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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 2026, 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 4.5 out of 5 stars in 2026.
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. 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 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 $3750.00 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) Medicare prescription drug plan features an annual drug deductible of $615. Under this plan, you pay no copay for Tier 1 preferred generic and Tier 2 generic drugs when using standard retail pharmacies or preferred mail-order services. If you choose standard mail-order delivery, Tier 1 drugs carry a $2 copay and Tier 2 drugs carry a $16 copay for a 1-month supply. For Tier 3 preferred brand drugs, you will pay a $30 copay for a 1-month supply at standard pharmacies and preferred mail-order, or a $47 copay through standard mail-order. Higher-tier medications require coinsurance, with Tier 4 non-preferred drugs requiring 40% coinsurance and Tier 5 specialty drugs requiring 25% coinsurance for a 1-month supply.
Additional Benefits
The CareAccess (HMO) plan offers comprehensive medical coverage featuring no copay for primary care doctor visits, routine preventive services, and home health care. For specialized care, members will pay a $30 copay for specialist visits and a $200 daily copay for days 1 through 7 of inpatient hospital stays, with no copay required for days 8 through 90. Outpatient hospital services range from no copay up to a $200 copay, while emergency room visits carry a $150 copay that is waived if admitted. This plan also includes valuable supplemental benefits such as routine dental, vision, and hearing care with no copay for annual exams, cleanings, and over-the-counter hearing aids. Additionally, members receive up to 26 one-way transportation trips per year to plan-approved locations with no copay, as well as diabetic supplies with no copay. While durable medical equipment and dialysis require a 20% coinsurance, other services like acupuncture and over-the-counter items are covered with no copay.
Inpatient Hospital See details
CareAccess (HMO) covers inpatient acute and psychiatric hospital stays with prior authorization and no coinsurance, requiring 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
CareAccess (HMO) outpatient services are covered with no coinsurance, featuring no copay for ambulatory surgical center, observation, and blood services. Patients will pay a $30 copay for outpatient substance abuse sessions and a copay ranging from $0 to $200 for outpatient hospital services, with prior authorization required for most of these benefits.
Partial Hospitalization See details
Partial hospitalization is covered by CareAccess (HMO) with a $25.00 copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
CareAccess (HMO) covers ambulance services with a $0 to $250 copay for ground transport and a 20% coinsurance for air transport. Transportation services are partially covered, offering up to 26 one-way trips per year to plan-approved locations with no copay and no coinsurance, while transportation to any other health-related location is not covered.
Emergency Services See details
CareAccess (HMO) covers emergency services with a $150 copay, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $25 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays ranging from $25 to $150.
Primary Care See details
CareAccess (HMO) offers primary care physician services with no copay and no coinsurance, while specialist visits, mental health, and physical therapy services require a $30 copay and no coinsurance. Chiropractic care is partially covered, offering up to 12 routine visits per year for a $20 copay and no coinsurance, though other chiropractic services are not covered.
Preventive Services See details
CareAccess (HMO) partially covers preventive services, offering no copay and no coinsurance for covered services such as annual physical exams, memory fitness, kidney disease education, and glaucoma screenings. However, several additional preventive benefits, including health education, weight management programs, and nutritional/dietary benefits, are not covered.
Hearing Services See details
CareAccess (HMO) covers hearing services, offering Medicare-covered exams for a $30 copay and no coinsurance, as well as annual routine exams and fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $250 per ear annually, though inner ear, outer ear, and over the ear models are not covered. Over-the-counter hearing aids are also covered with no copay and no coinsurance.
Vision Services See details
Vision services are partially covered by CareAccess (HMO) with no coinsurance, featuring no copay for one annual routine eye exam and no copay for contact lenses and eyeglasses up to a $100 yearly limit. Prior authorization is required for covered services, while other eye exams, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
CareAccess (HMO) dental services are partially covered, with Medicare-covered dental requiring a $30.00 copay and no coinsurance, while other covered services like exams, cleanings, x-rays, and oral surgery have no copay and no coinsurance. However, fluoride treatments, endodontics, prosthodontics, implants, and orthodontics are not covered under this plan, and prior authorization is required for most services.
Home Infusion bundled Services See details
CareAccess (HMO) covers Home Infusion bundled Services with no copay, though prior authorization and step therapy are required. Associated Medicare Part B chemotherapy, radiation, and other drugs carry a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
CareAccess (HMO) covers Dialysis Services with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
CareAccess (HMO) covers medical equipment, offering durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay, subject to prior authorization. Diabetic supplies are covered with no copay and no coinsurance, while diabetic therapeutic shoes or inserts have a $10 copay and no coinsurance.
Diagnostic and Radiological Services See details
CareAccess (HMO) covers diagnostic and radiological services with prior authorization, providing lab services, outpatient X-rays, and diagnostic radiological services with no copay. Diagnostic procedures and tests carry a copay of $0 to $75 with no coinsurance, while therapeutic radiological services require a minimum $30 copay and 20% coinsurance.
Home Health Services See details
CareAccess (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by CareAccess (HMO) with no coinsurance and require prior authorization, though only some services are covered. Standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered and carry a $30 copay.
Skilled Nursing Facility (SNF) See details
CareAccess (HMO) covers skilled nursing facility (SNF) services with no coinsurance and no prior three-day hospital stay required, though prior authorization is necessary. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by CareAccess (HMO), offering acupuncture, over-the-counter items, and chronic illness meal benefits with no copay and no coinsurance. Prior authorization is required for meal benefits and acupuncture, which is limited to 25 treatments per year, while Dual Eligible SNPs with Highly Integrated Services are not covered.
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