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Optimum Emerald Full (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Optimum Emerald Full (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 Full (HMO D-SNP) in 2026, please refer to our full plan details page.
Optimum Emerald Full (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 Full (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 Full (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 Full (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 Full (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:
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Drug Coverage
The Optimum Emerald Full (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. Members enjoy no copay for Tier 1 preferred generic drugs and Tier 5 supplemental drugs filled at standard pharmacies or through standard mail order. This cost-saving benefit applies to one-month, two-month, and three-month supplies. For Tier 2 preferred brand drugs and Tier 3 non-preferred drugs, you will pay a 25% coinsurance for one-month, two-month, or three-month supplies at standard retail locations and standard mail order. Tier 4 specialty drugs also require a 25% coinsurance, which is limited to a one-month supply.
Additional Benefits
The Optimum Emerald Full (HMO D-SNP) offers comprehensive healthcare coverage with no copay and no coinsurance for most essential medical services. This includes inpatient and outpatient hospital care, primary care and specialist visits, emergency care, and diagnostic testing. Members also benefit from no copays or coinsurance for home health care, skilled nursing facility stays up to 100 days, and durable medical equipment. Beyond standard medical care, this plan provides valuable additional benefits including dental, vision, and hearing coverage with no copays or coinsurance, though certain limits and prior authorizations apply. Members can also access unlimited transportation to plan-approved locations, a monthly allowance of up to $130 for over-the-counter items, and a chronic illness meal benefit at no extra cost. While coverage is extensive, some services like cardiac rehabilitation, acupuncture, and chiropractic care are not covered under this plan.
Inpatient Hospital See details
Optimum Emerald Full (HMO D-SNP) covers inpatient acute and psychiatric hospital 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 benefit.
Outpatient Services See details
Optimum Emerald Full (HMO D-SNP) covers outpatient services, including outpatient hospital care, ambulatory surgical center services, outpatient substance abuse treatment, and blood services, with no copays and no coinsurance. Prior authorization and referrals are required for most of these covered services.
Partial Hospitalization See details
Partial hospitalization is covered by Optimum Emerald Full (HMO D-SNP) with no copay and no coinsurance. Prior authorization and a referral are required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Optimum Emerald Full (HMO D-SNP) with no copays and no coinsurance, though prior authorization is required. This benefit includes ground and air ambulance services and unlimited one-way trips to plan-approved health-related locations, but transportation to any health-related location is not covered.
Emergency Services See details
Optimum Emerald Full (HMO D-SNP) covers emergency and urgently needed services with no copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with a $500 copay and no coinsurance, up to a maximum benefit limit of $100,000.
Primary Care See details
Optimum Emerald Full (HMO D-SNP) covers primary care, specialist visits, therapy services, and mental health care with no copay and no coinsurance. Chiropractic and podiatry services are not covered under this plan.
Preventive Services See details
Preventive Services are partially covered by Optimum Emerald Full (HMO D-SNP) with no copays and no coinsurance for covered options like Medicare-covered preventive services, kidney disease education, diabetes training, and select fitness and home safety benefits. However, the plan does not cover annual physical exams, health education, in-home safety assessments, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, or counseling services.
Hearing Services See details
Hearing services are covered by the Optimum Emerald Full (HMO D-SNP) plan, offering no copay and no coinsurance for Medicare-covered exams, routine hearing exams, and fitting evaluations. Prescription hearing aids are partially covered with no copay or coinsurance up to $1,000 per ear yearly, but OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by Optimum Emerald Full (HMO D-SNP), offering no copay and no coinsurance for routine eye exams and eyewear up to a $400 yearly limit, though other eye exam services, eyeglass lenses, and eyeglass frames are not covered. Covered benefits include one routine exam and one pair of contact lenses or eyeglasses per year, with a $30 copay and no coinsurance for upgrades.
Dental Services See details
Dental services are partially covered by Optimum Emerald Full (HMO D-SNP) with no copay and no coinsurance for covered services, although prior authorization is required for some benefits. Non-covered sub-services 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 Full (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required. This benefit fully covers Medicare Part B insulin, chemotherapy, radiation, and other Part B drugs with no copays and no coinsurance.
Dialysis Services See details
Optimum Emerald Full (HMO D-SNP) covers dialysis services for members with no copay and no coinsurance.
Medical Equipment See details
Optimum Emerald Full (HMO D-SNP) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic services, with no copay and no coinsurance. While prior authorization is required for these benefits, there are no vendor or manufacturer limitations on the equipment you receive.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Optimum Emerald Full (HMO D-SNP) with no copay and no coinsurance, although prior authorization and referrals are required. Covered services include outpatient diagnostic procedures, lab services, therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
Optimum Emerald Full (HMO D-SNP) 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 Emerald Full (HMO D-SNP) plan, as none of the individual sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are covered in practice.
Skilled Nursing Facility (SNF) See details
Optimum Emerald Full (HMO D-SNP) covers skilled nursing facility (SNF) services for days 1 through 100 with no copay and no coinsurance, though prior authorization and referrals are required. Additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Optimum Emerald Full (HMO D-SNP), which offers a meal benefit for chronic illnesses and up to $130 monthly for over-the-counter items with no copay and no coinsurance. Acupuncture is not covered under this plan, and the meal benefit requires a referral and prior authorization.
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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.
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