CarePlus Health Plans

What CarePlus Health Plans does

CarePlus Health Plans, Inc. is a Florida-licensed Health Maintenance Organization that operates as an indirect, wholly owned subsidiary of Humana, Inc., providing Medicare Advantage plans exclusively to Florida residents. Founded in 2000 and headquartered in Doral, Florida, the company has served Florida Medicare beneficiaries for more than 20 years and reports a membership base exceeding 400,000 across five regional service areas (South, West, Central, North Florida, and the Atlantic Coast).

CarePlus's product portfolio spans standard Medicare Advantage HMO and HMO-POS plans (CareOne Plus, CareSalute, CareFree Platinum Giveback), Dual-Eligible Special Needs Plans (D-SNP) under the CareNeeds brand (Plus, Platinum, Extra) for beneficiaries qualifying for both Medicare and Medicaid, and Chronic Condition Special Needs Plans (C-SNP) under the CareComplete and CareBreeze brands targeting diabetes, cardiovascular disorders, chronic heart failure, and chronic lung disorders. Member-facing technology includes the MyCarePlus secure portal, a provider finder tool, virtual care/telehealth services, the Go365 wellness rewards program, SilverSneakers fitness integration, and the CarePlus Community Navigator (powered by Findhelp) for social determinants of health resources. The company operates under NCQA SNP approvals and AAAHC accreditation.

CarePlus's business model is subscription-based, generating revenue from CMS Medicare Advantage capitation payments (Part C) and Part D prescription drug coverage premiums, supplemented by member premiums where applicable. Distribution occurs through licensed in-house sales agents via phone, the company website, and healthcare provider referrals using the Availity Essentials multi-payer portal. The company is structurally embedded in the broader Humana ecosystem, leveraging parent-owned assets including CenterWell Pharmacy for mail-order prescriptions and Carelon Behavioral Health for mental health and substance abuse services. CarePlus announced its 2026 Medicare Advantage plan portfolio in October 2025 with expanded benefits including out-of-network flexibility, enhanced wellness rewards, and no-cost preventive services.

Name

CarePlus Health Plans

Legal name

CarePlus Health Plans, Inc.

Website

https://careplushealthplans.com

Company type

Private

Founded year

2000

Operating status

Operating

Headcount range

501–1,000 employees

Short description

CarePlus Health Plans is a Florida-licensed Medicare Advantage HMO and indirect wholly owned subsidiary of Humana, Inc., serving more than 400,000 Medicare beneficiaries across Florida with HMO, HMO-POS, D-SNP, and C-SNP plans including supplemental dental, vision, hearing, and wellness benefits.

Ownership category

akta.pro rank

Product category

Medicare Advantage Health Insurance

NAICS

Direct Life, Health, and Medical Insurance Carriers (52411), HMO Medical Centers (621491), Direct Health and Medical Insurance Carriers (524114)

SIC

Hospital & Medical Service Plans (6324), Services-Health Services (8000)

akta.pro primary industry

Medicare Advantage HMOs (HMO/HMO-POS) (HLAEAMAH)

akta.pro secondary industries

MA HMO Plans (HLAEACAA), MA Prescription Drug Plans (MA-PD) (HLAEACAF), MA Chronic Condition Management & Supplemental Benefits (SSBCI) (HLAEACAI), Medicaid Expansion (ACA Adult) Managed Care Plans (HLAEAEAB)

Keywords

• Medicare Advantage plans
• HMO health insurance
• Prescription drug coverage
• Special needs plans
• Dual-eligible coverage

Headquarters

HQ city

Doral

HQ country

United States

HQ region

North America

Offices6 records

Markets served

GTM type

B2C

Offering type

Services

Cost components

Operations, Personnel, Marketing or Sales, Technology or R&D, Infrastructure, Supply Chain

Revenue model

1. Medicare Advantage Plan Premiums (Part C): CarePlus generates revenue through Medicare Part C premiums paid by the federal government for providing Medicare Advantage coverage to enrolled beneficiaries, plus any additional plan premiums charged to members
2. Medicare Part D Prescription Drug Coverage: Revenue from Medicare Part D prescription drug coverage included in most CarePlus Medicare Advantage plans, providing integrated medical and pharmacy benefits

Pricing tiers

Go-to-market motion2 records

Distribution channels4 records

Marketing channels5 records

Core offering

CarePlus Health Plans is a Florida-licensed HMO that sells Medicare Advantage plans (Part C) with integrated Part D prescription drug coverage to Medicare-eligible individuals in Florida. Its portfolio includes standard HMO and HMO-POS plans, Dual-Eligible Special Needs Plans (D-SNPs) for beneficiaries who qualify for both Medicare and Medicaid, and Chronic Condition Special Needs Plans (C-SNPs) for members with diabetes, cardiovascular disorders, chronic heart failure, and chronic lung disorders. Plans include extra benefits such as dental, hearing, vision, telehealth, SilverSneakers fitness, Go365 wellness rewards, and chronic condition care assistance.

Product overview

CarePlus Health Plans is a Florida-focused Medicare Advantage HMO plan provider that offers a portfolio of specialized health plans. The core offerings include CareNeeds D-SNP plans (CareNeeds Plus, CareNeeds Platinum, CareNeeds Extra) for dual-eligible Medicare and Medicaid beneficiaries, and CareComplete/CareBreeze C-SNP plans for beneficiaries with chronic conditions (diabetes, cardiovascular disorders, chronic heart failure, chronic lung disorders). Additional plans include CareOne Plus, CareSalute, and CareFree Platinum Giveback HMO-POS options with out-of-network flexibility. Member-facing platforms include MyCarePlus secure portal and Provider Finder tool, with integrated services for telehealth, fitness (SilverSneakers), pharmacy (CenterWell), behavioral health (Carelon), and wellness rewards (Go365). CarePlus is an indirect wholly owned subsidiary of Humana, Inc.

Differentiator

Problem solved

Functional benefit

Brands

• CareNeeds Plus: HMO D-SNP plan for dual-eligible beneficiaries receiving both Medicare and Medicaid
• CareNeeds Platinum
• CareNeeds Extra
• CareComplete
• CareComplete Platinum
• CareBreeze
• CareBreeze Platinum
• CareOne Plus
• CareSalute
• CareFree Platinum Giveback
• MyCarePlus
• Go365
• CarePlus Community Navigator
• CarePlus Link

Products and services

• CareNeeds Plus (HMO D-SNP) Dual Eligible Special Needs Plan (HMO D-SNP) for Medicare beneficiaries who also qualify for Medicaid (QMB/QMB+, SLMB/SLMB+, QI, QDWI, FBDE categories), combining Medicare Advantage medical and Part D prescription drug benefits with Medicaid-covered services.
• CareNeeds Platinum (HMO D-SNP) Dual Eligible Special Needs Plan (HMO D-SNP) with enhanced/platinum-tier benefits for dual-eligible Medicare and Medicaid beneficiaries; NCQA-approved to operate as a Special Needs Plan through December 31, 2026.
• CareNeeds Extra (HMO D-SNP) Dual Eligible Special Needs Plan (HMO D-SNP) for dual-eligible beneficiaries covered under QMB+, SLMB+, and FBDE categories.
• CareComplete (HMO C-SNP) Chronic Condition Special Needs Plan (HMO C-SNP) for Medicare beneficiaries diagnosed with diabetes, cardiovascular disorders, or chronic heart failure; NCQA-approved through December 31, 2025.
• CareComplete Platinum (HMO C-SNP and HMO-POS C-SNP) Chronic Condition Special Needs Plan with platinum-tier benefits in HMO and HMO-POS variants for members with diabetes, cardiovascular disorders, or chronic heart failure; NCQA-approved through December 31, 2025.
• CareBreeze (HMO C-SNP) Chronic Lung Condition Special Needs Plan (HMO C-SNP) for Medicare beneficiaries with chronic lung disorders; NCQA-approved through December 31, 2025.
• CareBreeze Platinum (HMO C-SNP and HMO-POS C-SNP) Chronic Lung Condition Special Needs Plan with platinum-tier benefits in HMO and HMO-POS variants for beneficiaries with chronic lung disorders; NCQA-approved through December 31, 2025.
• CareOne Plus (HMO-POS) HMO with Point-of-Service option that covers certain services received from out-of-network providers within the plan's service area; available in multiple plan variants (e.g., 001, 043).
• CareSalute (HMO-POS) HMO-POS plan providing out-of-network coverage for members while visiting Puerto Rico; non-contracted providers may deny care except in emergency or urgent situations.
• CareFree Platinum Giveback (HMO-POS) HMO-POS plan offering a Medicare Part B premium reduction (Giveback) benefit along with out-of-network coverage flexibility.
• Virtual Care and Telehealth Phone or video chat access to healthcare providers for evaluating and addressing common conditions including allergies, diarrhea, depression and anxiety, rashes, and sore throat; available to members who find it difficult to see their PCP or specialists in person (referral partner: CareNow).
• Chronic Condition Care Assistance Care management program offering up to $500 in financial assistance for purchases approved by a care manager for qualifying chronic conditions including diabetes mellitus, cardiovascular disorders, chronic lung disorders, and chronic heart failure.

Quantifiable outcome

• Members can earn rewards through Go365 for completing preventive screenings, exercise activities, and wellness programs

Segments3 records

Ideal customer profiles3 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration7 records

Feature4 records

Partnerships

Five partnerships are on record, tiered core.

• Humana Inc.coreOthersCarePlus Health Plans, Inc. is a Florida-licensed Health Maintenance Organization and an indirect, wholly owned subsidiary of Humana, Inc., a Delaware corporation and health maintenance organization holding company. CarePlus operates under Humana's corporate umbrella as part of its Medicare Advantage business.
• Availity EssentialscoreTechnology or IntegrationMulti-payer provider portal used by CarePlus network providers to check patient eligibility, review and submit claims, review patient benefits, and submit prior authorization requests. All CarePlus providers must use Availity for administrative tasks.
• Carelon Behavioral HealthcoreStrategic or Co-development PartnerCarePlus contracts with Carelon Behavioral Health to manage its network of providers rendering substance abuse and mental health counseling and treatment. Carelon coordinates behavioral health services for CarePlus members, encouraging care coordination between behavioral health and medical practitioners.
• SilverSneakerscoreStrategic or Co-development PartnerSilverSneakers fitness program included in all CarePlus plans at no additional cost, providing unlimited access to participating gym locations, fitness classes, SilverSneakers FLEX community classes, SilverSneakers GO app, SilverSneakers On-Demand, and SilverSneakers LIVE virtual classes.
• CenterWell PharmacycoreStrategic or Co-development PartnerPreferred cost-sharing mail-order pharmacy on CarePlus plans, offering prescription delivery to members. Members can register for CenterWell Pharmacy mail-order delivery by calling 1-800-526-1490 for convenient prescription refills.

Scale indicators2 records

Recent moves5 records

Expansion highlights4 records

Broad incumbents

• Humana Inc. Humana is the parent company and the largest Medicare Advantage-focused health insurer in the US. Highly comparable given CarePlus is wholly owned and operates under Humana's contracts, sharing back-office, pharmacy (CenterWell), and provider infrastructure.
• Aetna (CVS Health): Aetna offers Medicare Advantage HMO and D-SNP plans nationally including Florida, leveraging CVS retail and PBM infrastructure. A direct MA/HMO and SNP competitor in the same Florida counties.
• Cigna Medicare: Cigna sells Medicare Advantage HMO and PPO plans in select Florida counties and offers national Medicare Part D. Competes with CarePlus in MA and MA-PD benefit design and pricing.
• UnitedHealthcare (Medicare Solutions): The largest US health insurer with a national Medicare Advantage portfolio including HMO and SNP plans. Directly competes with CarePlus in Florida AEP and is the benchmark incumbent for scale, Stars performance, and supplemental benefits.

Emerging players

• Clover Health: Tech-forward Medicare Advantage insurer with PPO and HMO offerings concentrated in select counties. Operates in select Florida counties; comparable in MA-only model and Stars-focused operating philosophy.
• Devoted Health: Growth-stage Medicare Advantage HMO insurer focused on seniors with concierge-style service and broad supplemental benefits. Expanding into Florida with similar D-SNP and chronic-condition targeting.

Direct peers

• Alignment Health Plan: Technology-enabled Medicare Advantage HMO plan with strong California presence expanding into select Florida counties. Comparable as a focused MA HMO with HMO-POS optionality and supplemental benefit strategy similar to CarePlus.
• WellCare (Centene): WellCare is a Centene subsidiary focused on government-sponsored health plans including Medicare Advantage HMO, D-SNP, and C-SNP. Operates broadly in Florida and directly competes in SNP-heavy segments where CarePlus is positioned.
• Florida Blue (GuideWell): Florida's Blue Cross Blue Shield licensee offering Medicare Advantage HMO and PPO plans statewide. One of the most directly competitive regional MA carriers in CarePlus' exact service area.

Regional players

• Simply Healthcare (HealthSun/Carelon): Florida-focused Medicare Advantage carrier serving dual-eligible and chronic-condition populations, similar profile to CarePlus. Highly comparable for Florida D-SNP and C-SNP competition.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat4 records

Key risks6 records

Key highlights7 records

Customer concentration

• Facebookfacebook.com/careplushealthplans
• LinkedInlinkedin.com/company/careplus-health-plan
• Xx.com/careplushp

Compliance4 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles1 record

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about CarePlus Health Plans