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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 2025, 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 5 out of 5 stars in 2025.
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 $19.50. 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 $590.00 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:
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Drug Coverage
The Optimum Emerald Partial (HMO D-SNP) plan has an enhanced alternative drug benefit. The plan has a deductible of $590.00. During the initial coverage phase, after the deductible is met, you pay 25% coinsurance for preferred and standard generic and brand drugs. Non-preferred drugs have no copay. After your total drug costs reach $2000.00, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Optimum Emerald Partial (HMO D-SNP) plan offers a wide array of benefits with a focus on low-cost care. Many services, including inpatient and outpatient hospital care, primary care, preventive services, emergency services, hearing exams, vision exams, dental services, and home health services, are available with no copay. Additionally, the plan includes coverage for medical equipment, diagnostic services, and dialysis services. This plan also provides extra benefits, such as coverage for ambulance services, transportation to health-related locations, and over-the-counter items up to a monthly limit. The plan offers a fitness benefit and a meal benefit, both with no copay. However, it's important to note that some services, like cardiac rehabilitation, certain hearing aids, and specific dental and vision services, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered with no copay. Additional days for inpatient hospital and non-Medicare-covered stays, as well as upgrades, are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered with no copay. Prior authorization and a doctor referral may be required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Optimum Emerald Partial (HMO D-SNP) plan with no copay, but requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services, with no coinsurance and a copay of $0 for both. Transportation Services to a plan-approved health-related location are covered with no copay, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Optimum Emerald Partial (HMO D-SNP) plan. Emergency Services and Urgently Needed Services have no copay and no coinsurance, while Worldwide Emergency Services has a $500 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, with a maximum plan benefit of $100,000.
Primary Care See details
Under the Optimum Emerald Partial (HMO D-SNP) plan, Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered with a $0 copay, and Routine Chiropractic Care is not covered. Prior authorization and a doctor's referral are required for Chiropractic Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, and Opioid Treatment Program Services.
Preventive Services See details
Preventive services are covered, but annual physical exams, health education, in-home safety assessments, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers, additional sessions of smoking cessation counseling, enhanced disease management, and telemonitoring services are not covered. Other covered preventive services include Medicare-covered zero-dollar preventive services, with prior authorization and a doctor referral, and Kidney Disease Education Services, with no copay. Additional preventive services include Fitness Benefit with no copay, Personal Emergency Response System (PERS), Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), and Home and Bathroom Safety Devices and Modifications with no copay. Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are also covered with no copay.
Hearing Services See details
Hearing Services with the Optimum Emerald Partial (HMO D-SNP) plan includes hearing exams with no copay, routine hearing exams with no copay for 1 visit per year, and fitting/evaluation for hearing aids with no copay for 1 visit per year. Prescription hearing aids are partially covered, but Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams and eyewear, with no copay for routine eye exams. Eyewear has a combined maximum benefit of $400 per year, with no copay for contact lenses or eyeglasses, but eyeglass lenses and frames are not covered.
Dental Services See details
Dental Services are covered under the Optimum Emerald Partial (HMO D-SNP) plan, with no copay for Medicare Dental Services, Oral Exams, Dental X-Rays, Prophylaxis (Cleaning), Fluoride Treatment, Periodontics, Prosthodontics, removable, and Oral and Maxillofacial Surgery. Adjunctive General Services, Endodontics, Maxillofacial Prosthetics, Implant Services, Prosthodontics, fixed, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered by the Optimum Emerald Partial (HMO D-SNP). There is no copay for Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs.
Dialysis Services See details
Dialysis Services are covered by the Optimum Emerald Partial (HMO D-SNP) plan. You will pay 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has no copay and no coinsurance, but requires authorization and does not cover equipment for use outside the home. Medicare-covered prosthetic devices, medical supplies, and diabetic supplies and therapeutic shoes/inserts have no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures, lab services, and radiological services. There is no copay for diagnostic procedures, lab services, or outpatient X-ray services. Therapeutic Radiological Services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Optimum Emerald Partial (HMO D-SNP) with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Optimum Emerald Partial (HMO D-SNP) plan. Prior authorization and a doctor's referral are required for this benefit, but the plan does not cover any of the sub-services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered. Prior authorization and a doctor referral are required for SNF services.
Other Services See details
The Optimum Emerald Partial (HMO D-SNP) plan covers Over-the-Counter (OTC) items with no copay, and a maximum benefit coverage amount of $135.00 per month. The plan also covers a Meal Benefit with no copay, but requires prior authorization and a doctor's referral. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and many other services are not covered.
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