CareBreeze (HMO C-SNP)
Available to residents of Lake County, FL for 2026. Contract H1019, plan 154, segment 0.
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- Plan health benefits
- Benefits in plain text
- Rx cost-sharing for all pharmacies and tiers
- Other plans in Lake County
- Plan website
- Browse the CareBreeze (HMO C-SNP) formulary
New for 2026. This plan has no 2025 predecessor in the CMS crosswalk.
Plan details
| Monthly premium (Part C + D) | $0.00 |
|---|---|
| — medical (Part C) part | $0.00 |
| — drug (Part D) part | $0.00? |
| Monthly premium with full Extra Help (LIS) | $0.00? |
| Part B premium reduction (giveback) | $5.00 a month?You must continue to pay your Medicare Part B premium. |
| Health plan deductible (in-network) | None |
| In-network out-of-pocket maximum | $2,000.00? |
| Drug deductible | $615.00Tier 1, 2, 3 and 6 exempt |
| Drug out-of-pocket threshold | $2,100.00 |
| Plan type | HMO C-SNP? |
| Special needs plan | Chronic-condition SNP |
| Contract / plan | H1019-154-0 |
| Offered by | CarePlus Health Plans, Inc. |
| Parent organization | Humana Inc. |
| Formulary drugs | 3,359 |
| Formulary exception tier | 4? |
| Pharmacy search | www.careplushealthplans.com/pharmacy-finder |
| Member services | (888)685-8607TTY 711 |
CMS star ratings
- Overall
- 4.5 out of 5 stars for Overall
- Health plan (Part C)
- 4.5 out of 5 stars for Health plan (Part C)
- Drug plan (Part D)
- 3.5 out of 5 stars for Drug plan (Part D)
Published per contract — every plan under contract H1019 shares this rating.
Plan health benefits
| Service | In-network |
|---|---|
| Doctor visits | |
| Primary care doctor | $0 copay |
| Specialist | $10 copay(authorization and referral required) |
| Other health care professional | $0–$10 copay(authorization and referral required) |
| Additional telehealth services | $0–$10 copay(authorization and referral required) |
| Preventive care | |
| Medicare-covered preventive services | $0 copay |
| Annual physical exam | $0 copay |
| Kidney disease education | $0 copay |
| Glaucoma screening | $0 copay |
| Diabetes self-management training | $0 copay |
| Diagnostic tests, labs and imaging | |
| Diagnostic tests and procedures | $0–$150 copay(authorization and referral required) |
| Lab services | $0 copay(authorization and referral required) |
| Diagnostic radiology (e.g. MRI, CT) | $0–$50 copay(authorization and referral required) |
| Therapeutic radiology | $35 copay; 20% coinsurance(authorization and referral required) |
| Outpatient x-rays | $0–$25 copay(authorization and referral required) |
| Emergency and urgent care | |
| Emergency room | $140 copay |
| Urgent care | $10 copay |
| Worldwide emergency coverage | $140 copay |
| Worldwide urgent care | $10–$140 copay |
| Worldwide emergency transportation | $140 copay |
| Hospital care | |
| Inpatient hospital stay | $50 per day for days 1–5; $0 per day for days 6–90; $0 per day for days 91–999 (additional days)(authorization and referral required) |
| Outpatient hospital services | $0–$50 copay(authorization and referral required) |
| Outpatient observation | $0 copay(authorization and referral required) |
| Ambulatory surgical center | $0–$50 copay(authorization and referral required) |
| Outpatient blood services | $0 copay(authorization and referral required) |
| Skilled nursing and home health | |
| Skilled nursing facility | $0 per day for days 1–20; $150 per day for days 21–100(authorization and referral required) |
| Home health care | $0 copay(authorization and referral required) |
| Kidney dialysis | 20% coinsurance(authorization and referral required) |
| Rehabilitation | |
| Occupational therapy | $10 copay(authorization and referral required) |
| Physical therapy and speech-language therapy | $10 copay(authorization and referral required) |
| Cardiac rehabilitation | $10 copay(authorization and referral required) |
| Pulmonary rehabilitation | $10 copay(authorization and referral required) |
| Mental health and substance use | |
| Inpatient psychiatric hospital stay | $50 per day for days 1–5; $0 per day for days 6–90(authorization and referral required) |
| Outpatient mental health, individual session | $10 copay(authorization and referral required) |
| Outpatient mental health, group session | $10 copay(authorization and referral required) |
| Psychiatrist, individual session | $10 copay(authorization and referral required) |
| Psychiatrist, group session | $10 copay(authorization and referral required) |
| Partial hospitalization | $25 copay(authorization and referral required) |
| Intensive outpatient program | $25 copay(authorization and referral required) |
| Outpatient substance use, individual session | $10 copay(authorization and referral required) |
| Outpatient substance use, group session | $10 copay(authorization and referral required) |
| Opioid treatment program | $10 copay(authorization and referral required) |
| Ambulance and transportation | |
| Ground ambulance | $0–$250 copay(authorization required) |
| Air ambulance | 20% coinsurance(authorization required) |
| Transportation to plan-approved locations | $0 copay(authorization required, limits apply) |
| Medical equipment and supplies | |
| Durable medical equipment (e.g. wheelchairs, oxygen) | $0 copay; 10%–20% coinsurance(authorization required) |
| Prosthetics (e.g. braces, artificial limbs) | 20% coinsurance(authorization required) |
| Medical supplies | 20% coinsurance(authorization required) |
| Diabetes supplies | $0 copay(authorization required) |
| Diabetic therapeutic shoes or inserts | $10 copay(authorization required) |
| Chiropractic, acupuncture and foot care | |
| Chiropractic (Medicare-covered) | $20 copay(authorization required) |
| Routine chiropractic care | $20 copay(authorization required, limits apply) |
| Acupuncture | $0 copay(authorization required, limits apply) |
| Foot exams and treatment (Medicare-covered) | $10 copay(authorization required) |
| Routine foot care | $10 copay(authorization required) |
| Dental? | |
| Medicare-covered dental services | $10 copay(authorization and referral required) |
| Oral exams | $0 copay(authorization required, limits apply) |
| Cleanings | $0 copay(authorization required, limits apply) |
| Fluoride treatment | Not covered |
| Dental x-rays | $0 copay(authorization required, limits apply) |
| Other diagnostic dental services | $0 copay(authorization required, limits apply) |
| Other preventive dental services | $0 copay(authorization required, limits apply) |
| Restorative services (fillings, crowns) | $0 copay(authorization and referral required, limits apply) |
| Endodontics (root canals) | $0 copay(authorization and referral required, limits apply) |
| Periodontics (gum disease) | $0 copay(authorization and referral required, limits apply) |
| Dentures and other removable prosthodontics | $0 copay(authorization and referral required, limits apply) |
| Maxillofacial prosthetics | Not covered |
| Implants | Not covered |
| Bridges and other fixed prosthodontics | Not covered |
| Oral and maxillofacial surgery | $0 copay(authorization and referral required, limits apply) |
| Orthodontics | Not covered |
| Adjunctive general services | $0 copay(authorization and referral required) |
| Vision? | |
| Eye exam (Medicare-covered) | $0–$10 copay(authorization and referral required) |
| Routine eye exam | $0 copay(authorization and referral required, limits apply) |
| Eyewear after cataract surgery (Medicare-covered) | $0 copay(authorization and referral required, limits apply) |
| Eyewear plan limit | $200 plan limit every year |
| Contact lenses | $0 copay(authorization and referral required, limits apply) |
| Eyeglasses (frames and lenses) | $0 copay(authorization and referral required, limits apply) |
| Eyeglass lenses | Not covered |
| Eyeglass frames | Not covered |
| Eyewear upgrades | Not covered |
| Hearing? | |
| Hearing exam (Medicare-covered) | $10 copay(authorization and referral required) |
| Routine hearing exam | $0 copay(authorization and referral required, limits apply) |
| Hearing aid fitting and evaluation | $0 copay(authorization and referral required, limits apply) |
| Hearing aid plan limit | $250 plan limit every year |
| Hearing aids (all types) | $0 copay(limits apply) |
| Hearing aids, inner ear | Not covered |
| Hearing aids, outer ear | Not covered |
| Hearing aids, over the ear | Not covered |
| Medicare Part B drugs | |
| Part B insulin | 0%–20% coinsurance(authorization required, step therapy may apply) |
| Chemotherapy and radiation drugs | 0%–20% coinsurance(authorization required, step therapy may apply) |
| Other Part B drugs | 0%–20% coinsurance(authorization required, step therapy may apply) |
| Other extra benefits? | |
| Over-the-counter (OTC) allowance | Covered (allowance not stated) |
| Meals after a hospital stay or for a chronic condition | $0 copay(authorization required) |
| Fitness benefit | $0 copay |
| Health education | Not covered |
| Nutritional / dietary benefit | Not covered |
| Extra smoking and tobacco cessation counseling | Not covered |
| Enhanced disease management | Not covered |
| Telemonitoring | Not covered |
| Remote access technologies (web/phone, nurse line) | Not covered |
| Home and bathroom safety devices | Not covered |
| Counseling services | Not covered |
| In-home safety assessment | Not covered |
| Personal emergency response system (PERS) | Not covered |
| Medical nutrition therapy | Not covered |
| Post-discharge in-home medication reconciliation | Not covered |
| Re-admission prevention | Not covered |
| Wigs for hair loss from chemotherapy | Not covered |
| Weight management programs | Not covered |
| Alternative therapies | Not covered |
| Therapeutic massage | Not covered |
| Adult day health services | Not covered |
| Home-based palliative care | Not covered |
| In-home support services | Not covered |
| Support for caregivers | Not covered |
In-network cost-sharing as the plan filed it with CMS (CMS plan benefit package (PBP) files, CY2026). A range means the cost depends on the service or setting. Rows the filing does not state are left out rather than guessed. Contact the plan for the full Evidence of Coverage.
Drug tiers — preferred pharmacy, initial coverage
| Tier | Cost-sharing |
|---|---|
| Tier 1 | $0.00 |
| Tier 2 | $0.00 |
| Tier 3 | $40.00 |
| Tier 4 | 50% |
| Tier 5 | 25% |
| Tier 6 | $0.00 |
Rx cost-sharing by coverage phase
| Tier | 30-day supply | 90-day supply | ||||
|---|---|---|---|---|---|---|
| Preferred | Standard | Mail Order | Preferred | Standard | Mail Order | |
| Initial deductible phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 3: Preferred Brand | $40.00 | $40.00 | $40.00 | $120.00 | $120.00 | $80.00 |
| Tier 6: Select Care Drugs | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Initial coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 3: Preferred Brand | $40.00 | $40.00 | $40.00 | $120.00 | $120.00 | $80.00 |
| Tier 4: Non-Preferred Drug | 50% | 50% | 50% | 50% | 50% | 50% |
| Tier 5: Specialty Tier | 25% | 25% | 25% | n/a | n/a | n/a |
| Tier 6: Select Care Drugs | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Catastrophic coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 3: Preferred Brand | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 4: Non-Preferred Drug | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 5: Specialty Tier | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 6: Select Care Drugs | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
Also available in 19 other FL counties
Benefits in plain text
CareBreeze (HMO C-SNP) (H1019-154-0) is a 2026 HMO C-SNP Medicare Advantage plan offered by CarePlus Health Plans, Inc., available to residents of Lake County, FL.
The monthly premium is $0.00 (Part C and Part D together).
The plan reduces the member's Medicare Part B premium by $5.00 a month (a "giveback"); the Part B premium itself must still be paid.
With full Extra Help (the Low-Income Subsidy), the total monthly premium is $0.00.
There is no in-network deductible for health services.
Its in-network out-of-pocket maximum is $2,000.00.
The drug deductible is $615.00. Tier 1, 2, 3 and 6 exempt.
It is a special needs plan (Chronic-condition SNP).
The plan's formulary lists 3,359 drugs.
At a preferred pharmacy in the initial coverage phase, a 30-day supply costs tier 1: $0.00; tier 2: $0.00; tier 3: $40.00; tier 4: 50%; tier 5: 25%; tier 6: $0.00.
CMS gives the plan's contract (H1019) an overall rating of 4.5 out of 5 stars.
Email a copy of the plan benefit details
Plan facts come from the CMS quarterly prescription drug plan public use files; the premium split, Extra Help premium, MOOP and plan type from the CMS Landscape file; the Part B giveback and health benefits from the CMS plan benefit package (PBP) files.