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CareBreeze Platinum (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for CareBreeze 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 CareBreeze Platinum (HMO C-SNP) in 2025, please refer to our full plan details page.
CareBreeze Platinum (HMO C-SNP) is a HMO C-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Brevard, Flagler, Indian River, & Volusia Counties. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that CareBreeze 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:
CareBreeze 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 CareBreeze 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 CareBreeze 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 $100.00. 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 CareBreeze Platinum (HMO C-SNP) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay for your prescriptions. The copay varies depending on the drug tier and the pharmacy you use. For example, you can expect to pay a $5.00 copay at a standard pharmacy for preferred generic drugs, and a $85.00 copay for preferred brand drugs. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs.
Additional Benefits
The CareBreeze Platinum (HMO C-SNP) plan offers a wide range of benefits with varying costs. This plan includes coverage for inpatient and outpatient hospital services, with copays ranging from $0 to $225, as well as coverage for emergency and primary care services, often with no copay. Additional benefits include hearing, vision, and dental services, with specific copays and coverage limits for each. This plan also covers a variety of other services, such as ambulance, transportation, and home health services, often with no copay. Medical equipment, diagnostic, and radiological services are covered with copays or coinsurance. Some services, like partial hospitalization and skilled nursing facility, require prior authorization and have specific copay structures.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $225 copay for days 1-6 and no copay for days 7-90, while for Inpatient Hospital Psychiatric services, you will also pay a $225 copay for days 1-6 and no copay for days 7-90. Additional Days for Inpatient Hospital-Acute are covered with no copay for days 91-999, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
The CareBreeze Platinum (HMO C-SNP) plan covers outpatient services, including outpatient hospital services with a copay between $0 and $225, observation services, and ambulatory surgical center services with no copay, and outpatient substance abuse services with a copay between $30 and $35. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, requiring prior authorization and a doctor referral, with a $35 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the CareBreeze Platinum (HMO C-SNP) plan. Ground ambulance services have a copay of $0 - $250, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location are covered with no copay, up to 26 one-way trips per year.
Emergency Services See details
Emergency Services, including urgently needed services and worldwide emergency services, are covered by CareBreeze Platinum (HMO C-SNP). Emergency Services have a $140 copay, Urgently Needed Services have a $35 copay, and Worldwide Emergency Coverage and Transportation have a $140 copay while Worldwide Urgent Coverage has a copay between $35 and $140.
Primary Care See details
The CareBreeze Platinum (HMO C-SNP) plan covers primary care physician services with no copay, and chiropractic services with a $20 copay and prior authorization. Occupational therapy services have a $35 copay, and physician specialist services have a $35 copay, both requiring prior authorization and a doctor referral. Mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services are also covered, with varying copays and requirements for prior authorization and referrals.
Preventive Services See details
The CareBreeze Platinum (HMO C-SNP) plan covers preventive services, including an annual physical exam with no copay. Other covered services include Kidney Disease Education Services, Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following a Welcome Visit, all with no copay. Additional preventive services include Fitness Benefit with a minimum copay of $0 and a maximum copay of $0. 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
CareBreeze Platinum (HMO C-SNP) covers hearing exams with a $35 copay and routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription Hearing Aids are covered with a plan-specified amount of $250 per year and OTC Hearing Aids are covered with a maximum amount of $15 every month. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services See details
CareBreeze Platinum (HMO C-SNP) covers vision services, including eye exams and eyewear. Eye exams have a copay between $0 and $35, while routine eye exams and eyewear have no copay; however, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
CareBreeze Platinum (HMO C-SNP) covers a range of dental services, including oral exams with no copay, dental x-rays with no copay, other diagnostic dental services with no copay, prophylaxis (cleaning) with no copay, other preventive dental services with no copay, restorative services with no copay, adjunctive general services with no copay, endodontics with no copay, periodontics with no copay, prosthodontics (removable) with no copay, and oral and maxillofacial surgery with no copay, but does not cover fluoride treatment, maxillofacial prosthetics, implant services, prosthodontics (fixed), or orthodontics. Medicare dental services have a $35 copay.
Home Infusion bundled Services See details
The CareBreeze Platinum (HMO C-SNP) plan covers Home Infusion bundled Services, including Medicare Part B Insulin Drugs with a $35 copay and a coinsurance between 0% and 20%, Medicare Part B Chemotherapy/Radiation Drugs with a coinsurance between 0% and 20%, and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required for Home Infusion bundled Services.
Dialysis Services See details
Dialysis Services are covered by the CareBreeze Platinum (HMO C-SNP) plan, but require prior authorization and a doctor referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment (DME) with 20% coinsurance and preferred vendors, and Prosthetic Devices with no copay, and Medical Supplies with 20% coinsurance. Diabetic Equipment is covered, including Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests, lab services, and all radiological services. Diagnostic procedures/tests have a copay between $0 and $175, and lab services have no copay. Diagnostic radiological services have a copay of at most $225, therapeutic radiological services have a copay of at most $35 and 20% coinsurance, and outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered by the CareBreeze Platinum (HMO C-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization and a referral.
Cardiac Rehabilitation Services See details
CareBreeze Platinum (HMO C-SNP) does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization and a doctor referral are required to receive this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the CareBreeze Platinum (HMO C-SNP) plan, but require prior authorization and a doctor's referral. For days 1-20, there is no copay, and for days 21-100, there is a $150 copay. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The CareBreeze Platinum (HMO C-SNP) plan covers acupuncture with a $35 copay and up to 20 treatments per year. Over-the-counter (OTC) items are covered with a maximum benefit of $15 per month, and the plan offers a meal benefit with no copay.
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