CareFree Platinum Giveback (HMO)

H1019 - 094 - 0
4 out of 5 stars (4 / 5)

CareFree Platinum Giveback (HMO) is a Medicare Advantage Plan by CarePlus Health Plans, Inc..

This page features plan details for 2025 CareFree Platinum Giveback (HMO) H1019 – 094 – 0 available in Clay, Duval, and St. Johns Counties.

Locations

CareFree Platinum Giveback (HMO) is offered in the following locations.

Plan Overview

CareFree Platinum Giveback (HMO) offers the following coverage and cost-sharing.

Insurer:CarePlus Health Plans, Inc.
Health Plan Deductible:$0
MOOP:$3,900 In-network
Drugs Covered:Yes

Ready to sign up for CareFree Platinum Giveback (HMO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Medicare Part B Give Back Benefit

The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans. 

CareFree Platinum Giveback (HMO) qualifies for a monthly Medicare Give Back Benefit of $120.00.

Premium Reduction:$120.00

Premium Breakdown

CareFree Platinum Giveback (HMO) has a monthly premium of $0.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
Part B Part C Part D Part B Give Back Total
$185.00 $0.00 $0.00 $120.00 $
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
  • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

CareFree Platinum Giveback (HMO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible: $0.00
Drug Out-Of-Pocket maximum: $2,000.00
Drug Benefit Type: Enhanced Alternative

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

The table below shows how the LIS impacts the Part D premium of this plan.

Part DLIS Full
$0.00$0.00

Initial Coverage Phase

After you pay your $0.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $2,000.00. Once you reach that amount, you will enter the next coverage phase.

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.

Additional Benefits

CareFree Platinum Giveback (HMO) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

    • In-Network: No

Comprehensive Dental

  • Adjunctive General Services
    • In-Network: No Coins – 0.00 Copay (Limits Apply, Authorization Required, Referral Required)
  • Oral and Maxillofacial Surgery
    • In-Network: No Coins – 0.00 Copay (Authorization Required, Referral Required)
  • Restorative Services
    • In-Network: No Coins – 0.00 Copay (Authorization Required, Referral Required)

Diagnostic and Preventive Dental

  • Dental X-Rays
    • In-Network: No Coins – 0.00 Copay (Authorization Required)
  • Oral Exams
    • In-Network: No Coins – 0.00 Copay (Authorization Required)
  • Other Diagnostic Dental Services
    • In-Network: No Coins – 0.00 Copay (Authorization Required)
  • Prophylaxis (cleaning)
    • In-Network: No Coins – 0.00 Copay (Authorization Required)

Diagnostic procedures/lab services/imaging

  • Diagnostic tests and procedures
    • $0-110 copay (Authorization Required, Referral Required)
  • Diagnostic radiology services (e.g., MRI)
    • $0-300 copay (Authorization Required, Referral Required)
  • Lab services
    • $0 copay (Authorization Required, Referral Required)
  • Outpatient x-rays
    • $0-110 copay (Authorization Required, Referral Required)

Doctor visits

  • Primary
    • $0 copay
  • Specialist
    • $30 copay per visit (Authorization Required, Referral Required)

Emergency care/Urgent care

  • Emergency
    • $140 copay per visit (always covered)
  • Urgent care
    • $30 copay per visit (always covered)

Foot care (podiatry services)

  • Routine foot care
    • $30 copay (Authorization Required)
  • Foot exams and treatment
    • $30 copay (Authorization Required)

Ground ambulance

    • $0-250 copay

Health plan deductible

    • $0

Hearing

  • Fitting/evaluation
    • $0 copay (Limits Apply, Authorization Required, Referral Required)
  • Hearing aids
    • $0 copay (Limits Apply)
  • Hearing aids OTC
    • $0 copay (Limits Apply)
  • Medicare-Covered Hearing Exam
    • $30 copay (Authorization Required, Referral Required)

Inpatient hospital coverage

    • $300 per day for days 1 through 5
      $0 per day for days 6 through 90
      $0 per day for days 91 and beyond (Authorization Required, Referral Required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

    • $3,900 In-network

Medical equipment/supplies

  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • 20% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • 20% coinsurance per item (Authorization Required)
  • Diabetes supplies
    • $0 copay (Authorization Required)

Medicare Part B drugs

  • Chemotherapy
    • 0-20% coinsurance (Authorization Required)
  • Other Part B drugs
    • 0-20% coinsurance (Authorization Required)

Mental health services

  • Outpatient group therapy visit with a psychiatrist
    • $30 copay (Authorization Required, Referral Required)
  • Outpatient group therapy visit
    • $30 copay (Authorization Required, Referral Required)
  • Outpatient individual therapy visit
    • $30 copay (Authorization Required, Referral Required)
  • Inpatient hospital – psychiatric
    • $300 per day for days 1 through 5
      $0 per day for days 6 through 90 (Authorization Required, Referral Required)
  • Outpatient individual therapy visit with a psychiatrist
    • $30 copay (Authorization Required, Referral Required)

Optional supplemental benefits

    • No

Other health plan deductibles?

    • In-Network: No

Outpatient hospital coverage

    • $0-300 copay per visit (Authorization Required, Referral Required)

Preventive care

    • $0 copay

Rehabilitation services

  • Occupational therapy visit
    • $30 copay (Authorization Required, Referral Required)
  • Physical therapy and speech and language therapy visit
    • $30 copay (Authorization Required, Referral Required)

Skilled Nursing Facility

    • $10 per day for days 1 through 20
      $125 per day for days 21 through 100 (Authorization Required, Referral Required)

Transportation

    • Not covered

Vision

  • Eyeglass lenses
    • Not covered
  • Contact lenses
    • $0 copay (Limits Apply, Authorization Required, Referral Required)
  • Other
    • Not covered
  • Routine eye exam
    • $0 copay (Limits Apply, Authorization Required, Referral Required)
  • Upgrades
    • Not covered
  • Eyeglass frames
    • Not covered
  • Eyeglasses (frames and lenses)
    • $0 copay (Limits Apply, Authorization Required, Referral Required)

Wellness programs (e.g., fitness, nursing hotline)

    • Covered

Ready to sign up for CareFree Platinum Giveback (HMO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Need more information on CareFree Platinum Giveback (HMO)? See 2025 CareFree Platinum Giveback (HMO) at MedicareAdvantageRX.com.

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