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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 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 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 $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 $3800.00 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. In the initial coverage phase, you will pay varying copays or coinsurance amounts depending on the drug tier and the pharmacy you use. For example, you will pay a $5 copay for preferred generic drugs at preferred mail pharmacies, and a 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 covered drugs.
Additional Benefits
The CareBreeze Platinum (HMO C-SNP) plan offers comprehensive coverage with varying costs depending on the service. Inpatient hospital stays have a $200 copay for the first five days, while many outpatient services, including primary care, preventive services, and home health, have no copay. Emergency services and specialist visits require a $90 or $20 copay, respectively. This plan also includes additional benefits such as hearing, vision, and dental services, with some services having no copay. The plan offers coverage for ambulance and transportation services, as well as prescription hearing aids and monthly allowances for over-the-counter items. However, some services, like certain dental procedures and cardiac rehabilitation, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $200 copay for days 1-5, and no copay for days 6-90; additional days 91-999 have no copay. For Inpatient Hospital Psychiatric, you will pay a $200 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, with a doctor referral and prior authorization required. Outpatient Hospital Services have a copay between $0 and $110, Observation Services have no copay, and Ambulatory Surgical Center (ASC) Services have no copay. Outpatient Substance Abuse services include individual and group sessions, both with a copay of $20. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, with a $20 copay. Prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
The CareBreeze Platinum (HMO C-SNP) plan covers ambulance services, with a coinsurance for Medicare-covered ground ambulance services and a copay for Medicare-covered air ambulance services; it also covers transportation services to plan-approved health-related locations, with no copay and up to 26 one-way trips per year. Transportation services to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, and Worldwide Emergency Transportation all have a $90 copay, while Worldwide Urgent Coverage has a copay between $20 and $90. Urgently Needed Services has a $20 copay. There is no coinsurance for any of these services.
Primary Care See details
CareBreeze Platinum (HMO C-SNP) covers primary care physician services with no copay, and chiropractic services with a $20 copay. Occupational therapy, physical therapy, and speech-language pathology services have a $20 copay, and specialist and mental health services require a $20 copay for individual and group sessions. Podiatry services, other health care professional services, psychiatric services, opioid treatment program services, and additional telehealth benefits are covered, but have varying copays depending on the specific service.
Preventive Services See details
CareBreeze Platinum (HMO C-SNP) covers preventive services, including an annual physical exam with no copay. Additional preventive services include Fitness Benefit, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit with no copay.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $20 copay, and routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $250 per year, and OTC hearing aids are covered up to $35 per 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
The CareBreeze Platinum (HMO C-SNP) plan covers vision services, including eye exams with a copay between $0 and $20, and eyewear with a $0 copay. Contact lenses and eyeglasses (lenses and frames) are covered with no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The CareBreeze Platinum (HMO C-SNP) plan covers several dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services with no copay, but fluoride treatment, maxillofacial prosthetics, implant services, prosthodontics, fixed, and orthodontics are not covered. Medicare dental services require a $20 copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the CareBreeze Platinum (HMO C-SNP) plan. The plan has a $35 copay for Medicare Part B Insulin Drugs, with coinsurance ranging from 0% to 20% for all other Medicare Part B drugs.
Dialysis Services See details
Dialysis Services are covered by the CareBreeze Platinum (HMO C-SNP) plan, but require prior authorization and a doctor referral. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
The CareBreeze Platinum (HMO C-SNP) plan covers medical equipment, including durable medical equipment with a 10% to 20% coinsurance, and requires prior authorization. The plan also covers Prosthetics/Medical Supplies, with a coinsurance for Medicare-covered medical supplies and a copay for Medicare-covered prosthetic devices. Diabetic equipment is covered, including diabetic supplies with no copay, and diabetic therapeutic shoes/inserts with a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the CareBreeze Platinum (HMO C-SNP) plan, including Diagnostic Procedures/Tests with a copay between $0 and $110, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $110, Therapeutic Radiological Services with a copay up to $50 and a coinsurance of at least 20%, and Outpatient X-Ray Services with no copay. All services require prior authorization and a doctor referral.
Home Health Services See details
Home Health Services are covered by the CareBreeze 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 covered, but not in practice. Prior authorization and a doctor's referral are required, but the plan states that Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the CareBreeze Platinum (HMO C-SNP) plan, with a doctor referral and prior authorization required. For days 1-20, there is no copay, and for days 21-100, the copay is $125.
Other Services See details
The CareBreeze Platinum (HMO C-SNP) plan covers acupuncture with a $20 copay, and also covers Over-the-Counter (OTC) items with a maximum benefit coverage amount of $35 every month. The plan also covers a meal benefit with no copay. However, 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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