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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 Clay, Duval, and St. Johns 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 $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 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 varying copays or coinsurance amounts depending on the drug tier and pharmacy. For example, you will have no copay for preferred generic drugs at a standard pharmacy, but a $20 copay at a standard mail pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you will pay nothing for covered drugs. This plan may have a reduced premium if you qualify for the low-income subsidy (LIS).
Additional Benefits
The CareOne Plus (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services, including hospital and substance abuse services, have copays. Emergency services and transportation services are covered with copays, and primary care, hearing, vision, and dental services have copays. Preventive services, hearing exams, and eyewear have no copay, while prescription hearing aids and vision services have maximum annual benefits. The plan also covers medical equipment with coinsurance, diagnostic services with copays, and home health services with no copay. Other covered services include acupuncture, over-the-counter items, and a meal benefit, all with copays or maximum benefits.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care. For acute care, you pay a $175 copay for days 1-5, and no copay for days 6-90; additional days are covered with no copay. Inpatient psychiatric services have a $175 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for both acute and psychiatric care are not covered, and additional days for inpatient psychiatric are not covered.
Outpatient Services See details
The CareOne Plus (HMO) plan covers outpatient services, including outpatient hospital services with a copay between $0 and $175, observation services with no copay, and ambulatory surgical center (ASC) services with no copay. Outpatient substance abuse services have a $10 copay for both individual and group sessions, and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the CareOne Plus (HMO) plan, with a $10 copay. Prior authorization and a doctor's referral are required.
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 $250, while air ambulance services have a 20% coinsurance. Transportation services have no copay, but transportation to any health-related location is limited to 50 one-way trips per year, and transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the CareOne Plus (HMO) plan. Emergency Services have a $140 copay, while Urgently Needed Services have a $10 copay. Worldwide Emergency Coverage and Worldwide Emergency Transportation have a $140 copay, while Worldwide Urgent Coverage has a copay between $10 and $140.
Primary Care See details
The CareOne Plus (HMO) plan covers primary care physician services with no copay, and chiropractic services and routine chiropractic care with a $10 copay. This plan also covers occupational therapy services with a $10 copay, physician specialist services with a $10 copay, and physical therapy and speech-language pathology services with a $10 copay. Additionally, mental health and psychiatric services, podiatry services, other health care professional services, additional telehealth benefits, and opioid treatment program services are covered with copays ranging from $0 to $10.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, annual physical exams with no copay, and additional preventive services like fitness benefits, kidney disease education, and other preventive services. Glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit have 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, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers, 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
CareOne Plus (HMO) covers hearing exams with a $10 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a maximum benefit of $750 per year, and OTC hearing aids are covered with a maximum benefit of $50 per month.
Vision Services See details
CareOne Plus (HMO) covers vision services, including eye exams with a copay of $0-$10. Eyewear is covered with no copay, and a combined maximum benefit of $600 per year. Contact lenses and eyeglasses (lenses and frames) are covered with no copay, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The CareOne Plus (HMO) plan covers Medicare Dental Services with a $10 copay, while Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Restorative Services, Adjunctive General Services, Periodontics, Prosthodontics (removable), and Oral and Maxillofacial Surgery have no copay. Fluoride Treatment, Endodontics, Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the CareOne Plus (HMO) plan. For Medicare Part B Insulin Drugs, there is a $35 copay with coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the CareOne Plus (HMO) plan and require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with no copay for Diabetic Supplies and a $10 copay for Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the CareOne Plus (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $75, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $175. Therapeutic Radiological Services have a copay up to $50 and a coinsurance of at least 20%, while 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 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 referral. You will have no copay for days 1-20, and a $150 copay for days 21-100, and additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Under the CareOne Plus (HMO) plan, acupuncture has a $10 copay, and the plan covers up to 20 treatments per year. Over-the-counter items are covered, with a maximum benefit of $50 per month, and the plan also offers a meal benefit with no copay. However, other services such as Early and Periodic Screening, Diagnostic, and Treatment services, and Private Duty Nursing Services are not covered.
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