A non-government entity
Optimum Emerald Partial (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Optimum Emerald Partial (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Optimum Emerald Partial (HMO D-SNP) in 2026, please refer to our full plan details page.
Optimum Emerald Partial (HMO D-SNP) is a HMO D-SNP 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 Emerald Partial (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Optimum Emerald Partial (HMO D-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.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Optimum Emerald Partial (HMO D-SNP).
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 Emerald Partial (HMO D-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.
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 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 $500.00 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:
Sign up for Optimum Emerald Partial (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Optimum Emerald Partial (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs and Tier 5 supplemental drugs, members enjoy no copay for one-month, two-month, and three-month supplies at standard pharmacies or through standard mail order. This structure helps minimize out-of-pocket costs for essential daily medications. For higher-tier medications, the plan transitions to a coinsurance model. Tier 2 preferred brand drugs, Tier 3 non-preferred drugs, and Tier 4 specialty drugs all require a 25% coinsurance. This 25% coinsurance applies to standard retail pharmacy and standard mail-order services, with specialty drugs limited to a one-month supply.
Additional Benefits
The Optimum Emerald Partial (HMO D-SNP) offers robust coverage with no copays and no coinsurance for most essential medical services, including inpatient and outpatient hospital stays, primary and specialist care, emergency services, and skilled nursing facility care. While many of these benefits require prior authorization or referrals, members can access critical healthcare services with minimal out-of-pocket costs. However, some specialized services, such as dialysis and therapeutic radiological treatments, do require a 20% coinsurance. Additionally, the plan features valuable supplemental benefits designed to lower daily living and healthcare costs. Members benefit from dental, vision, and hearing services with no copays, including up to $1,000 per ear annually for prescription hearing aids and a $400 annual limit for routine vision care. The plan also includes a $130 monthly allowance for over-the-counter items and unlimited one-way transportation to plan-approved health locations at no cost.
Inpatient Hospital See details
Optimum Emerald Partial (HMO D-SNP) inpatient hospital services are partially covered, offering Medicare-approved acute and psychiatric stays with no copay and no coinsurance, though prior authorization and referrals are required. Additional days, upgrades, and non-Medicare-covered stays are not covered under this plan.
Outpatient Services See details
Outpatient services are covered by Optimum Emerald Partial (HMO D-SNP) with no copay and no coinsurance for outpatient hospital, ambulatory surgical center, substance abuse, and blood services. Prior authorization and referrals are required for most of these outpatient benefits.
Partial Hospitalization See details
Partial hospitalization is covered under the Optimum Emerald Partial (HMO D-SNP) with no copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Ambulance and Transportation Services See details
Optimum Emerald Partial (HMO D-SNP) covers ground and air ambulance services as well as transportation with no copay and no coinsurance, though prior authorization is required. Transportation is partially covered, offering unlimited one-way rides to plan-approved health-related locations, while transportation to any other health-related location is not covered.
Emergency Services See details
Optimum Emerald Partial (HMO D-SNP) covers emergency and urgently needed services with no copay and no coinsurance. Worldwide emergency, urgent care, and emergency transportation are also covered with no coinsurance and a $500 copay, up to a $100,000 maximum benefit limit.
Primary Care See details
Optimum Emerald Partial (HMO D-SNP) covers primary care, specialist visits, mental health, psychiatric, therapy, and telehealth services with no copays and no coinsurance. Chiropractic and podiatry services are not covered under this plan.
Preventive Services See details
Optimum Emerald Partial (HMO D-SNP) offers partially covered preventive services with no copays and no coinsurance, though several benefits such as annual physical exams, health education, and weight management are not covered. Covered services, which include Medicare-covered zero-dollar preventive care, kidney disease education, glaucoma screenings, and fitness benefits, typically require prior authorization and a referral.
Hearing Services See details
Optimum Emerald Partial (HMO D-SNP) covers hearing services with no copay, no coinsurance, and no deductible, including one annual routine exam and fitting evaluation. Prescription hearing aids are covered up to $1,000 per ear every year with no copay, but OTC hearing aids and specific prescription types—including inner ear, outer ear, and over the ear—are not covered.
Vision Services See details
Vision services are partially covered by Optimum Emerald Partial (HMO D-SNP), offering routine eye exams and eyewear with no copay and no coinsurance, up to a $400 annual limit. Other eye exams, individual eyeglass lenses, and individual eyeglass frames are not covered, though eyewear upgrades are available for a $30 copay.
Dental Services See details
Dental services are partially covered by Optimum Emerald Partial (HMO D-SNP) with no copay and no coinsurance for covered benefits, although prior authorization is required for certain services. Non-covered services under this plan include other diagnostic, other preventive, adjunctive general, endodontics, maxillofacial prosthetics, implants, fixed prosthodontics, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Optimum Emerald Partial (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required. Covered sub-services, including Medicare Part B insulin, chemotherapy, radiation, and other drugs, are also provided with no copays or coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Optimum Emerald Partial (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Optimum Emerald Partial (HMO D-SNP) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic supplies or therapeutic shoes, with no copay and no coinsurance. Prior authorization is required for these covered benefits, and there are no preferred vendor or manufacturer restrictions.
Diagnostic and Radiological Services See details
Optimum Emerald Partial (HMO D-SNP) covers diagnostic and radiological services with no copays and no coinsurance for lab services, diagnostic tests, diagnostic radiology, and outpatient X-rays. Covered therapeutic radiological services require a 20% coinsurance, and prior authorization and referrals are required.
Home Health Services See details
Home health services are covered by the Optimum Emerald Partial (HMO D-SNP) plan with no copay and no coinsurance, although a referral and prior authorization are required.
Cardiac Rehabilitation Services See details
Optimum Emerald Partial (HMO D-SNP) does not cover Cardiac Rehabilitation Services, as all sub-services—including cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD)—are not covered. Although the benefit technically features no copay and no coinsurance, no rehabilitation services are covered in practice under this plan.
Skilled Nursing Facility (SNF) See details
Optimum Emerald Partial (HMO D-SNP) partially covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance for days 1 through 100, although prior authorization and referrals are required. This benefit is partially covered because additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Optimum Emerald Partial (HMO D-SNP) provides partial coverage for other services, featuring over-the-counter (OTC) items up to $130 per month and a chronic illness meal benefit, both with no copay and no coinsurance. Acupuncture is not covered under this benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* 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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved