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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 Flagler and Volusia Counties. 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 $3.00. 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 $3500.00 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. In the initial coverage phase, you will pay different copays or coinsurance amounts depending on the drug tier and pharmacy type. For example, for preferred generic drugs, you will pay no copay at standard and preferred mail pharmacies, and a $20 copay at standard mail pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. This plan's premium may be reduced if you qualify for the low-income subsidy, also known as LIS or "Extra help".
Additional Benefits
The CareOne Plus (HMO) plan offers a wide range of benefits with varying cost-sharing. You'll find no copays for many services, including primary care visits, preventive services like annual physical exams, routine hearing exams, and eyewear. However, some services, like inpatient hospital stays, outpatient services, and specialist visits, have copays ranging from $15 to $140. The plan also includes coverage for ambulance and transportation services, emergency services, hearing and vision services, dental services, and more. Additional benefits include home health services with no copay, and coverage for over-the-counter items, and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $125 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute have no copay. Inpatient Hospital Psychiatric has a $125 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stay and upgrades for Inpatient Hospital-Acute are not covered, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient Hospital Services have a copay between $0 and $125, while Observation Services, Ambulatory Surgical Center Services, and Outpatient Blood Services have no copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay of $15.
Partial Hospitalization See details
Partial Hospitalization is covered, with a $15 copay. Prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by CareOne Plus (HMO). Ground ambulance services have a copay between $0 and $300, while air ambulance services have a 20% coinsurance, and transportation services to a plan-approved health-related location have no copay.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the CareOne Plus (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, Urgently Needed Services have a $15 copay, and Worldwide Urgent Coverage has a copay between $15 and $140, and Worldwide Emergency Transportation has a $140 copay.
Primary Care See details
The CareOne Plus (HMO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $15 copay, and physical therapy and speech-language pathology services with a $15 copay. The plan also covers physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, additional telehealth benefits, and opioid treatment program services, all with a copay of $15.
Preventive Services See details
The CareOne Plus (HMO) plan covers preventive services, including an annual physical exam with no copay, and also covers additional preventive services that may require a copay. Glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit have no copay. Other benefits like health education, in-home safety assessments, and others are not covered.
Hearing Services See details
CareOne Plus (HMO) covers hearing exams for a $15 copay. Routine hearing exams and fitting/evaluation for hearing aids have no copay, and prescription hearing aids are covered up to $1,250 per year, per ear, with no copay. OTC hearing aids are covered up to $100 every three months.
Vision Services See details
Vision services, including eye exams and eyewear, are covered by the CareOne Plus (HMO) plan. Eye exams have a copay between $0 and $15, while eyewear has no copay. However, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
CareOne Plus (HMO) covers a range of dental services including oral exams with no copay, dental x-rays with no copay, other diagnostic dental services with no copay, prophylaxis (cleaning) with no copay, restorative services with no copay, adjunctive general services with no copay, prosthodontics, removable with no copay, and oral and maxillofacial surgery with no copay. Fluoride treatment, endodontics, periodontics, maxillofacial prosthetics, implant services, prosthodontics, fixed, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the CareOne Plus (HMO) plan. For Medicare Part B Insulin Drugs, there is a $35 copay, and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the CareOne Plus (HMO) plan, but require prior authorization and a doctor's referral. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 10-20% coinsurance, and Prosthetics/Medical Supplies with no coinsurance and a copay for Medicare-covered supplies. Diabetic Equipment is covered with a copay for Medicare-covered supplies.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the CareOne Plus (HMO) plan, with a copay for Diagnostic Procedures/Tests ranging from $0 to $50, and no copay for Lab Services. Therapeutic Radiological Services have a maximum copay of $15 and a minimum coinsurance of 20%, while Diagnostic Radiological Services have a maximum copay of $125. 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 specific services including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the CareOne Plus (HMO) plan with prior authorization and a doctor's referral. For days 1-20, there is no copay, and for days 21-100, the copay is $160. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
The CareOne Plus (HMO) plan covers acupuncture with a $15 copay and a limit of 20 treatments per year, and also covers over-the-counter items with a maximum benefit of $100 every three months. The plan provides a meal benefit with no copay. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and other services are not covered.
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