In 2012, CarePlus is offering Medicare Advantage HMO benefit plans in the following service areas throughout Florida: Miami-Dade, Broward, Palm Beach, Hillsborough, Pinellas, Pasco, Orange, Osceola, Seminole, Brevard, Saint Lucie, Okeechobee, Indian River, Martin, Lake, Marion, Sumter, Charlotte, Lee, Sarasota, and Polk counties. Please check the links provided below to review the Summary of Benefits and/or Evidence of Coverage for each specific Medicare benefit plan, which will provide you with the plan's description of benefits.
Individuals must have both Medicare Part A and Part B. You must continue to pay your Medicare Part B premium. Eligible beneficiaries must use network pharmacies to access their prescription drug benefits, except under non-routine circumstances. Limitations, copayments, and restrictions may apply.
You must use plan providers, except in emergency or urgent care situations, or for out-of-area renal dialysis or other services. You must receive all routine care from plan providers. If you obtain routine care from out-of-network providers neither Medicare nor CarePlus Health Plans, Inc. will be responsible for the costs. Limitations, copayments and restrictions may apply.
The benefits, products, and services described below may not be available in all CarePlus' service areas. The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan. Benefits may change on January 1 of each year.
To learn more about 2012 CMS Plan Ratings information, click here.
CarePlus is a Coordinated Care plan with a Medicare contract and a contract with the Medicaid program.
+ These benefits plans are available to partial or full benefit dual eligible members. This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, copayments, coinsurance, and deductibles may vary based on the level of extra help you may receive. Please contact CarePlus Health Plans, Inc.'s Member Services department for further details.
++These benefit plans are available to QMB and QMB PLUS beneficiaries. Part B premium is covered by the state for full benefit dual eligible members. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact CarePlus Health Plans, Inc.’s Member Services department for further details. Sponsored by CarePlus Health Plans, Inc. and the State of Florida, Agency for Health Care Administration.
* These benefit plans are available to all people with Medicare who have been diagnosed with Diabetes.
The following plans will no longer be offering individual beneficiary coverage effective January 1, 2012.
CareNeeds (HMO SNP), CareNeeds Plus (HMO SNP) and CareDirect (HMO SNP) have been approved by the National Committee for Quality Assurance (NCQA), a non-profit organization dedicated to improving health care quality until December 31, 2013. The following plans will no longer be offering individual beneficiary coverage effective January 1, 2012:
CareDirect (HMO SNP) Plan in Miami-Dade county and CareComplete (HMO) Plan will not be renewing its Medicare contract effective January 1, 2012. You may choose to enroll in our plan, but your coverage will automatically end on December 31, 2011. Because this plan ends on December 31, 2011, if you decide to join, you are entitled to enroll in a new MA plan or PDP beginning December 8, 2011 through February 29, 2012. However, if you want your enrollment in the new plan to take effect on January 1, 2012, the new plan must receive your application by December 31st. You may also have the option of enrolling in a Medicare Cost Plan, if one is offered in your area. If you do not enroll in another MA plan, Medicare Cost Plan or PDP by December 31, 2011, you will be disenrolled from our plan and enrolled in Original Medicare on this date.
CareFree PLUS (HMO) Plan in Broward county will be combining with one of our other plans, CareFree (HMO). Enrolled members can choose a different Medicare Health Plan or switch to Original Medicare. However, if you don't choose another plan, we will automatically change your coverage to our CareFree (HMO) Plan on January 1, 2012.
If you have any questions or would like further information, please call Member Services at 1-800-794-5907; from 8 a.m. to 8 p.m., 7 days a week. From February 15th to September 30th, we are open Monday - Friday from 8 a.m. to 8 p.m. TTY users should call 711.