Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for CareBreeze (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 (HMO C-SNP) in 2026, please refer to our full plan details page.
CareBreeze (HMO C-SNP) is a HMO C-SNP plan offered by Humana Inc. available for enrollment in 2026 to people living in Select Counties in Florida. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that CareBreeze (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 (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.
Below are a few key facts and commonly-asked questions about CareBreeze (HMO C-SNP).
The cost of a Medicare Advantage Plan is made up of four main parts.
For CareBreeze (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 $5.00. 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 a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $2000.00 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.
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The CareBreeze (HMO C-SNP) Medicare prescription drug plan features an annual drug deductible of $615. You can save on healthcare costs with no copay for Tier 1 preferred generics, Tier 2 generics, and Tier 6 select care drugs when utilizing standard pharmacies or preferred mail order options. For standard mail order delivery, Tier 1 drugs cost $2 to $6, while Tier 2 drugs range from $16 to $48. For Tier 3 preferred brand-name drugs, you will pay a $40 copay for a one-month supply at standard pharmacies and through preferred mail order. Higher-tier medications require coinsurance, with Tier 4 non-preferred drugs carrying a 50% coinsurance and Tier 5 specialty drugs requiring a 25% coinsurance. This plan structure provides clear options for managing your prescription costs through preferred and standard pharmacies.
The CareBreeze (HMO C-SNP) plan offers comprehensive medical coverage with highly affordable out-of-pocket costs, featuring no copay for primary care visits, home health services, and standard laboratory or diagnostic radiology tests. For hospital stays, members pay a $50 copay for days 1 through 5 of inpatient care and no copay for days 6 through 90, with no coinsurance required. Outpatient services and specialist visits are also highly accessible, requiring either no copay or a minimal $10 copay for most consultations and therapy sessions. This plan also includes valuable supplemental benefits such as no copay for routine dental, vision, and hearing exams, alongside a $200 annual allowance for eyewear and covered transportation for up to 26 one-way trips. While durable medical equipment and dialysis services require a 10% to 20% coinsurance, members pay no copay or coinsurance for routine diabetic supplies, annual physicals, and select over-the-counter items. Additionally, emergency care is covered with a $140 copay, which is waived if you are admitted to the hospital within 24 hours.
Inpatient hospital benefits under CareBreeze (HMO C-SNP) are partially covered with no coinsurance, requiring a $50 copay for days 1 to 5 and no copay for days 6 to 90 for both acute and psychiatric stays. While unlimited additional acute days are covered with no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
CareBreeze (HMO C-SNP) covers outpatient services with no coinsurance, offering ambulatory surgical center, observation, and blood services with no copay. Outpatient hospital services have a copay of $0 to $50, while outpatient substance abuse sessions require a $10 copay, with prior authorization and referrals generally required.
Partial hospitalization is covered by CareBreeze (HMO C-SNP) with a $25 copay and no coinsurance. Prior authorization and a referral are required to receive these covered services.
CareBreeze (HMO C-SNP) covers ambulance services with prior authorization, requiring a $0 to $250 copay and coinsurance for ground transport, and a 20% coinsurance and copay for air transport. Transportation services are partially covered with no copay or coinsurance for up to 26 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
CareBreeze (HMO C-SNP) covers emergency services with a $140 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $10 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays ranging from $10 to $140.
CareBreeze (HMO C-SNP) offers primary care physician services with no copay and no coinsurance, while specialist, therapy, mental health, psychiatric, and podiatry services require a $10 copay and no coinsurance. Chiropractic services are partially covered, offering up to 12 routine visits per year for a $20 copay and no coinsurance, but other chiropractic services are not covered. Telehealth and other professional services range from a $0 to $10 copay with no coinsurance.
CareBreeze (HMO C-SNP) preventive services are partially covered with no copay and no coinsurance for annual physical exams, kidney disease education, and memory fitness. However, sub-services including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and weight management programs are not covered.
Hearing services covered by CareBreeze (HMO C-SNP) include Medicare-covered exams for a $10 copay and no coinsurance, as well as routine exams, fittings, and OTC hearing aids with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $250 annual maximum per ear, though inner ear, outer ear, and over the ear types are not covered.
Vision services are partially covered by CareBreeze (HMO C-SNP) with no deductibles and no coinsurance. Covered benefits include one annual routine eye exam with no copay (other eye exams have a $0 to $10 copay) and up to $200 yearly for contact lenses and eyeglasses with no copay, while other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental services are partially covered by CareBreeze (HMO C-SNP), with Medicare-covered dental requiring a $10.00 copay and no coinsurance, while other covered dental services have no copay and no coinsurance. Fluoride treatment, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics are not covered under this plan.
CareBreeze (HMO C-SNP) covers home infusion bundled services with no copay, although prior authorization is required. Covered Medicare Part B drugs, including chemotherapy, radiation, and insulin, carry a coinsurance ranging from no coinsurance up to 20%, with insulin drugs also requiring a $35 copay.
CareBreeze (HMO C-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these covered services.
CareBreeze (HMO C-SNP) covers durable medical equipment (DME) with a 10% to 20% coinsurance and no copay, and prosthetics and medical supplies with a 20% coinsurance and no copay. Diabetic equipment is covered with no coinsurance, featuring no copay for diabetic supplies and a $10 copay for diabetic therapeutic shoes or inserts.
CareBreeze (HMO C-SNP) covers diagnostic and radiological services, which require prior authorization and referrals. Members pay no coinsurance and a copay of up to $150 for diagnostic procedures, no copay for lab services, diagnostic radiology, and outpatient X-rays, and a $35 copay along with 20% coinsurance for therapeutic radiological services.
Home health services are covered under the CareBreeze (HMO C-SNP) plan with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services are covered by CareBreeze (HMO C-SNP) with no coinsurance, though some services are covered while standard Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered and require a $10 copay. Prior authorization and referrals are required for these services.
Skilled Nursing Facility (SNF) services are covered by CareBreeze (HMO C-SNP) with no coinsurance, featuring no copay for days 1 to 20 and a $150 copay for days 21 to 100. Prior authorization and referrals are required, and additional days beyond the standard Medicare-covered 100 days are not covered.
Other services are partially covered by CareBreeze (HMO C-SNP) with no copay and no coinsurance for acupuncture (up to 25 treatments per year), chronic illness meal benefits, and select over-the-counter items. Prior authorization is required for acupuncture and meal benefits, while highly integrated dual-eligible services and other unspecified services are not covered.
SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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