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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 2026, 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 4.5 out of 5 stars in 2026.
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 $6.00. 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 $500.00 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:
Sign up for CareOne Plus (HMO)
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Drug Coverage
The CareOne Plus (HMO) Medicare plan features a $0 drug deductible, allowing your prescription coverage to begin immediately. You will pay no copay for Tier 1 preferred generic and Tier 2 generic drugs for both 1-month and 3-month supplies at standard pharmacies and mail-order services. Tier 3 preferred brand drugs also feature no copay at standard pharmacies and preferred mail order, while standard mail order requires a low copay of $1 for a 1-month supply or $3 for a 3-month supply. For higher-tier medications, Tier 4 non-preferred drugs require a 48% coinsurance for 1-month and 3-month fills at standard pharmacies and mail-order options. Specialty drugs in Tier 5 carry a 33% coinsurance for a 1-month supply through standard retail pharmacies and mail-order programs.
Additional Benefits
The CareOne Plus (HMO) plan offers comprehensive medical coverage with no copays and no coinsurance for many essential services, including inpatient hospital stays, outpatient care, primary care, and specialist visits. Emergency services require a $130 copay, which is waived upon hospital admission, while urgent care and routine preventive services are available with no copay. Additionally, diagnostic lab tests, X-rays, and home health services are covered with no copays or coinsurance. For supplemental care, the plan features no copays or coinsurance for routine dental, vision, and hearing exams, which includes a $300 annual allowance for eyewear and up to $1,250 per ear for prescription hearing aids. While durable medical equipment and dialysis services require a 20% coinsurance, other medical supplies and acupuncture treatments are covered with no copay. Furthermore, skilled nursing care is available with no copay for the first 20 days, and Part B insulin is covered with a $35 copay and no deductible.
Inpatient Hospital See details
CareOne Plus (HMO) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, though prior authorization and referrals are required. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
CareOne Plus (HMO) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and no coinsurance. Prior authorization and referrals are required for these covered benefits.
Partial Hospitalization See details
Partial hospitalization is covered by CareOne Plus (HMO) with no copay and no coinsurance, though prior authorization and a referral are required.
Ambulance and Transportation Services See details
CareOne Plus (HMO) covers ground ambulance services with a $0 to $75 copay and coinsurance, and air ambulance services with a copay and 20% coinsurance. Transportation services are partially covered, offering up to 26 one-way trips per year to plan-approved locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
CareOne Plus (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services have no copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays ranging from no copay to $130.
Primary Care See details
CareOne Plus (HMO) primary care benefits feature no copays and no coinsurance for primary care visits, specialist services, physical therapy, and mental health care. Chiropractic services are partially covered with no copay for up to 12 routine visits per year, though other chiropractic services are not covered.
Preventive Services See details
CareOne Plus (HMO) offers preventive services that are partially covered, featuring no copay and no coinsurance for covered services like annual physical exams, memory fitness, kidney disease education, and glaucoma screenings. Supplemental services such as health education, personal emergency response systems, in-home safety assessments, and weight management programs are not covered.
Hearing Services See details
CareOne Plus (HMO) offers hearing services with no copay, no coinsurance, and no deductible for routine exams, fitting evaluations, and OTC hearing aids. Prescription hearing aids are partially covered with up to a $1,250 annual benefit per ear, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
CareOne Plus (HMO) features partially covered vision services with no copays, no coinsurance, and no deductibles for covered services. This benefit includes one routine eye exam per year and a $300 annual maximum for contact lenses and eyeglasses (lenses and frames), while other eye exams, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
CareOne Plus (HMO) provides partially covered dental services with no copay and no coinsurance for covered benefits. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
CareOne Plus (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, insulin, and other drugs are covered with coinsurance ranging from no coinsurance to 20%, with insulin specifically requiring a $35 copay and no deductible.
Dialysis Services See details
CareOne Plus (HMO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these covered services.
Medical Equipment See details
Medical Equipment is covered by CareOne Plus (HMO), with durable medical equipment (DME) requiring prior authorization, a 20% coinsurance, and no copay. Prosthetics, medical supplies, and diabetic supplies are covered with no copay and no coinsurance, while diabetic therapeutic shoes or inserts require a $10 copay and no coinsurance.
Diagnostic and Radiological Services See details
CareOne Plus (HMO) covers diagnostic and radiological services with no coinsurance, though prior authorization and referrals are required. Lab services and outpatient X-rays have no copay, diagnostic procedures and tests carry a copay of $0 to $50, and other radiological services have copayments starting at $0.
Home Health Services See details
Home health services are covered under CareOne Plus (HMO) with no copay and no coinsurance, although prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
CareOne Plus (HMO) covers some cardiac rehabilitation services with no copay and no coinsurance, though prior authorization and referrals are required. However, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
CareOne Plus (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $20 daily copay for days 21 through 100. Prior authorization and referrals are required, though a prior three-day inpatient hospital stay is not necessary, and additional days beyond the standard Medicare limit are not covered.
Other Services See details
CareOne Plus (HMO) offers coverage for other services with no copay and no coinsurance, including acupuncture up to 25 treatments per year, over-the-counter items, and chronic illness meal benefits. Prior authorization is required for acupuncture and meals, and some other supplemental services are not covered.
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