CareBreeze Platinum (HMO-POS C-SNP) Medicare Special Need Plan H1019-124 • 2027
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $3400.00In-network
- Part B Giveback
- −$154.00 reduction
- Prescription Coverage
- Enhanced, $700.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- See List
- Total Enrollment
- 111 beneficiaries
Introduction
CMS Plan ID H1019-124 identifies CareBreeze Platinum, a Medicare Advantage Chronic Condition Special Needs Plan (C-SNP) offered by CarePlus Health Plans, Inc.. Its provider network is a Health Maintenance Organization with a Point of Service (HMO-POS), and Medicare Part D prescription drug coverage is included. For 2027, the plan has a $0.00 monthly premium, $0.00 medical deductible, and $3400.00 in-network maximum out-of-pocket. The 2027 Part D prescription drug deductible is $700.00.
Enrollment across the plan's service areas totals 111 beneficiaries, according to CMS. Enrollment is limited to beneficiaries who live within the plan's service area: See List.
Eligibility
CareBreeze Platinum is a Chronic Condition Special Needs Plan (C-SNP) designed for people with qualifying health conditions.
- Special Needs Plan Type
- Chronic Condition Special Needs Plan (C-SNP)
- Medicare Requirement
- Must have Medicare Part A and Part B
- Special Needs Requirement
- This plan is for individuals with chronic lung disorders.
- Service Area Requirement
- Must live in the plan's service area
- Prescription Drug Coverage
- Medicare Part D prescription drug coverage is included.
Plan Benefits
CareBreeze Platinum has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H1019-124.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: $0 copay | In-network: $0 copay |
| Specialist | In-network: $20 copay Out-of-network: $35 copay |
In-network: $20 copay Out-of-network: $35 copay |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | In-network: $0 copay | In-network: $0 copay |
| Telehealth benefit | In-network: $0-$20 copay | In-network: $0-$20 copay |
| Routine chiropractic | In-network: $20 copay | In-network: $20 copay |
| Fitness benefits | Coming soon | In-network: $0 copay |
| Health education | Not covered | Not covered |
| Counseling services | Not covered | Not covered |
| Over-the-counter drug benefits | In-network: $0 copay | In-network: $0 copay |
| Health transportation (non-emergency) | Coming soon | In-network: $0 copay |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | In-network: $0-$200 copay Out-of-network: $0-$300 copay |
In-network: $0-$200 copay Out-of-network: $0-$300 copay |
| Lab services | In-network: $0 copay Out-of-network: $0-$25 copay |
In-network: $0 copay Out-of-network: $0-$25 copay |
| Outpatient x-rays | In-network: $0-$125 copay Out-of-network: $20-$175 copay |
In-network: $0-$125 copay Out-of-network: $0-$175 copay |
| Diagnostic tests and procedures | In-network: $0-$175 copay Out-of-network: $0-$175 copay |
In-network: $0-$175 copay Out-of-network: $0-$175 copay |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | $150 copay | $150 copay |
| Worldwide emergency care | Coming soon | $150 copay |
| Urgent care | $20 copay | $20 copay |
| Inpatient hospital care | In-network: Tier 1 $150 per day for days 1-7 $0 per day for days 8-90 $0 per stay Out-of-network: $275 per day for days 1-7 $0 per day for days 8-90 $0 per stay |
In-network: Tier 1 $150 per day for days 1-7 $0 per day for days 8-90 $0 per stay Out-of-network: $275 per day for days 1-7 $0 per day for days 8-90 $0 per stay |
| Skilled Nursing Facility | In-network: Tier 1 $0 per day for days 1-20 $160 per day for days 21-100 Out-of-network: $0 per day for days 1-20 $160 per day for days 21-100 $0 per stay |
In-network: Tier 1 $0 per day for days 1-20 $160 per day for days 21-100 Out-of-network: $0 per day for days 1-20 $160 per day for days 21-100 $0 per stay |
| Ground ambulance | In-network: $0-$250 copay Out-of-network: $250 copay |
In-network: $0-$250 copay Out-of-network: $250 copay |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | In-network: $20 copay Out-of-network: $35 copay |
In-network: $20 copay Out-of-network: $35 copay |
| Outpatient group therapy | In-network: $20 copay Out-of-network: $35 copay |
In-network: $20 copay Out-of-network: $35 copay |
| Inpatient psychiatric hospital care | In-network: Tier 1 $150 per day for days 1-7 $0 per day for days 8-90 $0 per stay Out-of-network: $275 per day for days 1-7 $0 per day for days 8-90 $0 per stay |
In-network: Tier 1 $150 per day for days 1-7 $0 per day for days 8-90 $0 per stay Out-of-network: $275 per day for days 1-7 $0 per day for days 8-90 $0 per stay |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: $20 copay Out-of-network: $35 copay |
In-network: $20 copay Out-of-network: $35 copay |
| Occupational therapy | In-network: $20 copay Out-of-network: $35 copay |
In-network: $20 copay Out-of-network: $35 copay |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Durable medical equipment | In-network: 20% coinsurance Out-of-network: 50% coinsurance |
In-network: $0 copay, 20% coinsurance Out-of-network: $0 copay, 50% coinsurance |
| Prosthetics | In-network: $0 copay Out-of-network: 20% coinsurance |
In-network: $0 copay Out-of-network: 20% coinsurance |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | In-network: 0%-20% coinsurance Out-of-network: 50% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 50% coinsurance |
| Other Part B drugs (Medicare-covered) | In-network: 0%-20% coinsurance Out-of-network: 50% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 50% coinsurance |
Dental Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Oral exam | In-network: $0 copay | In-network: $0 copay |
| Dental x-rays | In-network: $0 copay | In-network: $0 copay |
| Cleaning | In-network: $0 copay | In-network: $0 copay |
| Periodontics | In-network: 0% coinsurance | In-network: $0 copay |
| Endodontics | In-network: 0% coinsurance | In-network: $0 copay |
| Restorative services | In-network: 0% coinsurance | In-network: $0 copay |
| Implant services | Not covered | Not covered |
| Orthodontics | Not covered | Not covered |
| Oral/Maxillofacial surgery | In-network: 0% coinsurance | In-network: $0 copay |
Vision Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Routine eye exam | In-network: $0 copay | In-network: $0 copay |
| Contact lenses | In-network: $0 copay | In-network: $0 copay |
| Eyeglass frames only | Not covered | Not covered |
| Eyeglass lenses only | Not covered | Not covered |
| Eyeglasses (frames & lenses) | In-network: $0 copay | In-network: $0 copay |
| Upgrades | Not covered | Not covered |
Hearing Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Hearing exam | In-network: $0 copay | In-network: $0 copay |
| Fitting/evaluation | In-network: $0 copay | In-network: $0 copay |
| Prescription hearing aids | In-network: $499-$725 copay | In-network: $0 copay |
| OTC hearing aids | In-network: $0 copay | In-network: $0 copay |
Additional and Special Needs Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Adult day health services | Not covered | Not covered |
| Home-based palliative care | Not covered | Not covered |
| Personal emergency response system | Coming soon | Not covered |
| Weight management programs | Not covered | Not covered |
| Wigs for chemotherapy-related hair loss | Coming soon | Not covered |
| Alternative therapies | Not covered | Not covered |
| Massage therapy | Not covered | Not covered |
| Home/bathroom safety devices | Not covered | Not covered |
Certain preventive services are covered 100% by CareBreeze Platinum as a Part B benefit.
Prescription Drug Coverage
CareBreeze Platinum includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $0.00 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | $7.28 |
| Low-Income Premium Subsidy Paid by CMS: | $0.00 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $700.00 annual Part D deductible. You'll pay this deductible at the pharmacy before CarePlus Health Plans, Inc. starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, CareBreeze Platinum may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | $0.00 copay |
| Generic | $0.00 copay | $5.00 copay |
| Preferred Brand | 17% coinsurance | $45.00 copay |
| Non-Preferred Drug | 50% coinsurance | 50% coinsurance |
| Specialty Tier | 25% coinsurance | 33% coinsurance |
| Select Care Drugs | $0.00 copay | $0.00 copay |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H1019)
Medicare assigns star ratings to plans based on quality and performance across multiple measures, including customer service, member experience, and health outcomes. Ratings are updated annually by the Centers for Medicare & Medicaid Services (CMS) and are shown on a 1 to 5 star scale, with 5 stars representing the highest quality.
| CMS Measure | Star Rating |
|---|---|
| 2027 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 |
Contact Information for 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
- (888)685-8607
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (888)685-8607
- New Member Part D TTY Users
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Plan Availability
CareBreeze Platinum (H1019-124-0) is available in the following locations (click to open):
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | CMS Version |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | CY2027 Landscape (202609.1) |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | 2027 Star Ratings Data Tables |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | PBP Benefits-2027 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | 2026-09 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| CarePlus Health Plans, Inc. (official source) | http://www.careplushealthplans.com | October 4, 2026 |
| CMS.gov | Chronic Condition Special Needs Plans (C-SNPs) | April 28, 2026 |
| Medicare.gov | Understanding Medicare Advantage Plans | April 28, 2026 |
| NCOA.org | 5 Steps to Choosing the Right Medicare Plan for You | April 28, 2026 |
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Page content independently curated and maintained by David W. Bynon, Editorial Steward, using a standardized, data-driven methodology for accurate, non-commercial Medicare plan interpretation and resolution.