CarePlus Health Plans, Inc. CareFree (HMO) 2024 Benefit Details for Plan H1019-134-0 by CarePlus Health Plans, Inc.
CarePlus Health Plans, Inc. CareFree is a HMO Medicare Advantage plan, {with_without_pdp} Part D prescription drug benefits, available in 2024.
This health plan, from CarePlus Health Plans, Inc., includes all Original Medicare benefits, and may offer extra services, but out-of-pocket costs are different.
Plan Basics | |
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Plan ID: | H1019 134 0 |
Plan Type: | Local HMO |
Plan Year: | 2024 |
Premium: | $0.00/mo Plus your Medicare Part B premium. |
Health Plan Deductible: | $0.00 |
Out-of-Pocket Maximum: | $3,850/yr |
Part B Reduction: | $100.00/mo |
Drug Plan Benefit: | Enhanced, $0.00 deductible |
Rx Gap Coverage: | Yes |
Supplemental Benefits: | Dental, Vision, Hearing |
Availability: | See List |
Insured By: | CarePlus Health Plans, Inc. |
Summary of Benefits |
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Health Plan Cost Sharing
This CarePlus Health Plans, Inc. Medicare Advantage plan has cost-sharing. These are costs you must pay out-of-pocket when you use approved health services.
NOTE: Most preventive services are covered 100% by the plan as a Part B benefit.
The following table summarizes the most common out-of-pocket costs you will incur if you join this plan unless you go out-of-network:
Healthcare Service | Member Cost |
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Doctor Visits (In-Network) | |
Primary: | $0 Copay |
Specialist: | $20 Copay Authorization Required, Referral Required |
Wellness programs (e.g., fitness, nursing hotline): | None |
Preventive care: | $0 Copay |
Foot Care (In-Network) | |
Foot exams and treatment (Medicare-covered): | $20 Copay Authorization Required |
Routine foot care: | $20 Copay Authorization Required |
Chiropractic Care (In-Network) | |
Medicare-covered chiropractic care: | $20 Copay Authorization Required |
Routine chiropractic care: | Not Covered |
Emergency Care / Urgent Care | |
Emergency room care: | $120 Copay |
Urgent care: | $20 Copay |
Ground ambulance: | $90 Copay |
Inpatient hospital coverage: | $175.00 per day for days 1 through 7 $0.00 per day for days 8 and beyond |
Outpatient hospital coverage: | $100 Copay Authorization Required, Referral Required |
Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $150.00 per day for days 21 and beyond |
Optional supplemental benefits: | |
Mental Health Services (In-Network) | |
Outpatient individual therapy visit with a psychiatrist: | $20 Copay |
Outpatient group therapy visit with a psychiatrist: | $20 Copay |
Inpatient hospital - psychiatric: | $175.00 per day for days 1 through 7 $0.00 per day for days 8 and beyond |
Outpatient group therapy visit: | $20 Copay |
Outpatient individual therapy visit: | $0 |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy visit: | $20 Copay Authorization Required, Referral Required |
Occupational therapy visit: | $20 Copay Authorization Required, Referral Required |
Medical Equipment / Supplies (In-Network) | |
Diabetes supplies: | $0 Copay Authorization Required |
Durable medical equipment (e.g., wheelchairs, oxygen): | 20% Coinsurance Authorization Required |
Prosthetics (e.g., braces, artificial limbs): | 20% Coinsurance |
Diagnostic Procedures / Lab Services / Imaging (In-Network) | |
Diagnostic radiology services (e.g., MRI): | $100 Copay Authorization Required, Referral Required |
Lab services: | $0 Copay Authorization Required, Referral Required |
Outpatient x-rays: | $75 Copay Authorization Required, Referral Required |
Diagnostic tests and procedures: | $100 Copay Authorization Required, Referral Required |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | 20% Coinsurance |
Other Part B drugs (Medicare-covered) | 20% Coinsurance |
Feel free to download our CarePlus Health Plans, Inc. CareFree Summary of Benefits information.
Supplemental Benefits
The following is a summary of the supplemental benefits CarePlus Health Plans, Inc. includes with this plan:
Supplemental Healthcare Service | Member Cost |
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Preventive Dental | Maximum dental benefit: | Non Specified |
Oral exam (In-Network) | Covered |
Fluoride treatment (In-Network) | Covered |
Dental x-ray(s) (In-Network) | Covered |
Cleaning (In-Network) | Covered |
Comprehensive Dental | |
Periodontics (In-Network) | Not Covered |
Non-routine services (In-Network) | Not Covered |
Diagnostic services (In-Network) | Covered |
Extractions (In-Network) | Covered |
Endodontics (In-Network) | Not Covered |
Restorative services (In-Network) | Covered |
Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | Covered |
Hearing Aids | |
Fitting/evaluation (In-Network) | $0 Copay Authorization Required, Referral Required |
Hearing aids (In-Network) | Covered Limits may apply |
Hearing exam (In-Network) | $0 Copay Authorization Required, Referral Required |
Vision | Maximum vision benefit: | $200.00 Every year |
Eyeglasses (frames and lenses) (In-Network) | $0 Copay |
Routine eye exam (In-Network) | $0 Copay Authorization Required, Referral Required |
Contact lenses (In-Network) | $0 Copay |
Additional Benefits
None specified.
Prescription Drug Plan Costs & Benefits
CarePlus Health Plans, Inc. CareFree includes an enhanced benefit Medicare Part D plan (PDP). Enhanced plans have a higher actuarial value than basic plans. Actuarial value simply refers to the percentage of cost that's covered by the plan.
Prescription Drug Plan Premium
Although the prescription drug plan (Part D) premium is bundled with the total plan cost, some plans have supplemental costs and/or offer low-income subsidy (LIS) assistance. LIS, also known as Extra Help, is a Social Security program that helps people with limited income and resources lower or cut Part D costs.
The following table outlines the prescription drug plan premium details of this plan.
Basic Part D Premium: | $0.00 |
Supplemental Part D Premium: | $0.00 |
Total Part D Premium: | $0.00 |
Part D Premium with Full LIS Assistance: | $0.00 |
If you would like more information about the Extra Help program, you can refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $0.00. This is the amount you must pay at the pharmacy before CarePlus Health Plans, Inc. begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, CarePlus Health Plans, Inc. CareFree has out-of-pocket costs that you must pay when you pick up your prescriptions.
Drug Tier | Preferred | Standard |
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1 (Preferred Generic) | N/A | $0.00 copay |
2 (Generic) | N/A | $0.00 copay |
3 (Preferred Brand) | N/A | $25.00 copay |
4 (Non-Preferred Drug) | N/A | $55.00 copay |
5 (Specialty Tier) | N/A | 33% |
CMS 5-Star Rating Marks
Each year Medicare rates health plans (Part C) and drug plans (Part D) in several major categories based on a 5-star rating system. These ratings are designed to help you understand the quality of care and service you can expect if you join this CarePlus Health Plans, Inc. plan.
CMS Measure | Star Rating |
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2024 Overall Rating | |
Staying Healthy: Screenings, Tests, Vaccines | |
Managing Chronic (Long Term) Conditions | |
Member Experience with Health Plan | |
Complaints and Changes in Plans Performance | |
Health Plan Customer Service | |
Drug Plan Customer Service | |
Complaints and Changes in the Drug Plan | |
Member Experience with the Drug Plan | |
Drug Safety and Accuracy of Drug Pricing |
It's not a 5-star HMO plan, but its quality of care exceeds most Medicare Advantage HMO plans in the areas served (see list below). Staying healthy is the best way to save money on health care, and CarePlus Health Plans, Inc. CareFree does a good job keeping its members in top health through preventive care, including screenings, tests, and vaccines. This plan is good at managing its member's chronic (long-term) health conditions.
The member experience with this CarePlus Health Plans, Inc. plan is average. Complaints and changes in performance with this plan are average. The plan shines at customer service with an overall excellent mark on this important metric.
Healthy people in this plan get extra savings with the availability of dental, vision, and hearing benefits (see Health Plan Costs & Benefits for details).
With no additional monthly premium, this plan can save you money if you're healthy. If you're looking for all the savings you can get, this Local HMO plan has a Part B reduction benefit, often called a giveback, of $100.00 per month. One of the most important considerations is a plan's maximum out-of-pocket (MOOP) limit. CarePlus Health Plans, Inc. CareFree's annual MOOP is set at $3,850, which does not include prescriptions. This health plan does not have an annual deductible, making health care a little easier to budget.
Plan Availability
CarePlus Health Plans, Inc. CareFree (H1019-134-0) is available in the following locations (click to open):
Additional Medicare Advantage Plan Options
The Medicare Advantage program offers a myriad of options, including these plans:
- H1019-076-0: CareFree (HMO)
- H1019-110-0: CareOne Platinum (HMO-POS)
- H1019-133-0: CareSalute (HMO)
- H1019-119-0: CareSalute (HMO)
- H1019-057-0: CareOne Plus (HMO-POS)
Contact CarePlus Health Plans, Inc.
Plan Website: | http://www.careplushealthplans.com |
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Formulary Information: | http://www.careplushealthplans.com/pharmacy-finder |
Pharmacy Information: | CarePlus Health Plans, Inc. Pharmacy Page |
Prospective Members: | (800)794-4105 |
TTY Users: | 711 |
If you qualify for Medicare benefits but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna Healthcare, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, UnitedHealthcare(R), and Wellcare.
Citations & References
- CarePlus Health Plans, Inc., http://www.careplushealthplans.com, Last Accessed February 20, 2024
- Medicare.gov, "Medicare Advantage Plans cover all Medicare services", Last Accessed February 20, 2024
- Medicare.gov, "How Original Medicare Works", Last Accessed February 19, 2024
- Medicare.gov, "Medicare & You Handbook", Last Accessed February 19, 2024
- Medicare.gov, "Your Medicare Coverage", Last Accessed April 11, 2023
- CMS.gov, Landscape Source Files, Last Accessed February 21, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed February 21, 2024
- CMS.gov, Plan Benefits Package, Last Accessed February 21, 2024
About This H1019-134-0 Plan Detail Page
The data on this CarePlus Health Plans, Inc. CareFree plan detail page is derived from the 2024 Landscape Source Files, Plan Benefit Package, and Medicare Part C and Part D Performance Data published by CMS.
The author interprets these files, and their associated data dictionary, with great care, making every attempt to communicate the data submitted by CarePlus Health Plans, Inc. to CMS as clearly and accurately as possible. Given the complexity of the data, the author recommends that all potential enrollees request an official Summary of Benefits from CarePlus Health Plans, Inc., at (800)794-4105, prior to enrollment.