711. We welcome members’ input about our QI program. Members can provide feedback by writing to: 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 our care management programs. With these programs, we aim to provide health education and wellness promotion services to members, with an assigned care manager serving as their advocate. We review, analyze, and incorporate results from the satisfaction surveys into quality improvement activities, in an effort to enhance our care management programs and provide our members with high-quality services. If you have questions or want a copy of these survey results, please call the CarePlus Care Management Department at 1-866-657-5625 Monday - Friday, 8 a.m. - 5 p.m., EST.

Special Needs Plans (D-SNPs) Model of Care (MOC) Quality Improvement Evaluation (QIE)

CarePlus Health Plans conducts an annual evaluation of its MOC. If you want 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 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 (HMO D-SNP) and CareNeeds PLUS (HMO D-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.