Few certain healthcare providers will be more expansive than others when comparing Medicare Part C advantage plan options – honestly, depending on your location, you might only have one or two providers available for enrollment at any given time in your zip-code. For many, this controlled limitation can seem like a detriment, both for you as the enrollee and the healthcare company themselves, but you’ve got to fairly consider the positives of a provider’s decision to limit their outreach – by only providing coverage to small, select areas, a provider can:

  • Have a more direct communication with local doctors, special facilities, hospitals, and pharmacies
  • Provide a much stronger, tight-knit net of responsibility towards all enrollees, especially with a higher quality customer service
  • Best tailor their benefits to smaller, “more neighborly” communities in each respective coverage area, allowing for reliability and commitment

A great example of Medicare Part C advantage plan provision through limited coverage are the policies under the Florida healthcare provider Careplus – with plan options only ranging through some select service areas within Florida, including:

  • North Florida – Duval County
  • South Florida – Broward, Miami-Dade, and Palm Beach Counties
  • Orlando – Lake, Marion, Orange, Osceola, Seminole, and Sumter Counties
  • Tampa – Hillsborough, Pinellas, Pasco, and Polk Counties
  • Treasure and Space Coast – Brevard and Indian River Counties

Specializing primarily in HMO coverage, Careplus seeks to use its local stature to the advantage, creating recognizable and specialized coverage a Florida resident can feel comfortable considering as an option, and likely, allowing the same enrollee a much higher possibility of continuing their normal routine, including visiting participating doctors, facilities needed for high quality-of-life, and otherwise, without halt. Additionally, by working closely with many providers across Florida, enrollees may find that the familiarity between their healthcare provider and their doctors (or pharmacy) can create a great dialogue about your current status, especially in correlation to the correct coverage you’ll need to best keep your health.

  1. Careplus HMO Plans –

However, with further specialization comes a few insights to prepare for when seeking to enroll – first, you will not find a unique plan type through Careplus (such as PPO, PFFS, or HMO-POS,) only strict HMO and HMO-SNP, with the latter required as a necessity of all healthcare providers offering advantage plan coverage; a Special Needs Plan through Careplus will provide the correct service and coverage to individuals who would be applicable for its unique kind of supremely low cost coverage. With such conditions in mind, those who enroll from Florida’s available counties are given a very clear distinction between how to use their benefits – either keep to your carefully crafted local network or pay the full share out-of-pocket for procedures that you choose to complete outside of the Careplus network.

One of the lucrative elements of this lies in the divide between Careplus and other, more expansive providers – Careplus has no plan network types aside from HMO and only operates in Florida, but because the company only provides servicing for select counties in one state, the potential for individuals to realistically need or prefer out-of-network usages is made lower against the droves of built-upon community support over time. Like most other HMO policies though, you’ll be requested some priorities when enrolling to completely manage your healthcare coverage, especially when trying to build the communication between yourself, the provider, and the doctors or facilities you may most need moving forward:

  • You’ll need assure that your current primary doctor is considered a viable “Primary Care Provider” through Careplus – in some occasions, your current routine provider may be categorized differently per the plans they’ve decided to service, purposefully (or by the healthcare provider’s discretion) making themselves not an acceptable choice when enrolling. In the event your initial choice in primary care provider is ultimately passed over, you can be recommended a doctor of the Careplus network – no matter what, you’ll be required to make a proper selection before enrollment is complete.
  • You’ll need to communicate with whatever PCP is selected as your choice on the plan for any necessary specialist referrals – this is straight-forward, as your routine doctor should fairly be able to assess their judgement over your normal situation against any on-going, or sudden, health issues. Additionally, while not only required, referrals can best allow specialist doctors to build a rapport between themselves and your PCP, a communication that may already uniquely exist through Careplus’s tight-knit network.
  • Speaking of that tight-knit network – in order to keep your costs reflective of what is seen on the plan’s coverage listing, you’ll need to keep to the correct providers within that network; remember, it’s as simple as putting forward a few questions both during and prior to enrollment! Avoiding the ignorance of not knowing who your viable providers are could lead you to unnecessary bills, like having to pay completely out-of-pocket for something you could’ve saved tremendously on just a few miles apart.

Typically, the plan names across counties do not differ, but like any other state, different counties will be applicable for costs most comparable to the lifestyle of its locale – if we want to compare plans, we’ll still need to use a Florida community to do so, as to avoid a massive twist of very minor tweaks across multiple county spans. Miami-Dade County, home to one of Florida’s biggest and most metropolitan cities, Miami, can serve as an excellent template of how Careplus coverage greatly divides between each of its individually supplied advantage plans. By surveying the baseline coverage, along with comparative exterior benefits further provided (like dental, vision, and hearing,) a proper portrait of Careplus’s image can be better seen in comparison to itself, and more importantly, other nation-wide plans:

  1. CareOne Plus (HMO):

The first option, the CareOne Plus (HMO) acts as the standard for Careplus HMO plans, with low copays all throughout, many expected and eager advantage plan perks, and thorough coverage…

  • This plan’s premium, plan deductible, drug deductible, preventive care, primary care provider and specialist copay is $0.
  • $1,000 maximum out-of-pocket responsibility (MOOP)
  • Inpatient and Outpatient Hospital Care is provided at $0.
  • Both Emergency Room and Urgent Care are provided – a $120 copay for ER and a $0 copay for UC, respectively.
  • Routine dental, vision, and hearing benefits are offered, including coverage for hearing aids, fillings, dentures, eyeglasses, and contact lenses.
  • The plan comes with built-in prescription drug coverage at no additional premium – each drug falls into a tier between ranging between 1 to 5 with copays as low as $0 per drug (and as high as 33% of the cost.)
  • Your Skilled Nursing Facility is provided – $0 per day for days 1-7, then $20 per day for days 8-100.
  • Transportation is provided – unlimited one-way trips to plan approved locations.
  • You are given an Over-the-Counter Allowance of $100 every month for the purchase of any supplies using a Careplus mail-order service.
  • A SilverSneakers membership is provided, allowing access to a local accepting fitness center and program.
  • Both Home Healthcare and Hospice are covered at no cost.
  1. CareFree Plus (HMO):

As you move to the CareFree Plus (HMO) a unique opportunity arises – the Part B giveback. By adjusting plan costs against this amount returned to the enrollee per month, this plan highlights the ability to shift costs in association to exterior benefits. With more money to use on everyday purposes, an individual who may find themselves comfortable paying higher copays (but likely less often) may see incentive in such a plan…

  • This plan’s premium, plan deductible, drug deductible, preventive care, primary care provider and specialist copay is $0.
  • This plan offers you a $90 Part B premium reduction, lowering the amount taken from your Social Security check each month – this essentially gives you an additional $90 per month to spend of your own accord.
  • $3,400 maximum out-of-pocket responsibility (MOOP)
  • Inpatient Hospital Care is provided – $50 copay per day for days 1-5 in Inpatient Hospital, but a $0 cost for any day after.
  • Outpatient Hospital Care is provided – copay is between $0 to $40 depending on service required during visit.
  • Both Emergency Room and Urgent Care are provided – a $120 copay for ER and a $0 copay for UC, respectively.
  • Routine dental and vision benefits are offered including coverage for fillings, dentures, eyeglasses, and contact lenses; however, there is only very limited coverage for hearing, with no help for Hearing Aids provided.
  • The plan comes with built-in prescription drug coverage at no additional premium – each drug falls into a tier between ranging between 1 to 5 with copays as low as $0 per drug (and as high as 33% of the cost.)
  • Your Skilled Nursing Facility is provided – $0 per day for days 1-7, then $20 per day for days 8-100.
  • Transportation is provided – unlimited one-way trips to plan approved locations.
  • You are given an Over-the-Counter Allowance of $25 every month for the purchase of any supplies using a Careplus mail-order service.
  • A SilverSneakers membership is provided, allowing access to a local accepting fitness center and program.
  • Both Home Healthcare and Hospice are covered at no cost.
  1. CareExtra (HMO):

The last example, the CareExtra (HMO) provides an opportunity to those who would rather be inclined to paying their fair share to bolster the coverage elsewhere along their plan. With a monthly premium and annual drug deductible, but greatly reduced or removed individual copays elsewhere, an appeal can be created for those willing to give a little each month…

  • This plan’s premium is $12 per month.
  • The plan deductible, preventive care, primary care provider and specialist copay is $0.
  • $1,500 maximum out-of-pocket responsibility (MOOP)
  • Inpatient and Outpatient Hospital Care is provided at $0.
  • Emergency Room and Urgent Care are also provided at $0.
  • Routine dental, vision, and hearing benefits are offered, including coverage for hearing aids, fillings, dentures, eyeglasses, and contact lenses.
  • The plan comes with built-in prescription drug coverage at no additional premium, but with a drug deductible of $415 for all tiers – each drug falls into a tier between ranging between 1 to 5 with copays as low as $0 per drug (and as high as 25% of the cost.)
  • Your Skilled Nursing Facility is provided at a $0 copay.
  • Transportation is provided – unlimited one-way trips to plan approved locations.
  • You are given an Over-the-Counter Allowance of $75 every month for the purchase of any supplies using a Careplus mail-order service.
  • A SilverSneakers membership is provided, allowing access to a local accepting fitness center and program.
  • Both Home Healthcare and Hospice are covered at no cost.
  1. Careplus HMO-SNP Plans –

Generally, all healthcare providers will have applicable Special Needs Plans, known commonly as SNPs, that will properly provide coverage to those who can properly apply to it’s need – sometimes this may include specific plans created for those with long-term health issues such as HIV or diabetes, but in the case of CarePlus, provided plans require the enrollee to have a certain level of Medicaid to be considered viable for its coverage. These plans are typically devoid of many of the costs you’ll find in a standard HMO plan, essentially bringing most copays to $0 while keeping, or even improving, the additional benefits provided by the plan outside of hospital and medical coverage.

As you’ll find in each of the examples below, despite similar benefits, these plans are very particular as for who gets to use their respective coverage. Take for example the unique element of CarePlus plans in how certain levels of Medicaid can control the cost-sharing of certain portions of a plan, making your own individual copays range based on your need and status (even with a variety of Medicaid types being viable for the same plan.) Remember, this means that some of costs below will not apply to you unless your part of the applicable marked Medicaid status, but it won’t stop you from continuing to enroll into the plan.

  1. CareNeeds (HMO-SNP):

The CareNeeds (HMO-SNP) is the special needs plan that applies to Qualified Medicare Beneficiaries (QMB,) as well as lower-tier Medicaid levels including Specified Low-Income Medicare Beneficiares (SLMB,) Qualified Individuals (QI,) and Qualified Disabled and Working Individuals (QDWI.) Through enrollment, further elevation occurs from the enrollees Extra Help level, uniting the forces of one’s state and federal coverage to calculate some of the plan’s listed costs. Overall however, like expected of most SNPs, most costs remain $0 for many eligible members, but especially for those are QMB…

  • This plan’s premium will be between $0 to $17.70 per month, dependent on your level of Extra Help – the higher your level of federal drug assistance, the lower your premium.
  • The plan deductible, preventive care, primary care provider and specialist copay is $0.
  • $3,400 maximum out-of-pocket responsibility (MOOP)
  • Inpatient and Outpatient Hospital Care is provided at $0.
  • Both Emergency Room and Urgent Care are provided for a $0 for QMB members – however, for all other members, the copay for Emergency Room is $120.
  • Routine dental, vision, and hearing benefits are offered, including coverage for hearing aids, fillings, dentures, eyeglasses, and contact lenses.
  • The plan comes with built-in prescription drug coverage at no additional premium, but it may have a deductible between $0 to $85 depending on your level of federal Extra Help – drug costs, also, will depend on level of Extra Help, with costs as high as 15% of the drug’s retail value, and as low as between $0 to $8.50 per prescription.
  • Your Skilled Nursing Facility is provided at a $0 copay.
  • Ambulance is a $0 copay for QMB members – for all other members, it is a $100 copay.
  • Transportation is provided – unlimited one-way trips to plan approved locations.
  • You are given an Over-the-Counter Allowance of $100 every month for the purchase of any supplies using a Careplus mail-order service.
  • A SilverSneakers membership is provided, allowing access to a local accepting fitness center and program.
  • Both Home Healthcare and Hospice are covered at no cost.
  1. CareNeeds Plus (HMO-SNP):

Comparatively, the CareNeeds Plus (HMO-SNP) serves to reach out to the higher levels of Medicaid, including special Qualified and Specified Low-Income Medicare Beneficiaries (QMB+ and SLMB+) alongside members who are considered Full Benefit Dual Eligible (FBDE.) The unique element shared amongst these levels is their correlation to Extra Help – when applicable to any above status, you are automatically eligible for 100% Extra Help, allowing Careplus to provide a unique plan to those they know will not have varieties in additional help through the state or government.

Simply put, this makes the CareNeeds Plus a direct step-up from the previous CareNeeds plan, but with a significantly more inclusive barrier of entry…

  • This plan’s premium is $0.
  • The plan deductible, drug deductible, preventive care, primary care provider and specialist copay is $0.
  • $3,400 maximum out-of-pocket responsibility (MOOP)
  • Inpatient and Outpatient Hospital Care is provided at $0.
  • Both Emergency Room and Urgent Care are provided for a $0 for Qualified Medicaid Beneficiaries (QMB Members) – however, for all other members, the copay for Emergency Room is $120.
  • Routine dental, vision, and hearing benefits are offered, including coverage for hearing aids, fillings, dentures, eyeglasses, and contact lenses.
  • The plan comes with built-in prescription drug coverage at no additional premium – all drug costs will range between $0 to $8.50 per prescription.
  • Your Skilled Nursing Facility is provided at a $0 copay.
  • Ambulance is a $0 copay for QMB members – for all other members, it is a $100 copay.
  • Transportation is provided – unlimited one-way trips to plan approved locations.
  • You are given an Over-the-Counter Allowance of $400 every 3 months for the purchase of any supplies using a Careplus mail-order service.
  • A SilverSneakers membership is provided, allowing access to a local accepting fitness center and program.
  • Both Home Healthcare and Hospice are covered at no cost.

References Used:

https://www.careplushealthplans.com/medicare-plans/hmo

https://www.careplushealthplans.com/medicare-plans/2019-service-areas

https://www.careplushealthplans.com/medicare-plans/hmo

https://www.careplushealthplans.com/medicare-plans/2019

http://apps.humana.com/marketing/documents.asp?file=3448029