Detalles de los beneficios
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¿Cómo funciona?
Chronic Condition Care Assistance is a special supplemental benefit for the chronically ill that provides up to $500 in financial assistance to members with certain chronic health conditions.** Eligible members work with a care manager who approves funds to be used for certain expenses based on their individual health and wellness needs.
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Eligibility criteria
CarePlus offers Chronic Condition Care Assistance on select Medicare Advantage plans as part of a special program for members with specific health conditions. To qualify for this benefit, you must:
- Be enrolled in a plan that offers the benefit;
- Have a diagnosis of one or more complex chronic conditions;
- Have a high risk of hospitalization or other adverse health outcomes;
- Require intensive care coordination; and
- Work with a care manager who decides how the benefit may be used based on your healthcare needs
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Qualifying health conditions
Some CarePlus plans with the benefit require a member to have one condition to be eligible. Other CarePlus plans require two conditions. Qualifying conditions include:
- Trastornos autoinmunes
- Cáncer
- Trastornos cardiovasculares
- Chronic disabling mental health conditions
- Insuficiencia cardíaca crónica
- Insuficiencia pulmonar crónica
- Chronic alcohol use disorder and other substance use disorders (SUDs)
- Insuficiencia cardíaca congestiva
- Enfermedad renal crónica
- Demencia
- Diabetes mellitus
- HIV/AIDS (VIH/SIDA)
- Trastornos neurológicos
- Post-organ transplantation care
- Severe hematologic (blood) disorders
- Accidente cerebrovascular
Obtener detalles del plan
Are there limits on products that can be purchased?
Your care manager will select eligible purchases for you based on your healthcare needs. Some items may have quantity limits. To view these limits, please select a category below.
- Dehumidifier
- Handheld shower head
- High-efficiency air purifier
- Humidifier
- Portable air conditioning unit
- Robotic pet
- Shower or bath/tub transfer bench
- Calefactores
- Bathtub safety rails
- Easy-use faucets
- Grab bar sets
- Oscillating fans
- Asientos elevadores de inodoro
- Easy-use doorknobs
- High-efficiency air filter replacements for air purifiers
- 2 housecoats
- 2 packs of regular socks
- 2 pairs of shoes
- 2 robes
- 3 packs of underpants
- 4 hooded sweatshirts
- 4 long-sleeved shirts
- 4 sets of pajamas or sleepwear
- 4 packs of shirts
- 4 pairs of long pants
- 4 pairs of shorts
- 6 bras (including 2 front clasps, 2 sports bras and 2 back clasps)
The guidelines above are designed to support appropriate and consistent use of this benefit for approved items. Covered and non-covered services are subject to change. For additional details, please contact your care manager.
What’s excluded?
Select the categories below to view examples of expenses that are not covered. Chronic Condition Care Assistance cannot be used for the following items.
- Electrodomésticos
- Electronics such as televisions, cameras, security systems, computers and telephones
- Equipamiento para ejercitar
- Muebles
- Tarjetas de regalo
- Personal vehicles and related expenses
- Cargos por solicitud
- Depósitos de cualquier tipo
- Homeowner/renter fees or maintenance fees
- Memberships such as Amazon Prime, Costco and Sam’s Club
- Gastos por mudanza
- Payments on accounts that do not belong to the member or would solely benefit an individual who is not the member*
- Pagos a agencias de cobro
- Payments to family members
- Personal loans/credit card payments - Any
- Tax liabilities - Any
- Garantías
- Zero-balance accounts, including prepayments of goods or services to be received at a future point in time
*Payments may be made on accounts that are not in the member’s name only when the service address matches the service address that CarePlus has on file as the member’s permanent address.
- Cannabis products, paraphernalia, procurement or related services
- Cost share for Part D prescription drug benefits
- Servicios dentales
- Direct member reimbursement
- Durable medical equipment purchased outright
- Insurance premiums
- Procedimientos solo con fines cosméticos y que no se basan en la cobertura de Medicare tradicional
Note: Not all medical and insurance expenses are excluded. The benefit may be used to help pay for your share of costs, such as deductibles, co-insurance, or copayments, for services covered by your plan after your claim is processed
- Entertainment such as cable, satellite and streaming services
- Planificación y gastos fúnebres
- Home repairs or general maintenance
- Providers that are not licensed or certified to provide the services requested
- Service or maintenance agreements
- Services received outside of the effective dates of the plan
The above is not an exhaustive list. There may be items we are unable to assist with that are not explicitly listed. Covered and non-covered services are subject to change.
Explore related topics
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Spending card
Certain plans include an allowance on the CarePlus Spending Account Card. If you have qualifying chronic conditions, you can use it to buy eligible groceries and more.**
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Productos de venta sin receta
If your plan includes an over-the-counter (OTC) allowance, you can order approved OTC products through mail-order from CenterWell Pharmacy®.
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Manejo de afecciones crónicas
At CarePlus, we are here to help you manage your health. Take time to learn about covered and recommended screenings for conditions such as diabetes, heart disease and lung conditions.
**Chronic Condition Care Assistance is a special program for members with specific health conditions. Las afecciones elegibles incluyen diabetes mellitus, trastornos cardiovasculares, afecciones de la salud mental crónicas o incapacitantes, trastornos pulmonares crónicos e insuficiencia cardíaca crónica, entre otras. Algunos planes requieren al menos dos afecciones y se aplican otros requisitos. Consulte la Evidencia de cobertura de su plan para más detalles. Si usa la asignación de este programa para pagar la renta o los servicios públicos, el Departamento de Vivienda y Desarrollo Urbano (HUD) requiere que lo informe como ingreso, en caso de buscar asistencia. Si tiene preguntas, contáctese con su HUD local.
