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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 South 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. 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 $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) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay different costs depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at standard pharmacies and preferred mail order, but a $16 copay at standard mail order. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase and 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 a variety of benefits with varying costs. Inpatient hospital stays have a copay, but many outpatient services, including primary care, preventive services, and dental services, have no copay. Emergency services and urgent care have copays, and ambulance services have a mix of copays and coinsurance. The plan provides coverage for hearing and vision services, including hearing exams, and eye exams, with copays. Medical equipment, dialysis, and home infusion services are covered with coinsurance. This plan also includes benefits like home health services, Cardiac Rehabilitation Services, and skilled nursing facilities, some of which include copays.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both requiring prior authorization. For days 1-5, there is a $50 copay, and for days 6-90, there is no copay. Additional days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered by the CareAccess (HMO) plan, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $50, and outpatient blood services, observation services, and ambulatory surgical center services have no copay. Individual and group sessions for outpatient substance abuse have a $10 copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $10 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by CareAccess (HMO), including all ambulance services and transportation services to plan-approved health-related locations. Ground ambulance services have a copay between $0 and $300, while air ambulance services have a 20% coinsurance; transportation services have no copay, but transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by CareAccess (HMO). Emergency Services have a $140 copay, while Urgently Needed Services have a $35 copay, and there is no coinsurance for either. Worldwide Emergency Coverage and Worldwide Emergency Transportation have a $140 copay, and Worldwide Urgent Coverage has a copay between $35 and $140.
Primary Care See details
The CareAccess (HMO) plan covers primary care physician services with no copay, chiropractic services with a $10 copay, occupational therapy services with a $10 copay, physician specialist services with a $10 copay, and mental health specialty services with a $10 copay for individual and group sessions. The plan also covers podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services with a $10 copay, additional telehealth benefits with a $0-$35 copay, and opioid treatment program services with a $10 copay.
Preventive Services See details
CareAccess (HMO) covers preventive services, including an annual physical exam with no copay. Additional preventive services, including Fitness Benefit, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, are covered with no copay.
Hearing Services See details
Hearing exams are covered by the CareAccess (HMO) plan with a $10 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids (all types) are covered, with a maximum plan benefit coverage of $750 per year, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
The CareAccess (HMO) plan covers vision services, including eye exams with a copay of $0-$10 and eyewear with no copay. 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
CareAccess (HMO) covers Medicare Dental Services with a $10 copay, as well as Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable), and Oral and Maxillofacial Surgery with no copay. Fluoride Treatment, Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by CareAccess (HMO), and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay, and the coinsurance ranges from 0% to 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 is covered by CareAccess (HMO), including Durable Medical Equipment with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment. Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the CareAccess (HMO) plan, with a $0 to $75 copay for Diagnostic Procedures/Tests, and no copay for Lab Services. Diagnostic Radiological Services have a copay of at most $50, while Therapeutic Radiological Services have a copay of at most $35 and coinsurance of at least 20%, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by CareAccess (HMO), 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 any of the sub-services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the CareAccess (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $75 per day; additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services includes acupuncture and a meal benefit, both with no copay. Over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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