Miami-Dade County

CarePlus Health Plans wins Medicare’s highest rating

David Jarboe is regional president of CarePlus Health Plans, which recently was awarded the federal government’s highest rating, 5 stars, for a privately-run Medicare HMO plan.
David Jarboe is regional president of CarePlus Health Plans, which recently was awarded the federal government’s highest rating, 5 stars, for a privately-run Medicare HMO plan. Humana, Inc.

CarePlus Health Plans, a Medicare HMO plan and subsidiary of health insurance giant Humana, won a coveted quality rating from the federal government this year — just in time for open enrollment, which began Oct. 15.

The five-star rating allows the CarePlus plan, which is offered in 19 Florida counties and has 94,000 members statewide, to enroll new members all year long, not just during open enrollment.

CarePlus, which is based in Doral, also will receive a higher monthly payment-per-member from Medicare, and a greater share of rebates than plans with lower quality ratings.

Last year, another Miami-Dade Medicare HMO plan — HealthSpring of Florida, Inc., which operates as Leon Medical Centers Health Plan — won the five-star rating. But this year, Leon Medical scored four-and-a-half stars, which means it does not receive the higher payments, the greater share of rebates and the ability to enroll members all year.

For 2015, the average monthly payment-per-member for Medicare Advantage plans in Miami-Dade will range from a high of $1,151 to a low of $1,093, while in Broward that rate will range from $916 to $870, according to the Centers for Medicare and Medicaid Services rate book.

Because Medicare spends more per beneficiary in Miami-Dade than almost any other county in the nation, reimbursement rates are typically higher for healthcare services than other areas.

Privately-run Medicare HMOs are immensely popular in Florida, where nearly 1.5 million beneficiaries were enrolled in some type of managed care plan as of October, according to CMS.

As of October, CarePlus had nearly 29,000 members in Miami-Dade and about 14,000 in Broward, CMS reports.

DANIEL CHANG

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