CareBreeze Platinum (HMO C-SNP): Costs+Coverage H1019-151-2
CareBreeze Platinum (HMO C-SNP): Costs+Coverage H1019-151-2
Explore the benefits and costs of CareBreeze Platinum (HMO C-SNP), a 2025 Medicare Special Needs Plan designed to meet your unique healthcare needs. Review this plan to understand how it aligns with your health and financial goals.
This CarePlus Health Plans, Inc. HMO C-SNP plan is required to provide all of the same benefits as Original Medicare, but out-of-pocket costs are different. This private health insurance option may include extra benefits not covered by Medicare Part A or Part B.
- Doctor Visits
- Foot Care
- Chiropractic
- Urgent & Emergency
- Mental Health
- Rehab Services
- Equipment & Supplies
- Diag, Lab, Imaging
- Part B Drugs
- Dental
- Hearing Aids
- Vision
- Prescriptions
| Plan ID H1019-151-2 Overview | |
|---|---|
| Health Plan ID: | H1019-151-2 |
| Medicare Advantage Plan Type: | HMO C-SNP |
| Plan Year: | 2025 |
| Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | 2,500.00 |
| Part B Give Back: | $0.00/mo |
| Part D Drug Plan Benefit: | Enhanced, $0.00 deductible |
| Supplemental Benefits: | Vision, Hearing |
| Availability: | See List |
| Insured By: | CarePlus Health Plans, Inc. |
| We're Here to Help You Enroll |
|---|
Health Plan Cost Sharing & Benefits
CareBreeze Platinum is a Health Maintenance Organization (HMO) plan. As an HMO {plan_type_2} member, you typically receive healthcare services through the plan’s local network of providers, with referrals generally required to see specialists and other providers. However, CareBreeze Platinum does cover out-of-network care for emergencies and out-of-area dialysis.
Find out the costs for visiting your primary care doctor and specialists, as well as coverage for wellness and preventive programs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Primary: | $0 Copay |
| Specialist: | $10 Copay Prior Authorization Required, Referral Required |
Review the costs for emergency services, urgent care, ambulance services, inpatient hospital stays, and skilled nursing facility care.
| Service | Enrollee Cost |
|---|---|
| Emergency room care: | $120 Copay |
| Urgent care: | $10 Copay |
| Ground ambulance: | $200 Copay |
| Inpatient hospital care: | $50.00 per day for days 1 through 7 $0.00 per day for days 8 and beyond |
| Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $150.00 per day for days 21 and beyond |
This section covers Medicare-approved foot care services, including exams and routine foot care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Foot Exams and Treatments (Medicare-covered): | $10 Copay Prior Authorization Required |
| Routine Foot Care: | $10 Copay Prior Authorization Required |
Understand the coverage for Medicare-approved chiropractic services and routine chiropractic care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Medicare-covered chiropractic: | $10 Copay Prior Authorization Required |
| Routine chiropractic: | $10 Copay Prior Authorization Required |
This section explains the costs for mental health services, including individual and group therapy, and inpatient care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Outpatient individual therapy: | $10 Copay |
| Outpatient group therapy: | $10 Copay |
| Inpatient psychiatric hospital care: | $50.00 per day for days 1 through 7 $0.00 per day for days 8 and beyond |
See the cost details for rehabilitation services, including physical therapy, speech therapy, and occupational therapy.
| Service | Enrollee Cost (in-network) |
|---|---|
| Physical therapy and speech and language therapy: | $10 Copay Prior Authorization Required, Referral Required |
| Occupational therapy: | $10 Copay Prior Authorization Required, Referral Required |
Learn about the costs associated with medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diabetes supplies: | $0 Copay Prior Authorization Required |
| Durable medical equipment: | 20% Coinsurance Prior Authorization Required |
| Prosthetics: | Not Covered |
This section outlines the costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diagnostic radiology services: | $50 Copay Prior Authorization Required, Referral Required |
| Lab services: | $0 Copay Prior Authorization Required, Referral Required |
| Outpatient x-rays: | $25 Copay Prior Authorization Required, Referral Required |
| Diagnostic tests and procedures: | $100 Copay Prior Authorization Required, Referral Required |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Chemotherapy: | 20% Coinsurance |
| Other Part B drugs (Medicare-covered): | 20% Coinsurance |
This section details the dental services covered under your plan including, Medicare-covered preventive dental, oral exams, x-rays, dental cleanings, and comprehensive dental.
| Service | Member Cost (in-network) |
|---|---|
| Medicare Covered Preventive Dental | $10 Copay Prior Authorization Required |
| Oral exam | |
| Dental x-rays | |
| Cleaning | |
| Periodontics | |
| Endodontics | |
| Restorative Services |
This section outlines the coverage for hearing-related services, including exams, fittings, and hearing aids.
| Service | Member Cost (in-network) |
|---|---|
| Fitting/evaluation | $0 Copay Prior Authorization Required, Referral Required |
| Hearing aids | Covered Limits may apply |
| Hearing exam | $0 Copay Prior Authorization Required, Referral Required |
Learn about the costs for vision-related services, including eye exams, eyeglasses, and contact lenses.
| Service | Member Cost (in-network) |
|---|---|
| Medicare-covered eye exam (in-network) | $0 to $10 Copay |
| Routine eye exam (in-network) | $0 Copay Prior Authorization Required, Referral Required, 1 Every year |
| Eyewear benefits | Eyeglasses: Yes Contact Lenses: Yes Eyeglass Lenses: No Eyeglass Frames: No Eyewear Upgrades: No |
Maximum eyewear benefit: | $300.00 Every year |
Prescription Drug Plan Costs & Benefits
Prescription Drug Plan Premium
The following table outlines the prescription drug plan premium details of this plan.
| Basic Part D Premium: | $(53.80) |
| Supplemental Part D Premium: | $53.80 |
| Total Part D Premium: | $0.00 |
| Low Income Premium Subsidy: | $20.30 |
| Low Income Premium Subsidy CMS Pays: | $0.00 |
| Low Income Subsidy Premium: | $0.00 |
For more information about the Low Income Subsidy, refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $0.00. This is the amount you must pay at the pharmacy before CarePlus Health Plans, Inc. begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, CareBreeze Platinum has out-of-pocket costs that you must pay when you pick up your prescriptions. The following table shows you those costs.
| Drug Tier | Retail | Mail Order | |
|---|---|---|---|
| Preferred Generic | $0.00 | $2.00 | |
| Generic | $5.00 | $16.00 | |
| Preferred Brand | $47.00 | $47.00 | |
| Non-Preferred Drug | 50.00% | 50.00% | |
| Specialty Tier | 33.00% | 33.00% | |
| Select Care Drugs | $0.00 | $0.00 | |
| *Deductible does not apply. | |||
CMS Rating Marks
The Centers for Medicare & Medicaid Services (CMS) annually rates Medicare Advantage {plan_type_2}s in nine key categories using a 5-star system. These ratings help you gauge the quality of care and service you might receive with this CarePlus Health Plans, Inc. plan.
| CMS Measure | Star Rating |
|---|---|
| 2025 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Eligibility Criteria for Enrolling in CareBreeze Platinum
To enroll in CareBreeze Platinum , you must meet the following criteria:
- You are eligible for Medicare;
- You reside within the plan’s service area; and
- You have been diagnosed with one or more severe or disabling chronic conditions.
This plan is for individuals with chronic lung disorders.
SNP Plan Enrollment Periods
Once you’ve confirmed your eligibility for CareBreeze Platinum , it’s crucial to enroll during the appropriate Medicare Enrollment Period to ensure you receive the coverage you need without delay. Depending on your situation, you may need to enroll during one of the following periods:
- Initial Enrollment Period (IEP): This is your first opportunity to enroll when you become Medicare-eligible.
- Annual Enrollment Period (AEP): The annual window when you can review and adjust your Medicare coverage.
- Special Enrollment Periods (SEPs): Special situations may allow you to enroll or change plans outside of the standard periods.
To get a deeper understanding of these enrollment periods, click here to learn more and stay informed about your Medicare choices.
Plan Availability
CareBreeze Platinum (H1019-151-2) is available in the following locations (click to open):
Contact CarePlus Health Plans, Inc.
| Website: | CarePlus Health Plans, Inc. Plan Page |
|---|---|
| Providers: | CarePlus Health Plans, Inc. Providers Page |
| Formulary: | CarePlus Health Plans, Inc. Formulary Page |
| Pharmacy: | CarePlus Health Plans, Inc. Pharmacy Page |
| New Member Health Plan Help: | (800)794-4105 |
| New Member Health Plan TTY: | 711 |
| New Member Part D Help: | (800)794-4105 |
| New Member Part D TTY Users: | 711 |
If you qualify for Medicare benefits but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov.
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