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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 Broward, Miami-Dade, & Palm Beach Counties. 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 $6.00. 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 $2250.00 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 plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 preferred generics and Tier 2 generics, you will pay no copay for 1-month or 3-month supplies at standard pharmacies and through preferred mail order. If you choose standard mail order, Tier 1 drugs require a $2 copay for a 1-month supply ($6 for 3-month) and Tier 2 drugs require a $16 copay for a 1-month supply ($48 for 3-month). Tier 3 preferred brand drugs require a $30 copay for a 1-month supply at standard pharmacies and preferred mail order, while standard mail order costs $47. For higher-tier prescriptions, Tier 4 non-preferred drugs carry a 47% coinsurance across all pharmacy and mail order options for both 1-month and 3-month supplies. Specialty medications in Tier 5 require a 33% coinsurance for a 1-month supply regardless of whether you use standard pharmacies, preferred mail order, or standard mail order.
Additional Benefits
The CareAccess (HMO) plan offers robust coverage with predictable cost-sharing, including no copay for primary care visits and a low ten-dollar copay for specialist, therapy, and mental health services. Inpatient hospital stays require a fifty-dollar daily copay for the first five days and no copay thereafter, while outpatient hospital services feature copays ranging from zero to one hundred twenty-five dollars. Emergency care is subject to a one hundred fifty-dollar copay, which is waived if you are admitted, and urgent care visits require a ten-dollar copay. Beneficiaries can also take advantage of excellent routine benefits, including no copay for annual physicals, preventive dental services, routine vision exams, and routine hearing exams. The plan provides up to four hundred dollars annually for eyewear and up to seven hundred fifty dollars per ear for prescription hearing aids with no copay. Additionally, the plan covers up to fifty one-way transportation trips per year to approved locations with no copay and features no copay for home health services.
Inpatient Hospital See details
CareAccess (HMO) inpatient hospital services are partially covered with no coinsurance, requiring prior authorization and a $50 daily copay for days 1 through 5 and no copay for days 6 through 90. Non-Medicare-covered stays, hospital upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
CareAccess (HMO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center services, outpatient blood services, and observation services. Outpatient hospital services carry a copay ranging from $0 to $125, while individual and group substance abuse sessions require a $10 copay, with prior authorization required for most services.
Partial Hospitalization See details
Partial hospitalization services are covered by CareAccess (HMO) with a $10.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by CareAccess (HMO), featuring a copay of $0 to $335 for ground ambulance services, a 20% coinsurance for air ambulance services, and no copay or coinsurance for up to 50 one-way trips per year to plan-approved locations. Prior authorization is required for these benefits, and transportation to any health-related location is not covered.
Emergency Services See details
CareAccess (HMO) emergency services are covered with a $150 copay and no coinsurance, with the copay 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
Primary care benefits offered by CareAccess (HMO) feature no copay and no coinsurance for primary care physician visits, while specialist, therapy, and mental health services require a $10 copay and no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance for up to 12 routine visits per year, while other chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by CareAccess (HMO) with no copay and no coinsurance for annual physical exams, kidney disease education, memory fitness, and various screenings. However, additional preventive benefits are only partially covered, as the plan excludes health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home modifications, and counseling.
Hearing Services See details
Hearing services are covered under the CareAccess (HMO) plan, featuring a $10 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. OTC hearing aids are covered with no copay or coinsurance, while prescription hearing aids are partially covered up to $750 per ear annually with no copay or coinsurance, excluding inner ear, outer ear, and over-the-ear models.
Vision Services See details
CareAccess (HMO) partially covers vision services, offering routine eye exams (one per year) and eyewear, such as contact lenses and eyeglasses, with no copay and no coinsurance, up to a $400 annual maximum. Prior authorization is required, and other eye exams, separate eyeglass lenses, separate frames, and upgrades are not covered.
Dental Services See details
CareAccess (HMO) dental services are partially covered, with Medicare-covered dental services requiring a $10.00 copay and no coinsurance, and other covered preventive and comprehensive dental services requiring no copay and no coinsurance. However, fluoride treatments, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by CareAccess (HMO) with no copay, though prior authorization and step therapy are required. Associated Medicare Part B chemotherapy and other drugs have no copay and range from no coinsurance to 20% coinsurance, while covered insulin carries a $35 copay and no coinsurance 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, featuring durable medical equipment (DME) with a 20% coinsurance and no copay, and prosthetic devices with no copay. Medical supplies require a 20% coinsurance, while diabetic supplies have no coinsurance and no copay, except for diabetic therapeutic shoes or inserts which carry a $10 copay.
Diagnostic and Radiological Services See details
CareAccess (HMO) covers diagnostic and radiological services, requiring prior authorization for all services. Diagnostic tests and procedures have no coinsurance and a copay ranging from $0 to $75, while lab services, diagnostic radiological services, and outpatient X-rays feature no copay. Therapeutic radiological services require a minimum 20% coinsurance and a minimum $35 copay.
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 a $10 copay, though prior authorization is required. However, in practice, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
CareAccess (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 to 20 and a $75 copay for days 21 to 100. Prior authorization is required and a prior three-day inpatient hospital stay is not needed, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by CareAccess (HMO) with no copay and no coinsurance for approved benefits, while Dual Eligible SNPs, Other 1, Other 2, and Other 3 are not covered. Covered benefits include acupuncture limited to 25 treatments per year, over-the-counter items, and chronic illness meals, with prior authorization required for acupuncture and meal services.
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