CarePlus offer Medicare Advantage plans in Florida. The plans provide hospitalization and medical insurance, along with prescription drug coverage. Extra benefits include dental and vision care.
Most of the company’s plans have a $0 monthly premium. The copays and annual limit on costs vary among the plans.
This article introduces CarePlus and provides an overview of Medicare Advantage before discussing the coverage, costs, and availability of CarePlus Advantage plans. It also describes how the plans fit within Medicare and explains how people can get more information.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Miami-based CarePlus Health Plans have more than 166,000 members and offer only Medicare Advantage plans. The company hold accreditation with the Accreditation Association for Ambulatory Health Care, and they partner with the Florida Department of Children and Families’ ACCESS Florida Community Network as an Assisted Service Site.
Medicare Advantage plans (Part C) provide an alternative way for a person to get the same benefits that original Medicare (Part A and Part B) provides, with the option of additional benefits.
Most Advantage plans include prescription drug coverage, wellness programs, and dental, vision, and hearing care.
Advantage plans differ from original Medicare as follows:
- Most Advantage plans require a person to choose from in-network providers, while original Medicare allows them to choose from any providers who accept Medicare.
- Advantage plans put a limit on yearly out-of-pocket costs, but original Medicare does not.
- Most Advantage plans include prescription drug coverage, but original Medicare does not.
- Some Advantage plans offer additional benefits that Medicare does not provide.
CarePlus Advantage offer five HMO plans, two of which are tailored to the needs of people with certain chronic diseases. Some plans have $0 monthly premiums.
All CarePlus plans require a person to choose from a network of doctors, pharmacies, and hospital providers. In most instances, they will need to get a referral from their primary care doctor before seeing other healthcare providers.
Most plans include:
- inpatient hospitalization
- outpatient services, such as lab tests and doctor visits
- prescription drugs
- dental, vision, and hearing care
- mail-order pharmacy, with free delivery
- over-the-counter drug allowance
- fitness classes
- preventive care rewards program
- telehealth services
- transportation benefits
- a meal program after hospital discharge
All CarePlus Advantage plans include prescription drug benefits. Each plan has a formulary, which is a list of the medications that it covers.
Formularies include brand name and generic drugs in commonly prescribed classes. The plans divide the formularies into tiers based on the size of the medications’ copay. The cost of a prescription depends on the tier in which the drug falls.
The table below includes some examples of CarePlus Advantage plans:
| Plan | Location | Monthly premium | Maximum annual out-of-pocket |
|---|---|---|---|
| CareNeeds Plus (HMO D-SNP) | Broward, Miami-Dade, and Palm Beach Counties, South Florida | $0 to $16.30 | $3,400 |
| CareComplete (HMO C-SNP) | Hillsborough, Lake, Marion, Orange, Osceola, Pasco, Pinellas, Polk, Seminole, and Sumter Counties, Central/West Florida | $0 | $3,400 |
| CareOne Plus (HMO-POS) | Lake, Marion, Orange, Osceola, Seminole, and Sumter Counties, Orlando | $0 | $2,750 |
| CareOne Platinum (HMO-POS) | Brevard and Indian River Counties, Space Coast | $0 | $3,750 |
| CareFree (HMO) | Clay and Duval Counties, North Florida | $0 | $3,900 |
| CareOne Plus (HMO) | Volusia County, Daytona | $0 | $3,400 |
Depending on the CarePlus plan a person chooses, there may be other costs:
- $0 to $150 copays for the first few days of hospitalization
- $0 to $25 copays for specialist doctor visits
- $0 to $140 copays for outpatient medical services
- $90 to $120 copays to hospitals for emergency care
- $0 to $25 copays for urgent care
Those with a CarePlus Advantage plan must pay Medicare Part B monthly premiums of $148.50 in 2021, unless they qualify for Medicaid and their particular program covers the premiums or they have a CarePlus Advantage plan that reduces the premiums by up to $100.
Where are CarePlus plans available?
The company offer plans in the following counties in Florida:
- Brevard
- Broward
- Clay
- Duval
- Hillsborough
- Indian River
- Lake
- Marion
- Miami-Dade
- Orange
- Osceola
- Palm Beach
- Pasco
- Pinellas
- Polk
- Sumter
- Seminole
- Volusia
Medicare Advantage takes the place of original Medicare for beneficiaries who want another way of getting hospital and medical insurance.
A person with an Advantage plan is not eligible to buy a Part D plan, which provides prescription drug coverage. However, all CarePlus plans include this coverage.
An individual with an Advantage plan is also not eligible to buy Medigap, which is Medicare supplement insurance.
How to get more information
Anyone who needs help selecting a CarePlus Advantage plan can call 1-855-605-6171. Deaf people may call 711. Alternatively, people can use this online search tool to find the CarePlus plans available in their area.
If people living in certain counties of Florida are looking for an alternative to original Medicare, CarePlus offer Advantage plans that they may wish to consider.
All CarePlus Advantage plans provide hospital and medical insurance, as well as prescription drug coverage. Other benefits differ among plans, along with the costs.