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Optimum Platinum Plan (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Optimum Platinum Plan (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Optimum Platinum Plan (HMO) in 2026, please refer to our full plan details page.
Optimum Platinum Plan (HMO) is a HMO plan offered by Elevance Health, Inc. available for enrollment in 2025 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 Optimum Platinum Plan (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Optimum Platinum Plan (HMO).
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 Optimum Platinum Plan (HMO), 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.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $1000.00 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 Optimum Platinum Plan (HMO) features a $0 drug deductible, allowing your prescription drug coverage to begin immediately. Under this plan, there is no copay for Tier 1 preferred generic drugs, regardless of whether you use preferred, standard, or standard mail-order pharmacies. For Tier 2 preferred brand drugs, you will pay a low copay starting at $5.00 for a one-month supply. For Tier 3 non-preferred drugs, the copay starts at $50.00 for a one-month supply at preferred or standard mail-order pharmacies, and $55.00 at standard pharmacies. Specialty drugs in Tier 4 require a 33% coinsurance for a one-month supply at preferred, standard, and standard mail-order pharmacies.
Additional Benefits
The Optimum Platinum Plan (HMO) offers comprehensive medical coverage with no copays and no coinsurance for inpatient hospital stays, primary care visits, specialist services, and home health care. For outpatient services, members will pay no coinsurance and a $75 copay for hospital and observation services, while emergency room visits carry a $120 copay that is waived if admitted. Urgent care visits require a low $10 copay, and skilled nursing facility stays feature no copay for the first 20 days followed by a $95 daily copay. This plan also includes valuable supplemental benefits, featuring no deductible and no copay or coinsurance for annual routine vision exams and eyewear up to a $400 limit. Routine hearing exams, dental care, and home infusion services also have no copay, while prescription hearing aids are covered up to $750 per ear annually. Additionally, members receive an $85 monthly allowance for over-the-counter items and pay no copay alongside a 20% coinsurance for durable medical equipment and dialysis services.
Inpatient Hospital See details
Optimum Platinum Plan (HMO) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, although prior authorization and referrals are required. This benefit is partially covered because additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Optimum Platinum Plan (HMO) covers outpatient services with no coinsurance, featuring a $75 copay for outpatient hospital and observation services, and no copay for ambulatory surgical center and blood services. Outpatient substance abuse sessions are also covered with no coinsurance and copays ranging from $0 to $75, with most services requiring prior authorization and referrals.
Partial Hospitalization See details
Optimum Platinum Plan (HMO) covers partial hospitalization services with a $25.00 copay and no coinsurance. Prior authorization and a referral are required to access this covered benefit.
Ambulance and Transportation Services See details
Optimum Platinum Plan (HMO) covers ground ambulance services with a $200 copay and coinsurance, and air ambulance services with a 20% coinsurance and a copay, both requiring prior authorization. Transportation services are partially covered, offering unlimited one-way trips to plan-approved locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by the Optimum Platinum Plan (HMO) with a $120 copay (waived if admitted to the hospital within 72 hours) and no coinsurance, while urgently needed services require a $10 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with a $500 copay per service and no coinsurance, up to a $100,000 maximum plan benefit.
Primary Care See details
Primary Care benefits under the Optimum Platinum Plan (HMO) feature no copays and no coinsurance for primary care visits, specialist services, therapies, and mental health care, though chiropractic and podiatry services are not covered. Opioid treatment program services are covered with no coinsurance and a copay ranging from $0 to $75.
Preventive Services See details
Preventive services are partially covered by the Optimum Platinum Plan (HMO) with no copay and no coinsurance for covered care, such as Medicare-covered preventive services, kidney disease education, and glaucoma screenings. However, several sub-services are not covered under this plan, including annual physical exams, health education, in-home safety assessments, and personal emergency response systems.
Hearing Services See details
Optimum Platinum Plan (HMO) covers hearing services with no copay and no coinsurance, including one routine hearing exam and one fitting evaluation per year. Prescription hearing aids are partially covered with no copay and no coinsurance up to $750 per ear annually, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision Services under the Optimum Platinum Plan (HMO) have no deductible and feature no copay or coinsurance for annual routine eye exams and eyewear up to a $400 annual limit. This benefit is partially covered as other eye exam services, eyeglass lenses, and eyeglass frames are not covered, though eyewear upgrades are available for a $30 copay.
Dental Services See details
Dental services are partially covered under the Optimum Platinum Plan (HMO) with no copay and no coinsurance for covered care. Sub-services that are not covered include other diagnostic, other preventive, adjunctive general, endodontics, maxillofacial prosthetics, implants, fixed prosthodontics, and orthodontics.
Home Infusion bundled Services See details
Optimum Platinum Plan (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B insulin has a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other drugs require no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by the Optimum Platinum Plan (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered under the Optimum Platinum Plan (HMO) with no copays, although prior authorization is required for these services. Members will pay a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes, while diabetic supplies feature a coinsurance ranging from no coinsurance up to 20%.
Diagnostic and Radiological Services See details
Optimum Platinum Plan (HMO) covers diagnostic and radiological services, requiring prior authorization and referrals. Lab services and outpatient X-rays feature no copay, while other diagnostic procedures and radiological services incur copays ranging from $0 to $75 and coinsurance up to 20%.
Home Health Services See details
Optimum Platinum Plan (HMO) covers home health services with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Optimum Platinum Plan (HMO), as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Optimum Platinum Plan (HMO) with no coinsurance, featuring no copay for days 1 through 20 and a $95 daily copay for days 21 through 100. Prior authorization and referrals are required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Optimum Platinum Plan (HMO) partially covers other services, offering over-the-counter (OTC) items with an $85 monthly limit and chronic illness meal benefits with no copay and no coinsurance. Acupuncture is not covered under this benefit.
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