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CareOne Plus (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for CareOne Plus (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on CareOne Plus (HMO-POS) in 2026, please refer to our full plan details page.
CareOne Plus (HMO-POS) is a HMO-POS plan offered by Humana Inc. available for enrollment in 2025 to people living in Brevard and Indian River Counties. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that CareOne Plus (HMO-POS) 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-POS).
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-POS), 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 $1.00. 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 a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $3500.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $3500.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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-POS) prescription drug plan features an annual drug deductible of $615. You will pay no copay for Tier 1 preferred generic and Tier 2 generic drugs when filled through standard pharmacies or preferred mail order. For standard mail order, Tier 1 and Tier 2 generic drugs require a copay of $10 to $20 for a 1-month supply. Tier 3 preferred brand drugs have a $25 copay for a 1-month supply at standard pharmacies and preferred mail order, while standard mail order costs $47. Higher-tier prescriptions require coinsurance, with Tier 4 non-preferred drugs carrying a 48% coinsurance and Tier 5 specialty drugs requiring 25% coinsurance. Understanding these tier costs can help you estimate your annual out-of-pocket expenses with the CareOne Plus (HMO-POS) plan.
Additional Benefits
The CareOne Plus (HMO-POS) plan offers comprehensive medical coverage with affordable out-of-pocket costs and no coinsurance for many primary services. Members enjoy no copay for primary care visits, preventive care, and home health services, while specialist visits and urgent care require low copays between $10 and $15. Inpatient hospital stays require a $200 daily copay for the first seven days and no copay thereafter, while emergency room visits carry a $150 copay. For supplemental care, the plan features routine dental, vision, and hearing benefits with no copay or coinsurance, including allowances for eyeglasses and hearing aids. Members also receive up to 20 one-way transportation trips to approved locations and acupuncture treatments at no copay. Durable medical equipment and dialysis services generally require a 20% coinsurance with no copay, providing clear and manageable cost structures for specialized needs.
Inpatient Hospital See details
CareOne Plus (HMO-POS) inpatient hospital benefits are partially covered with no coinsurance, featuring a $200 daily copay for days 1 through 7 and no copay for days 8 through 90. Unlimited additional acute days are covered at no copay, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by CareOne Plus (HMO-POS) with no coinsurance, featuring no copays for ambulatory surgical center, observation, and blood services. Outpatient hospital services carry a copay of $0 to $200, while individual and group outpatient substance abuse sessions require a $10 copay.
Partial Hospitalization See details
Partial hospitalization is covered by CareOne Plus (HMO-POS) with a $25.00 copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by CareOne Plus (HMO-POS), with ground ambulance requiring a $0 to $250 copay and coinsurance, and air ambulance requiring a 20% coinsurance and a copay. Transportation services are partially covered with no copay or coinsurance for up to 20 one-way trips to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
CareOne Plus (HMO-POS) covers emergency services with a $150 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $10 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays ranging from $10 to $150.
Primary Care See details
CareOne Plus (HMO-POS) primary care benefits feature no copay and no coinsurance for primary care physician visits, while specialists, therapies, and mental health services carry copays between $10 and $15 with no coinsurance. Chiropractic services are partially covered, with routine care costing a $15 copay and no coinsurance for up to 12 visits yearly, while other chiropractic services are not covered.
Preventive Services See details
CareOne Plus (HMO-POS) provides partially covered preventive services with no copay and no coinsurance for covered options like annual physicals, kidney disease education, glaucoma screenings, diabetes training, memory fitness, and chemotherapy wigs. Uncovered services under this plan include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, additional smoking cessation, disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
CareOne Plus (HMO-POS) covers hearing services with no coinsurance, requiring a $15 copay for Medicare-covered exams and no copay for routine exams, fittings, and OTC hearing aids. Prescription hearing aids are partially covered with no copay or coinsurance up to $500 per ear annually, but inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services under CareOne Plus (HMO-POS) feature no coinsurance, no deductibles, and no copay for one routine annual eye exam and covered eyewear, which includes contact lenses and eyeglasses up to a $350 yearly limit. Prior authorization and referrals are required, and some services—including other eye exams, upgrades, and individual eyeglass lenses or frames—are not covered.
Dental Services See details
CareOne Plus (HMO-POS) partially covers dental services with a $15 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for covered preventive and comprehensive services. Fluoride treatments, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by CareOne Plus (HMO-POS) with no copay and no coinsurance, though prior authorization and step therapy may apply. Associated Medicare Part B chemotherapy and other drugs have no copay and no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by CareOne Plus (HMO-POS) with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these services.
Medical Equipment See details
Medical Equipment covered by CareOne Plus (HMO-POS) includes durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. 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
Diagnostic and radiological services are covered by CareOne Plus (HMO-POS) with prior authorization and referrals required. Lab services and diagnostic radiological services feature no copay and no coinsurance, diagnostic procedures require a $0 to $30 copay with no coinsurance, outpatient X-rays have no copay with coinsurance, and therapeutic radiological services require a minimum $15 copay and 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the CareOne Plus (HMO-POS) plan with no copay and no coinsurance. Both prior authorization and a referral are required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by CareOne Plus (HMO-POS) with no coinsurance, though only some services are covered in practice since standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and carry a $15 copay. Prior authorization and a referral are required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by CareOne Plus (HMO-POS) with no coinsurance, though prior authorization and a referral are required. There is no copay for days 1 through 20 and a $203.00 copay for days 21 through 100, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
CareOne Plus (HMO-POS) covers other services including acupuncture, over-the-counter (OTC) items, and meals for chronic illnesses with no copay and no coinsurance. Prior authorization is required for acupuncture (limited to 25 treatments per year) and meal benefits, while other miscellaneous services are not covered.
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