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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 2025, 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 5 out of 5 stars in 2025.
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 $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 Full (HMO D-SNP) plan has a $590 deductible for prescription drugs. In the initial coverage phase, after you meet your deductible, you will pay 25% coinsurance for preferred generic, standard generic, and preferred brand drugs at standard and mail order pharmacies. Non-preferred drugs have no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Optimum Emerald Full (HMO D-SNP) plan offers comprehensive coverage with no copays for many key services. This includes inpatient and outpatient hospital services, ambulance and transportation, emergency services, primary care, preventive services, hearing, vision, dental, and home infusion. Dialysis services, medical equipment, diagnostic and radiological services, home health, and skilled nursing facility services are also covered with no copay. Additional benefits include no copay for over-the-counter items and meal benefits, though some services like partial hospitalization, cardiac rehabilitation, and skilled nursing facilities require prior authorization and/or a doctor referral. This plan does not cover certain services such as acupuncture, private duty nursing, and some long-term care options.
Inpatient Hospital See details
Inpatient Hospital coverage with the Optimum Emerald Full (HMO D-SNP) plan includes both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services with no copay, but additional days, and non-Medicare covered stays are not covered.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. There is no copay for outpatient hospital services, observation services, ambulatory surgical center (ASC) services, and outpatient blood services; there is also no copay for individual or group sessions for outpatient substance abuse.
Partial Hospitalization See details
Partial Hospitalization is covered with no copay, but requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Optimum Emerald Full (HMO D-SNP) plan. Ground and Air Ambulance Services have no coinsurance and no copay. Transportation Services to a plan-approved health-related location are covered with no copay and no coinsurance; transportation to any other health-related location is not covered.
Emergency Services See details
The Optimum Emerald Full (HMO D-SNP) plan covers emergency services and urgently needed services with no copay and no coinsurance. Worldwide emergency services have 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
The Optimum Emerald Full (HMO D-SNP) plan covers 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. Chiropractic Services, Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services require prior authorization and a doctor referral. Primary care physician services, physician specialist services, and physical therapy and speech-language pathology services have no copay. Routine chiropractic care is not covered.
Preventive Services See details
Preventive services are covered, including Medicare-covered services with no copay, while annual physical exams are not covered. Additional services like Personal Emergency Response System (PERS), Fitness Benefit, Remote Access Technologies, and Home and Bathroom Safety Devices have a $0 copay. Other covered services include Kidney Disease Education Services and Other Preventive Services with no copay for Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit.
Hearing Services See details
The Optimum Emerald Full (HMO D-SNP) plan covers hearing exams and routine hearing exams with no copay. Fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered, but inner ear, outer ear, and over the ear prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
The Optimum Emerald Full (HMO D-SNP) plan covers vision services, including routine eye exams and eyewear with no copay, with a combined maximum of $400 per year for eyewear. Contact lenses, and eyeglasses (lenses and frames) are covered with no copay, while eyeglass lenses, and eyeglass frames are not covered, and upgrades have a $30 copay.
Dental Services See details
Dental services include oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, periodontics, prosthodontics (removable), and oral and maxillofacial surgery, all with no copay. 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 are covered by the Optimum Emerald Full (HMO D-SNP) plan, including Medicare Part B Insulin Drugs, Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. There is no copay for Medicare Part B Insulin Drugs, and no copay for Medicare Part B Chemotherapy/Radiation Drugs, and no copay for Other Medicare Part B Drugs.
Dialysis Services See details
Dialysis Services are covered with no copay and no coinsurance.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has no coinsurance and no copay, but Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have no coinsurance and no copay for Medicare-covered items. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Optimum Emerald Full (HMO D-SNP) plan. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services all have no copay.
Home Health Services See details
Home Health Services are covered by the Optimum Emerald Full (HMO D-SNP) plan 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 covered, but the specific services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization and a doctor referral are required for SNF services, and the plan does not charge the Medicare-defined cost share for tier 1.
Other Services See details
Under "Other Services", Optimum Emerald Full (HMO D-SNP) does not cover acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services. Over-the-counter (OTC) items are covered with no copay. Meal benefits are covered with no copay, but require prior authorization and a doctor's referral.
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