CarePlus Health Plans, Inc. CareComplete (C-SNP) Plan Details for Osceola County, FL
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*CMS rated this CarePlus Health Plans, Inc. plan (H1019-150-0) 4 (Good) out of 5 stars.
CarePlus Health Plans, Inc. CareComplete (C-SNP) is a Chronic or Disabling Condition Medicare Advantage Special Needs Plan. The 2025 Annual Enrollment period starts October 15. Plan benefits begin Ja
The delivery of healthcare services and costs by CarePlus Health Plans, Inc. is different than Original Medicare. This private health insurance option may include additional benefits that are not provided by Medicare Part A and Part B.
Only individuals who meet all Chronic or Disabling Condition SNP qualification requirements are eligible to join this C-SNP plan.
| Plan Basics | |
|---|---|
| Plan ID: | H1019-150-0 |
| Plan Type: | HMO C-SNP |
| Plan Year: | 2025 |
| Premium: | $0.00/mo Plus your Part B premium. |
| Health Plan Deductible: | $0.00 |
| Out-of-Pocket Maximum: | 2,500.00 /yr |
| Part B Reduction: | $0.00/mo |
| Drug Plan Benefit: | Enhanced $0.00 deductible |
| Supplemental Benefits: | Vision, Hearing |
| Availability: | Osceola County, FL |
| Insured By: | CarePlus Health Plans, Inc. |
| Summary of Benefits |
|---|
Health Plan Cost Sharing & Benefits
The following table is a summary of the most common out-of-pocket costs you will incur if you join this CarePlus Health Plans, Inc. plan:
Doctor's Office Visits
| Service | Enrollee Cost (in-network) |
|---|---|
| Primary: | $0 Copay |
| Specialist: | $10 Copay Prior Authorization Required, Referral Required |
Emergency, Urgent, and Inpatient Hospital Coverage
| Service | Enrollee Cost |
|---|---|
| Emergency room care: | $140 Copay |
| Urgent care: | $35 Copay |
| Ground ambulance: | $300 Copay |
| Inpatient hospital care: | $50.00 per day for days 1 through 5 $0.00 per day for days 6 and beyond |
| Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $150.00 per day for days 21 and beyond |
Foot Care
| Service | Enrollee Cost (in-network) |
|---|---|
| Foot Exams and Treatments (Medicare-covered): | $10 Copay Prior Authorization Required |
| Routine Foot Care: | $10 Copay Prior Authorization Required |
Chiropractic Care
| Service | Enrollee Cost (in-network) |
|---|---|
| Medicare-covered chiropractic: | $10 Copay Prior Authorization Required |
| Routine chiropractic: | $10 Copay Prior Authorization Required |
Mental Health Services
| Service | Enrollee Cost (in-network) |
|---|---|
| Outpatient individual therapy: | $10 Copay |
| Outpatient group therapy: | $10 Copay |
| Inpatient psychiatric hospital care: | $50.00 per day for days 1 through 5 $0.00 per day for days 6 and beyond |
Rehabilitation Services
| Service | Enrollee Cost (in-network) |
|---|---|
| Physical therapy and speech and language therapy: | $10 Copay Prior Authorization Required, Referral Required |
| Occupational therapy: | $10 Copay Prior Authorization Required, Referral Required |
Medical Equipment and Supplies
| Service | Enrollee Cost (in-network) |
|---|---|
| Diabetes supplies: | $0 Copay Prior Authorization Required |
| Durable medical equipment: | 20% Coinsurance Prior Authorization Required |
| Prosthetics: | Not Covered |
Diagnostics, Lab Services, and Imaging
| Service | Enrollee Cost (in-network) |
|---|---|
| Diagnostic radiology services: | $100 Copay Prior Authorization Required, Referral Required |
| Lab services: | $0 Copay Prior Authorization Required, Referral Required |
| Outpatient x-rays: | $50 Copay Prior Authorization Required, Referral Required |
| Diagnostic tests and procedures: | $150 Copay Prior Authorization Required, Referral Required |
Medicare Part B Drugs
| Service | Enrollee Cost (in-network) |
|---|---|
| Chemotherapy: | 20% Coinsurance |
| Other Part B drugs (Medicare-covered): | 20% Coinsurance |
Dental Services
| Service | Member Cost (in-network) |
|---|---|
| Medicare Covered Preventive Dental | $10 Copay Prior Authorization Required |
| Oral exam | $0 Copay Prior Authorization Required |
| Dental x-rays | $0 Copay Prior Authorization Required |
| Cleaning | $0 Copay Prior Authorization Required |
| Periodontics | Not Covered |
| Endodontics | Not Covered |
| Restorative Services | Not Covered |
Hearing Aids and Services
| Service | Member Cost (in-network) |
|---|---|
| Fitting/evaluation | Covered Limits may apply |
| Hearing aids | Covered Limits may apply |
| Hearing exam | Covered Limits may apply |
Vision Services
| Service | Member Cost (in-network) |
|---|---|
| Medicare-covered eye exam (in-network) | $ to $10 Copay |
| Routine eye exam (in-network) | $0 Copay 1 Every year |
| Eyewear benefits | Eyeglasses: No Contact Lenses: No Eyeglass Lenses: No Eyeglass Frames: No Eyewear Upgrades: No |
Maximum eyewear benefit: | $2.00 Every three years |
Feel free to download our CarePlus Health Plans, Inc. CareComplete Summary of Benefits information.
Prescription Drug Plan Costs & Benefits
CarePlus Health Plans, Inc. CareComplete 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 premium details of this prescription drug plan.
| Basic Part D Premium: | $(81.10) |
| Supplemental Part D Premium: | $81.10 |
| Total Part D Premium: | $0.00 |
| Low Income Premium Subsidy: | $20.30 |
| Low Income Premium Subsidy CMS Pays: | $0.00 |
| Low Income Subsidy Premium: | $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. You must pay this amount 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. CareComplete has out-of-pocket costs you must pay when you pick up your prescriptions.
| Drug Tier | Retail | Mail Order | |
|---|---|---|---|
| Preferred Generic | $0.00 | $2.00 | |
| Generic | $0.00 | $16.00 | |
| Preferred Brand | $40.00 | $47.00 | |
| Non-Preferred Drug | 50.00% | 50.00% | |
| Specialty Tier | 33.00% | 33.00% | |
| Select Care Drugs | $0.00 | $0.00 | |
| *The Part D deductible does not apply. | |||
CMS 5-Star Rating Marks
Each year CMS rates Medicare Special Needs Plans in nine broad categories based on a 5-star system. The table below shows the quality ratings for this CarePlus Health Plans, Inc. plan.
| CMS Measure | Star Rating |
|---|---|
| 2025 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 |
Additional C-SNP Plan Options
Here are some additional Medicare SNP plans that might be worth reviewing:
- CareBreeze Platinum
- CareComplete Platinum
- CareComplete Platinum
- CareComplete Platinum
- CareBreeze Platinum
Contact CarePlus Health Plans, Inc.
| Website: | CarePlus Health Plans, Inc. Plan Page |
|---|---|
| Providers: | CarePlus Health Plans, Inc. Providers Page |
| Formulary: | CarePlus Health Plans, Inc. Formulary Page |
| Pharmacy: | CarePlus Health Plans, Inc. Pharmacy Page |
| New Member Health Plan Help: | (800)794-4105 |
| New Member Health Plan TTY: | 711 |
| New Member Part D Help: | (800)794-4105 |
| New Member Part D 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.
Health Plan Compatibility
Special Needs Plans (SNPs) under Medicare Advantage typically do not work with other types of health insurance. If you have Medicare Part A or Part B and decide to join an SNP plan, you will be removed from Original Medicare. Furthermore, you cannot be enrolled in an SNP plan and hold a Medigap Insurance policy at the same time.
With a D-SNP, members retain their existing Medicaid plan and benefits. Veterans who have VA Health Benefits may also be able to receive care at their local VA hospital.
Citations & References
- CarePlus Health Plans, Inc., http://www.careplushealthplans.com, Last Accessed October 13, 2024
- Medicaid.gov, "Medicaid & CHIP in Florida", Last Accessed October 1, 2024
- CMS.gov, Landscape Source Files, Last Accessed October 2, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed October 2, 2024
- CMS.gov, Plan Benefits Package, Last Accessed October 5, 2024
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Baylor Scott & White Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, GlobalHealth, Health Care Service Corporation, Healthy Blue, HealthSun, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.