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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 North Florida. 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 $5.00. 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 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) prescription drug plan features an annual drug deductible of $615. Beneficiaries enjoy no copay for Tier 1 preferred generic and Tier 2 generic drugs when using a standard pharmacy or preferred mail order for 1-month or 3-month supplies. Standard mail order options for these generic tiers require a copay, starting at $10 for Tier 1 and $20 for Tier 2 for a 1-month supply. For brand-name and higher-tier medications, costs vary by category and pharmacy type. Tier 3 preferred brand drugs have a 1-month copay of $45 at standard pharmacies and preferred mail order, or $47 through standard mail order. Non-preferred drugs in Tier 4 require a 50% coinsurance, while Tier 5 specialty drugs carry a 25% coinsurance for a 1-month supply across all pharmacy and mail order services.
Additional Benefits
The CareOne Plus (HMO) plan offers comprehensive medical coverage with no copay or coinsurance for primary care doctor visits and covered preventive services. For specialized medical needs, members pay a low $10 copay for specialist visits, while inpatient hospital stays require a $200 daily copay for the first five days and no copay for days six through ninety. Outpatient hospital services and emergency care are also covered with no coinsurance, featuring a $150 copay for emergency room visits. Beyond standard medical care, this plan provides valuable extra benefits including no copay for routine dental, vision, and hearing services, alongside annual allowances for eyewear and hearing aids. Members also benefit from no copay for home health services and up to 26 free one-way transportation trips per year to plan-approved locations. Durable medical equipment is covered with a 20% coinsurance and no copay, while diabetic supplies are fully covered with no copay or coinsurance.
Inpatient Hospital See details
CareOne Plus (HMO) inpatient hospital benefits are partially covered with no coinsurance, requiring a $200 daily copay for days 1 through 5 and no copay for days 6 through 90. Unlimited additional acute care days are covered at no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
CareOne Plus (HMO) covers outpatient services with no coinsurance, offering a $0 to $200 copay for outpatient hospital services and no copay for observation, ambulatory surgical center, and blood services. Outpatient substance abuse services are also covered with no coinsurance and a $10 copay for individual or group sessions, with prior authorization and referrals required for most services.
Partial Hospitalization See details
CareOne Plus (HMO) covers partial hospitalization services with a $25 copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
CareOne Plus (HMO) covers ambulance services with prior authorization, featuring a copay ranging from no copay to $250 plus coinsurance for ground transport, and a 20% coinsurance plus a copay for air transport. Transportation services are partially covered with no copay and no coinsurance for up to 26 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
CareOne Plus (HMO) covers emergency services with a $150 copay and no coinsurance, which is 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) covers primary care physician services with no copay and no coinsurance. Specialist visits, mental health, and therapy services require a $10 copay and no coinsurance, while chiropractic care is partially covered with a $15 copay for routine visits and no coinsurance, excluding other chiropractic services.
Preventive Services See details
Preventive services are partially covered under CareOne Plus (HMO) with no copay and no coinsurance for covered benefits such as annual physicals, kidney disease education, and memory fitness. Non-covered sub-services include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs for chemotherapy hair loss, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, tobacco cessation counseling, disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
CareOne Plus (HMO) covers hearing services, though prescription hearing aids are only partially covered because inner ear, outer ear, and over the ear models are not covered. Medicare-covered exams require a $10 copay and no coinsurance, while routine exams, fitting evaluations, OTC hearing aids, and covered prescription aids (up to $600 per ear annually) have no copay and no coinsurance.
Vision Services See details
Vision services are partially covered by CareOne Plus (HMO) with no deductibles, no coinsurance, and copays ranging from $0 to $10, with prior authorization and referrals required. This benefit includes one routine eye exam per year and up to $500 annually for contact lenses and eyeglasses (lenses and frames) with no copay, while other eye exams, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by CareOne Plus (HMO), with Medicare-covered dental services requiring a $10 copay and no coinsurance, while other covered preventive and comprehensive dental services have no copay and no coinsurance. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by CareOne Plus (HMO) with no copay, while associated Medicare Part B chemotherapy and other drugs require no copay and a coinsurance ranging from no coinsurance to 20%. Medicare Part B insulin is also covered with a $35 copay and a coinsurance ranging from no coinsurance to 20%.
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
CareOne Plus (HMO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies are offered with no copay or 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, though prior authorizations and referrals are required. Lab and diagnostic radiological services feature no copay and no coinsurance, while diagnostic tests cost between a $0 and $75 copay with no coinsurance, outpatient X-rays have no copay but require coinsurance, and therapeutic radiological services require a minimum 20% coinsurance and a $10 minimum copay.
Home Health Services See details
Home Health Services are covered under the CareOne Plus (HMO) plan with no copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Cardiac Rehabilitation Services See details
CareOne Plus (HMO) covers some cardiac rehabilitation services with no coinsurance, but standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a $10 copay.
Skilled Nursing Facility (SNF) See details
CareOne Plus (HMO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Referral and prior authorization are required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
CareOne Plus (HMO) offers partially covered other services, featuring acupuncture with a $10 copay and no coinsurance, alongside over-the-counter items and meal benefits for chronic illnesses with no copay and no coinsurance. Prior authorization is required for acupuncture and meals, while other miscellaneous services and dual eligible SNP benefits are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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