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CareComplete Platinum (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for CareComplete Platinum (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on CareComplete Platinum (HMO C-SNP) in 2025, please refer to our full plan details page.
CareComplete Platinum (HMO C-SNP) is a HMO C-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Clay, Duval, and St. Johns Counties. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that CareComplete Platinum (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
CareComplete Platinum (HMO C-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about CareComplete Platinum (HMO C-SNP).
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 CareComplete Platinum (HMO C-SNP), 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 $95.00. 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 $3900.00 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 CareComplete Platinum (HMO C-SNP) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the tier and pharmacy you use. For example, you may pay a $5 copay for preferred generic drugs at a preferred pharmacy, or 50% coinsurance for preferred brand drugs. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy, you will pay $0 for your prescriptions.
Additional Benefits
The CareComplete Platinum (HMO C-SNP) plan offers a wide range of benefits with varying costs. This plan includes coverage for inpatient and outpatient services, with copays ranging from $0 to $275. You'll also find coverage for primary care, hearing, vision, and dental services, each with specific copays and limits. Additional benefits include ambulance and transportation, emergency services, and home health services with no copay. The plan also covers diagnostic and radiological services and provides coverage for medical equipment. However, certain services like Cardiac Rehabilitation and additional hours of care are not covered.
Inpatient Hospital See details
Inpatient Hospital services are covered under the CareComplete Platinum (HMO C-SNP) plan, with a $275 copay for days 1-5, and no copay for days 6-90 for Inpatient Hospital-Acute and Psychiatric. Additional days for Inpatient Hospital-Acute have no copay, but Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Psychiatric are not covered.
Outpatient Services See details
The CareComplete Platinum (HMO C-SNP) plan covers outpatient services, including outpatient hospital services with a copay between $0 and $275, observation services with no copay, and ambulatory surgical center services with no copay. Additionally, outpatient substance abuse services have a $20 copay, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $25 copay, and requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the CareComplete Platinum (HMO C-SNP) plan. Ground ambulance services have a copay between $0 and $250, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location have no copay, with a limit of 26 one-way trips per year. 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 the CareComplete Platinum (HMO C-SNP) plan. Emergency Services has a $140 copay and no coinsurance, while Urgently Needed Services has a $20 copay and no coinsurance. Worldwide Emergency Services has a $140 copay for Worldwide Emergency Coverage and Worldwide Emergency Transportation, and a copay between $20 and $140 for Worldwide Urgent Coverage, with no coinsurance for all of these services.
Primary Care See details
CareComplete Platinum (HMO C-SNP) covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $25 copay, and physical therapy and speech-language pathology services with a $25 copay. The plan also covers physician specialist services with a $25 copay, mental health specialty services with a $25 copay for individual and group sessions, podiatry services with a $25 copay, other health care professional services with a copay between $0 and $25, psychiatric services with a $25 copay for individual and group sessions, additional telehealth benefits with a copay between $0 and $25, and opioid treatment program services with a $20 copay.
Preventive Services See details
Preventive services include coverage for Medicare-covered services, annual physical exams with no copay, and additional preventive services. Additional preventive services include Fitness Benefit, Kidney Disease Education Services, and Other Preventive Services with no copay for Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. However, Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $25 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription Hearing Aids are partially covered, with a maximum benefit of $250 per year, and OTC hearing aids are covered with a maximum of $35 per month.
Vision Services See details
CareComplete Platinum (HMO C-SNP) covers vision services, including eye exams with a copay of $0-$25 and eyewear with no copay, and a combined maximum of $150 per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
CareComplete Platinum (HMO C-SNP) covers dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), restorative services, adjunctive general services, periodontics, prosthodontics, removable, and oral and maxillofacial surgery, with various copays and visit limitations. Fluoride treatment, endodontics, maxillofacial prosthetics, implant services, prosthodontics, fixed, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the CareComplete Platinum (HMO C-SNP) plan, but require prior authorization and a doctor's referral. The coinsurance for these services is 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment with a 10-20% coinsurance and Prosthetic Devices with a 20% coinsurance. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic and radiological services, are covered under the CareComplete Platinum (HMO C-SNP) plan. Diagnostic Procedures/Tests have a copay between $0 and $110. Lab Services have no copay. Diagnostic Radiological Services have a maximum copay of $275. Therapeutic Radiological Services have a copay of at least $20 and at most $50, as well as a coinsurance of 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the CareComplete Platinum (HMO C-SNP) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the CareComplete Platinum (HMO C-SNP) plan, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization and a doctor's referral are required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the CareComplete Platinum (HMO C-SNP) plan, but require prior authorization and a doctor's referral. There is no copay for days 1-20, and a $125 copay for days 21-100. The plan does not cover additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays.
Other Services See details
The CareComplete Platinum (HMO C-SNP) plan covers acupuncture with a $25 copay and a limit of 20 treatments per year, and also covers Over-the-Counter (OTC) items with a maximum benefit coverage amount of $35 every month. The plan also provides a meal benefit with no copay for chronic illnesses. However, 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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