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CareAccess (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for CareAccess (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on CareAccess (HMO) in 2025, please refer to our full plan details page.
CareAccess (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties In Florida. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that CareAccess (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 CareAccess (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 CareAccess (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.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $4900.00 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 CareAccess (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 you use. For example, preferred generic drugs have no copay at standard pharmacies and preferred mail, while standard mail has a $16 copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you will pay nothing for covered Part D drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The CareAccess (HMO) plan offers comprehensive coverage, including inpatient and outpatient hospital services with varying copays. You'll find no copays for many services, such as primary care visits, preventive services like annual physicals, routine hearing exams, and certain vision and dental services like oral exams and x-rays. The plan also covers home health services, skilled nursing facilities, and ambulance services, with copays or coinsurance applying to specific services. This plan includes benefits for emergency services, and offers coverage for hearing and vision services with some no copay options. Additional benefits include coverage for home infusion, dialysis, medical equipment, and diagnostic services, with copays or coinsurance depending on the service. The plan also offers other services such as acupuncture and a meal benefit, both with no copay, and covers transportation to plan-approved health-related locations.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For days 1-7, there is a $225 copay, and for days 8-90, there is no copay. Additional days for Inpatient Hospital-Acute have no copay. However, Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered. Outpatient Hospital Services have a copay between $0 and $225, while Observation Services, Ambulatory Surgical Center (ASC) Services, and Outpatient Blood Services have no copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay of $30.
Partial Hospitalization See details
Partial Hospitalization is covered by CareAccess (HMO), requiring prior authorization, with a $30 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the CareAccess (HMO) plan, including ground and air ambulance services. Ground ambulance services have a copay between $0 and $240, while air ambulance services have a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay and up to 26 one-way trips per year, but 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 CareAccess (HMO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $30 copay, while Worldwide Emergency Services have copays ranging from $30 to $125 depending on the specific service.
Primary Care See details
Primary Care Physician Services have no copay, while Chiropractic Services have a $20 copay. Occupational Therapy Services have a $30 copay, and Physician Specialist Services have a $30 copay. Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, and Opioid Treatment Program Services have a copay of $30, while Physical Therapy and Speech-Language Pathology Services have a $30 copay. Additional Telehealth Benefits have a copay between $0 and $30.
Preventive Services See details
The CareAccess (HMO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, including fitness benefits, are covered, with a copay; specific copay information for these services is provided in the plan details.
Hearing Services See details
CareAccess (HMO) covers hearing exams with a $30 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription Hearing Aids (all types) are covered with no copay for up to two visits per year, while Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered. OTC Hearing Aids are also not covered.
Vision Services See details
CareAccess (HMO) offers vision services, including eye exams with a copay of $0-$30, and eyewear with a $0 copay and a combined maximum plan benefit coverage amount of $100 per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The CareAccess (HMO) plan covers dental services, including oral exams with a $0 copay for up to 4 visits per year, dental x-rays with a $0 copay (bitewing x-rays 1 set/year, pano film 1/3 years), other diagnostic dental services with a $0 copay for 1 visit every three years, prophylaxis (cleaning) with a $0 copay for up to 2 visits per year, and oral and maxillofacial surgery with a $0 copay for 1 visit per year. However, fluoride treatment, endodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the CareAccess (HMO) plan and require prior authorization. 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, the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the CareAccess (HMO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices with no copay. Medical Supplies have a 20% coinsurance, and Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the CareAccess (HMO) plan. Diagnostic Procedures/Tests have a copay of up to $75, while Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $225, and Therapeutic Radiological Services have a copay of up to $30 with 20% coinsurance, while Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the CareAccess (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 by CareAccess (HMO), but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, SET for PAD Services, and Additional Cardiac Rehabilitation Services. A copay applies for some services; see the plan details for more information.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the CareAccess (HMO) plan. You will have no copay for days 1-20, and a $200 copay for days 21-100.
Other Services See details
Other Services include acupuncture and a meal benefit, both with no copay, but the plan does not cover over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, or other services like Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services. Acupuncture requires prior authorization and is limited to 25 treatments per year.
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