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CareOne Plus (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for CareOne Plus (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on CareOne Plus (HMO) in 2025, please refer to our full plan details page.
CareOne Plus (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Miami-Dade County. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that CareOne Plus (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about CareOne Plus (HMO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For CareOne Plus (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $7.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $900.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The CareOne Plus (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay varying costs depending on the drug tier and pharmacy type. For example, Tier 1 and Tier 2 generic drugs have no copay at standard and preferred pharmacies. For preferred brand drugs, you pay 43% coinsurance, and for non-preferred drugs, you pay 33% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The CareOne Plus (HMO) plan offers a comprehensive range of benefits with a focus on affordability. Many services, including inpatient hospital stays, outpatient services, primary care, preventive services, hearing exams, vision exams, and dental services, have no copay. The plan also covers services like ambulance, emergency, and home health services, and offers additional benefits like OTC items and a meal benefit. While many services have no copay, some services have associated costs. For example, emergency services have a $120 copay, and air ambulance services have a 20% coinsurance. Additionally, services like home infusion bundled services, dialysis services, and durable medical equipment have associated coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with no copay for Medicare-covered stays. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, and Outpatient Blood Services have no copay, and Individual and Group Sessions for Outpatient Substance Abuse also have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the CareOne Plus (HMO) plan, with prior authorization and a doctor's referral required. There is no copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the CareOne Plus (HMO) plan. Ground ambulance services have a copay between $0 and $75, and air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location are covered with no copay, with up to 26 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered by the CareOne Plus (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $120 copay, while Urgently Needed Services has no copay. Worldwide Urgent Coverage has a copay between $0 and $120, and Worldwide Emergency Transportation has a $120 copay.
Primary Care See details
The CareOne Plus (HMO) plan covers primary care physician services, chiropractic services, occupational therapy, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, physical therapy, speech-language pathology services, and additional telehealth benefits have no copay.
Preventive Services See details
The CareOne Plus (HMO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, including fitness benefits, kidney disease education services, and other preventive services such as glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, are covered with no copay. Health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefit, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing services include hearing exams with no copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $1,250 per year with no copay, and OTC hearing aids are covered up to $90 every three months.
Vision Services See details
Vision services include coverage for eye exams and eyewear. Routine eye exams and eyewear have no copay, and routine eye exams are limited to one per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The CareOne Plus (HMO) plan offers dental services with no copay for Medicare dental services, oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), implant services, and oral and maxillofacial surgery. Fluoride treatment, maxillofacial prosthetics, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs. For Medicare Part B Insulin Drugs, you will pay a $35 copay, and coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the CareOne Plus (HMO) plan, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the CareOne Plus (HMO) plan, with Durable Medical Equipment (DME) subject to a coinsurance between 10% and 20% and requiring prior authorization. Prosthetic Devices and Medical Supplies have no copay, while Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic and radiological services, are covered. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the CareOne Plus (HMO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization and a doctor's referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the CareOne Plus (HMO) plan, but require prior authorization and a doctor's referral. For days 1-7, there is no copay, and for days 8-100, the copay is $20.
Other Services See details
Other services covered by CareOne Plus (HMO) include acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture has no copay, and OTC items are covered up to $90 every three months, and the meal benefit has no copay.
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