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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 Miami-Dade County. 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 $150.00. 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 $3400.00 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'll pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, you'll pay a $5 or $6 copay for a preferred generic drug, and 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, your Part D costs will be $0.
Additional Benefits
The CareBreeze Platinum (HMO C-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $50 copay for days 1-5, with no copay for days 6-90. Outpatient services, primary care, preventive services, and many other services like dental exams and hearing exams, have either no copay or a small copay. The plan also covers ambulance services with copays ranging from $0-$120 for ground transport and 20% coinsurance for air transport. Additionally, the plan includes benefits for hearing aids, vision, and dental care, and covers home health services, skilled nursing facilities, and medical equipment with copays or coinsurance depending on the service.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both requiring prior authorization and a doctor referral, with a $50 copay for days 1-5 and no copay for days 6-90. Additional days for Inpatient Hospital-Acute have no copay for days 91-999, while Non-Medicare-covered stay and Upgrades for Inpatient Hospital-Acute and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered under the CareBreeze Platinum (HMO C-SNP) plan, with the following cost sharing: Outpatient Hospital Services have a copay between $0 and $50, Observation Services, Ambulatory Surgical Center (ASC) Services, and Outpatient Blood Services have no copay, and Individual and Group Sessions for Outpatient Substance Abuse have a copay of $10.
Partial Hospitalization See details
Partial Hospitalization is covered under the CareBreeze Platinum (HMO C-SNP) plan, and requires prior authorization and a doctor referral. The copay for this benefit is $10.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the CareBreeze Platinum (HMO C-SNP) plan. Ground Ambulance Services have a copay of $0-$120, 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. Transportation Services to any other health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the CareBreeze Platinum (HMO C-SNP) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, while Urgently Needed Services and Worldwide Urgent Coverage have copays of $10 and $140, respectively. Worldwide Emergency Transportation also has a $140 copay.
Primary Care See details
CareBreeze Platinum (HMO C-SNP) covers primary care physician services with no copay, chiropractic services with a $10 copay, and occupational therapy services with a $10 copay. The plan also covers physician specialist services, mental health specialty services, podiatry services, psychiatric services, physical therapy and speech-language pathology services, opioid treatment program services, and additional telehealth benefits.
Preventive Services See details
The CareBreeze Platinum (HMO C-SNP) plan covers preventive services, including an annual physical exam with no copay. Other preventive services such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit have no copay.
Hearing Services See details
CareBreeze Platinum (HMO C-SNP) covers hearing exams with a $10 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a maximum plan benefit of $750 per year, and OTC hearing aids are covered with a maximum benefit of $50 per month.
Vision Services See details
Vision services under the CareBreeze Platinum (HMO C-SNP) plan include eye exams with a copay of $0-$10, and eyewear with no copay, including contact lenses and eyeglasses (lenses and frames), with a combined maximum benefit of $200 per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
CareBreeze Platinum (HMO C-SNP) covers dental services, including oral exams with no copay, and Medicare dental services with a $10 copay. Other services like fluoride treatment, maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
CareBreeze Platinum (HMO C-SNP) covers Home Infusion bundled Services, including Medicare Part B Insulin Drugs with a $35 copay and between 0% and 20% coinsurance, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with between 0% and 20% coinsurance; prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the CareBreeze Platinum (HMO C-SNP) plan, with a coinsurance of 20%. Prior authorization and a doctor's referral are required.
Medical Equipment See details
Medical Equipment is covered by CareBreeze Platinum (HMO C-SNP), including Durable Medical Equipment (DME) with 20% coinsurance, and Prosthetics/Medical Supplies with a coinsurance of 20% for Medicare-covered supplies, and a copay for Medicare-covered medical supplies. Diabetic Equipment is also covered, with no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $40, lab services with no copay, and outpatient X-ray services with no copay. Therapeutic Radiological Services have a coinsurance of at least 20% and a copay between $10 and $25, while Diagnostic Radiological Services have a copay of at most $50.
Home Health Services See details
Home Health Services are covered by the CareBreeze Platinum (HMO C-SNP) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
CareBreeze Platinum (HMO C-SNP) covers Cardiac Rehabilitation Services, but these services are not covered. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the CareBreeze Platinum (HMO C-SNP) plan, but require prior authorization and a doctor referral. For days 1-20, there is no copay, and for days 21-100, the copay is $75. Additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered.
Other Services See details
The CareBreeze Platinum (HMO C-SNP) plan covers acupuncture with no copay, and over-the-counter items with a maximum benefit coverage amount of $50.00 per month. The plan also covers a meal benefit with no copay, and the other services benefit does not cover the following 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.
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