Benefit details
-
How does it work?
Chronic Condition Care Assistance is a special supplemental benefit for the chronically ill that provides up to $500 in financial assistance to members with certain chronic health conditions.** Eligible members work with a care manager who approves funds to be used for certain expenses based on their individual health and wellness needs.
-
Eligibility criteria
CarePlus offers Chronic Condition Care Assistance on select Medicare Advantage plans as part of a special program for members with specific health conditions. To qualify for this benefit, you must:
- Be enrolled in a plan that offers the benefit;
- Have a diagnosis of one or more complex chronic conditions;
- Have a high risk of hospitalization or other adverse health outcomes;
- Require intensive care coordination; and
- Work with a care manager who decides how the benefit may be used based on your healthcare needs
-
Qualifying health conditions
Some CarePlus plans with the benefit require a member to have one condition to be eligible. Other CarePlus plans require two conditions. Qualifying conditions include:
- Autoimmune disorders
- Cancer
- Cardiovascular disorders
- Chronic disabling mental health conditions
- Chronic heart failure
- Chronic lung disorders
- Chronic alcohol use disorder and other substance use disorders (SUDs)
- Congestive heart failure
- Chronic Kidney Disease
- Dementia
- Diabetes mellitus
- HIV/AIDS
- Neurologic disorders
- Post-organ transplantation care
- Severe hematologic (blood) disorders
- Stroke
Get plan details
Are there limits on products that can be purchased?
Your care manager will select eligible purchases for you based on your healthcare needs. Some items may have quantity limits. To view these limits, please select a category below.
- Dehumidifier
- Handheld shower head
- High-efficiency air purifier
- Humidifier
- Portable air conditioning unit
- Robotic pet
- Shower or bath/tub transfer bench
- Space heater
- Bathtub safety rails
- Easy-use faucets
- Grab bar sets
- Oscillating fans
- Raised toilet seats
- Easy-use doorknobs
- High-efficiency air filter replacements for air purifiers
- 2 housecoats
- 2 packs of regular socks
- 2 pairs of shoes
- 2 robes
- 3 packs of underpants
- 4 hooded sweatshirts
- 4 long-sleeved shirts
- 4 sets of pajamas or sleepwear
- 4 packs of shirts
- 4 pairs of long pants
- 4 pairs of shorts
- 6 bras (including 2 front clasps, 2 sports bras and 2 back clasps)
The guidelines above are designed to support appropriate and consistent use of this benefit for approved items. Covered and non-covered services are subject to change. For additional details, please contact your care manager.
What’s excluded?
Select the categories below to view examples of expenses that are not covered. Chronic Condition Care Assistance cannot be used for the following items.
- Appliances
- Electronics such as televisions, cameras, security systems, computers and telephones
- Exercise equipment
- Furniture
- Gift cards
- Personal vehicles and related expenses
- Application fees
- Deposits of any kind
- Homeowner/renter fees or maintenance fees
- Memberships such as Amazon Prime, Costco and Sam’s Club
- Moving fees
- Payments on accounts that do not belong to the member or would solely benefit an individual who is not the member*
- Payments to collection agencies
- Payments to family members
- Personal loans/credit card payments - Any
- Tax liabilities - Any
- Warranties
- Zero-balance accounts, including prepayments of goods or services to be received at a future point in time
*Payments may be made on accounts that are not in the member’s name only when the service address matches the service address that CarePlus has on file as the member’s permanent address.
- Cannabis products, paraphernalia, procurement or related services
- Cost share for Part D prescription drug benefits
- Dental services
- Direct member reimbursement
- Durable medical equipment purchased outright
- Insurance premiums
- Procedures that are solely cosmetic in nature and do not extend upon Traditional Medicare coverage
Note: Not all medical and insurance expenses are excluded. The benefit may be used to help pay for your share of costs, such as deductibles, co-insurance, or copayments, for services covered by your plan after your claim is processed
- Entertainment such as cable, satellite and streaming services
- Funeral planning and expenses
- Home repairs or general maintenance
- Providers that are not licensed or certified to provide the services requested
- Service or maintenance agreements
- Services received outside of the effective dates of the plan
The above is not an exhaustive list. There may be items we are unable to assist with that are not explicitly listed. Covered and non-covered services are subject to change.
Explore related topics
-
Spending card
Certain plans include an allowance on the CarePlus Spending Account Card. If you have qualifying chronic conditions, you can use it to buy eligible groceries and more.**
-
Over-the-counter products
If your plan includes an over-the-counter (OTC) allowance, you can order approved OTC products through mail-order from CenterWell Pharmacy®.
-
Chronic condition management
At CarePlus, we are here to help you manage your health. Take time to learn about covered and recommended screenings for conditions such as diabetes, heart disease and lung conditions.
**Chronic Condition Care Assistance is a special program for members with specific health conditions. Qualifying conditions include diabetes mellitus, cardiovascular disorders, chronic and disabling mental health conditions, chronic lung disorders, or chronic heart failure, among others. Some plans require at least two conditions and other requirements apply. See the plan's Evidence of Coverage for details. If you use this program for rent or utilities, Housing and Urban Development (HUD) requires it to be reported as income if you seek assistance. Contact your local HUD office if you have questions.
