If you live in FLORIDA and you have MEDICARE PARTS A and B, you may qualify to
Receive Up to a $145 INCREASE to your Social Security Check MONTHLY with this Medicare Advantage plan.
PLUS,
Monthly premium
$0.00
Medical deductible
$0
Prescription drug deductibles
$0
Annual plan premiums
$0($0.00 premium x 12 months)
Maximum Out-of-Pocket
In-Network
Maximum out-of-pocket responsibility
$4,000
The out-of-pocket maximum is the maximum amount that you will be required to pay a year for deductibles, copayments, and coinsurance on covered services. It does not include the amount you pay for monthly premiums.
Covered Doctor Copays
In-Network
Primary care copay
$0 copay
Specialist copay
$40 copay
1,000 participating providers
Prescription Drug Costs & Coverage
Important Message About What You Pay for Vaccines - Our Medicare Advantage Prescription Drug plans cover most Part D vaccines* at no additional cost to you, even if your plan has a deductible and you haven’t paid it.
Important Message About What You Pay for Insulin - You won’t pay more than $35 for a one-month (up to 30-day) supply of each Part D insulin product covered by the plan, no matter what cost-sharing tier it’s on, even if your plan has a deductible and you haven’t paid it.
Retail Pharmacies include:
CVS PHARMACY
WALGREENS PHARMACY
WINN DIXIE PHARMACY
PUBLIX PHARMACY
WALMART PHARMACY and MORE
Initial Coverage Stage
You pay the initial coverage costs below until your total yearly drug costs reach $5,030. Total yearly drug costs are the total drug costs paid by both you and CarePlus. Once you reach $5,030, you will enter the coverage gap (Coverage Gap Stage).
Tier 1 – Preferred Generic
$0 copay
Tier 2 – Generic
$5 copay
Tier 3 – Preferred Brand
$45 copay
Tier 4 – Non-Preferred Drug
$85 copay
Tier 5 – Specialty Tier
33% coinsurance
Coverage Gap Stage
After you enter the coverage gap, you pay 25 percent of the plan’s cost for covered brand name drugs and 25 percent of the plan’s cost for covered generic drugs until your costs total $8,000 — which is the end of the coverage gap. Not everyone will enter the coverage gap. See Evidence of Coverage for complete details.
Catastrophic Coverage Stage
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $8,000, you pay the greater of:
0% of the cost, or
$0.00 copay for generic (including brand drugs treated as generic) and a $0.00 copayment for all other drugs
Hospital & Urgent Care
In-Network
Inpatient hospital care
$225 copay per day for day 1 to 7 $0 copay per day for day 8 to 90
Outpatient surgery at hospital
$200 copay
Outpatient surgery at surgical center
$200 copay
Emergency room
If you are admitted to the hospital within 24 hours, you do not have to pay your share of the cost for the emergency care.
$120 copay
Urgent care
Urgently needed services are provided to treat a non-emergency, unforeseen medical illness, injury or condition that requires immediate medical attention.
$40 copay
Labs & X-Rays
In-Network
Cost share may vary depending on the service and where service is provided.
Diagnostic procedures/tests
$0-$200 copay
Lab services
$0 copay
Diagnostic radiological services
$125-$200 copay
X-ray services
$0-$125 copay
$0 Copays for:
Routine vision coverage
Routine dental coverage
Routine hearing coverage
Meal delivery service
OTC Allowance $25 per month
SilverSneakers® fitness program
Transportation
Annual Flex Allowance of $250 on a prepaid card
Mental Health Services
In-Network
Inpatient care at a psychiatric facility
Your plan covers up to 190 days in a lifetime for inpatient mental health care in a psychiatric hospital.
$225 copay per day for day 1 to 7 $0 copay per day for day 8 to 90
Outpatient group and individual therapy visits
Cost share may vary depending on where service is provided
$30 copay
Dental Benefits
In-Network
Medicare-covered dental services
$40 copay
Routine Dental
Bitewing x-rays up to 1 set(s) per year
$0 copay
Periodic oral exam up to 2 per year
$0 copay
Prophylaxis (cleaning) up to 2 per year
$0 copay
Amalgam and/or composite filling up to unlimited per year
$0 copay
Comprehensive oral evaluation or periodontal exam up to 1 every 3 years
$0 copay
Simple or surgical extraction up to unlimited per year
$0 copay
Necessary anesthesia with covered service up to unlimited per year
$0 copay
Maximum benefit
$2,000 maximum benefit coverage amount per year
Vision Benefits
In-Network
Medicare-covered vision services
$40 copay
Diabetic eye exam
$0 copay
Glaucoma screening
$0 copay
Eyewear (post cataract surgery)
$0 copay
Routine Vision
Routine exam up to 1 per year
$0 copay
Contact lenses up to unlimited pair(s) per year
$0 copay
Eyeglasses-lenses and frames up to unlimited pair(s) per year
$0 copay
Fitting for eyeglasses-lenses and frames up to unlimited per year
$0 copay
Refraction up to 1 per year
$0 copay
Max benefits: contact lenses, eyeglasses-lenses and frames, fitting for eyeglasses-lenses and frames
$150 maximum benefit coverage amount per year
Additional notes
$0 copayment for refraction and dilation (if necessary) with routine exam up to 1 per year. $150 maximum benefit coverage amount per year for contact lenses or eyeglasses-lenses and frames plus fitting; or, 1 pair of select eyeglasses at no cost. Eyeglasses include ultraviolet protection and scratch resistant coating.
Hearing Benefits
In-Network
Medicare-covered hearing services
$40 copay
Routine Hearing
Fitting/evaluation up to 1 per year
$0 copay
Routine hearing exams up to 1 per year
$0 copay
Hearing aids (all types) up to 1 per ear per year
$250 maximum benefit coverage amount per ear per year
Preventive Benefits
In-network: $0 for the following preventive services when you see an in-network provider:
Bone mass measurement
Annual wellness visit
Breast cancer screening (mammogram)
Cardiovascular screenings
Cervical and vaginal cancer screening
Colorectal cancer screening
Diabetes screening
Immunizations
Lung cancer screening
Medicare diabetes prevention program (MDPP)
Prostate cancer screening exam
Routine physical exams
This Plan Becomes Effective The 1st of the Month following your enrollment
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