2024 CareNeeds Plus D-SNP: H1019-026-0 by CarePlus Health Plans, Inc.
What is Plan H1019-026-0 by CarePlus Health Plans, Inc.?
CareNeeds Plus (HMO D-SNP) is a 2024 Medicare Advantage Special Needs Plan from CarePlus Health Plans, Inc.. It offers all of the same basic benefits as Original Medicare, plus some additional benefits that Medicare Part A and Part B do not cover, but out-of-pocket costs are different.
You must meet all qualification requirements to join this D-SNP plan.
Plan Basics | |
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Plan ID: | H1019-026-0 |
Plan Type: | HMO |
Plan Year: | 2024 |
Premium: | $28.20/mo Plus your Part B premium. |
Health Plan Deductible: | $0.00 |
Out-of-Pocket Maximum: | /yr |
Part B Reduction: | $0.00/mo |
Drug Plan Benefit: | Basic $545.00 deductible |
Rx Gap Coverage: | {gap} |
Supplemental Benefits: | Dental, Vision, Hearing |
Availability: | See List |
Insured By: | CarePlus Health Plans, Inc. |
Summary of Benefits |
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Health Plan Costs & Benefits
CareNeeds Plus is a Health Maintenance Organization (HMO) plan. HMO plan members usually receive health care services through the plan’s local network of providers. Referrals are almost always required to see a specialist and other providers. However, CareNeeds Plus does allow out-of-network care for emergencies and out-of-area dialysis.
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:
Healthcare Service | Member Cost |
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Doctor Visits (In-Network) | |
Primary: | $0 Copay |
Specialist: | $0 Copay Authorization Required, Referral Required |
Wellness programs (e.g., fitness, nursing hotline): | |
Preventive care: | $0 Copay |
Foot Care (In-Network) | |
Foot exams and treatment (Medicare-covered): | $0 Copay Authorization Required |
Routine foot care: | $0 Copay Authorization Required |
Chiropractic Care (In-Network) | |
Medicare-covered chiropractic care: | $0 Copay Authorization Required |
Routine chiropractic care: | $0 Copay Authorization Required |
Emergency Care / Urgent Care | |
Emergency room care: | $120 Copay |
Urgent care: | $0 Copay |
Ground ambulance: | $100 Copay |
Inpatient hospital coverage: | $0.00 per stay |
Outpatient hospital coverage: | $0 Copay Authorization Required, Referral Required |
Skilled Nursing Facility: | Unknown |
Optional supplemental benefits: | Not Covered |
Mental Health Services (In-Network) | |
Outpatient individual therapy visit with a psychiatrist: | $0 Copay |
Outpatient group therapy visit with a psychiatrist: | $0 Copay |
Inpatient hospital - psychiatric: | $0.00 per stay |
Outpatient group therapy visit: | $0 Copay |
Outpatient individual therapy visit: | $0 |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy visit: | $0 Copay Authorization Required, Referral Required |
Occupational therapy visit: | $0 Copay Authorization Required, Referral Required |
Medical Equipment / Supplies (In-Network) | |
Diabetes supplies: | $0 Copay Authorization Required |
Durable medical equipment (e.g., wheelchairs, oxygen): | $0 Copay Authorization Required |
Prosthetics (e.g., braces, artificial limbs): | $0 |
Diagnostic Procedures / Lab Services / Imaging (In-Network) | |
Diagnostic radiology services (e.g., MRI): | $0 Copay Authorization Required, Referral Required |
Lab services: | $0 Copay Authorization Required, Referral Required |
Outpatient x-rays: | $0 Copay Authorization Required, Referral Required |
Diagnostic tests and procedures: | $0 Copay Authorization Required, Referral Required |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | $0 Copay |
Other Part B drugs (Medicare-covered) | $0 Copay |
Feel free to download our CareNeeds Plus Summary of Benefits information.
Supplemental Health Plan Benefits (H1019-026-0)
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: | $6,000.00 Every year |
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) | Covered |
Non-routine services (In-Network) | Covered |
Diagnostic services (In-Network) | Covered |
Extractions (In-Network) | Covered |
Endodontics (In-Network) | Covered |
Restorative services (In-Network) | Covered |
Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | Covered |
Hearing | |
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: | $400.00 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 Supplemental Benefits
None specified.
Prescription Drug Plan Costs & Benefits
CareNeeds Plus includes an basic benefit Medicare Part D plan (PDP). This simply means that the plan covers the minimum amount required by the Centers for Medicare & Medicaid Services, whereas enhanced benefit plans cover more.
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. The following table outlines the prescription drug plan premium details of this plan.
Basic Part D Premium: | $28.20 |
Supplemental Part D Premium: | $0.00 |
Total Part D Premium: | $28.20 |
Part D Premium with Full LIS Assistance: | $0.00 |
For more information about the Low-Income Subsidy (aka, "Extra Help") program, refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $545.00. 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, CareNeeds Plus has out-of-pocket costs that you must pay when you pick up your prescriptions. The following table shows you those costs.
Drug Tier | Preferred | Standard |
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$0 copay on all covered generic and brand-name prescriptions. |
CMS 5-Star Rating Marks
Each year the Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage D-SNP's in nine broad categories using a 5-star rating system. Medicare's star ratings will 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 |
How to Qualify to Enroll in
CareNeeds Plus
To qualify for enrollment in CareNeeds Plus in County, you must be eligible for both Medicare and Medicaid. To be eligible for Medicare, you must be age 65 or older, or have Social Security Disability Insurance for 24 months. To be eligible for Medicaid, your income and assets must be at or below 's state thresholds.
Before enrolling in CareNeeds Plus, or any other dual-eligible SNP, be sure to ask the following questions:
- What costs should I expect to pay out-of-pocket (premiums, deductibles, copayments)?
- Will I be able to use my doctors? Are they in the plan's network?
- Are the plan's in-network providers and facilities in convenient locations?
- Does the plan provide coverage for services I receive from out-of-network providers?
- Do I need a referral to see a specialist?
- Are my medications on the Part D plan's formulary? What if I can't afford my medications?
- What special accommodations does the plan make for persons with disabilities?
- Does the plan offer free meal delivery after a stay in the hospital?
- What help is offered for caregivers? Is adult day care covered?
- Does the plan offer a prepaid card for over the counter medications and covered groceries?
Plan Availability
CareNeeds Plus (H1019-026-0) is available in the following locations (click to open):
Additional D-SNP Plan Options
Here are some additional Medicare SNP plans that might be worth reviewing:
- H1019-023-0: CareNeeds Plus (D-SNP)
- H1019-141-0: CareComplete Platinum (C-SNP)
- H1019-122-0: CareComplete Platinum (C-SNP)
- H1019-109-0: CareComplete Platinum (C-SNP)
- H1019-117-0: CareBreeze Platinum (C-SNP)
Contact CarePlus Health Plans, Inc.
Plan Website: | http://www.careplushealthplans.com |
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Formulay 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 October 13, 2023
- Medicaid.gov, "Medicaid & CHIP in ", Last Accessed January 4, 2024
- CMS.gov, "Dual Eligible Special Needs Plans (D-SNPs)", Last Accessed January 20, 2023
- CMS.gov, Landscape Source Files, Last Accessed January 2, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed January 2, 2024
- CMS.gov, Plan Benefits Package, Last Accessed January 3, 2024