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Optimum Diamond Rewards (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Optimum Diamond Rewards (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Optimum Diamond Rewards (HMO C-SNP) in 2025, please refer to our full plan details page.
Optimum Diamond Rewards (HMO C-SNP) is a HMO C-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 Diamond Rewards (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Optimum Diamond Rewards (HMO C-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 Diamond Rewards (HMO C-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 Diamond Rewards (HMO C-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. Additionally, this plan comes with a Part B Premium reduction of $174.70. You must continue to pay paying your reduced 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 $1650.00 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 Diamond Rewards (HMO C-SNP) plan has an enhanced alternative drug benefit. This plan has a $0 deductible. During the initial coverage phase, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy. For example, preferred generic drugs have a $15 copay, while preferred brand drugs have a 33% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Optimum Diamond Rewards (HMO C-SNP) plan offers comprehensive coverage, including inpatient hospital stays with a copay, outpatient services, and ambulance services. Emergency services, primary care, preventive services, and hearing services are covered, often with no copay, alongside vision and dental services. This plan also includes coverage for home infusion, dialysis, medical equipment, diagnostic services, and home health services.
Inpatient Hospital See details
Inpatient hospital stays, both acute and psychiatric, are covered by the Optimum Diamond Rewards (HMO C-SNP) plan. For days 1-5, there is a $65 copay, and for days 6-90, there is no copay.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services and Observation Services, require prior authorization and a doctor referral, with a $75 copay. Ambulatory Surgical Center (ASC) Services require prior authorization and a doctor referral, with a $25 copay. Outpatient Substance Abuse Services have a copay that ranges from $10 to $75 for individual or group sessions. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $55 copay, and requires both prior authorization and a doctor referral.
Ambulance and Transportation Services See details
The Optimum Diamond Rewards (HMO C-SNP) plan covers ambulance and transportation services, including services not usually covered by Medicare. Ground ambulance services have a $200 copay, and air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location have no copay.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Optimum Diamond Rewards (HMO C-SNP) plan. Emergency Services has a $120 copay, Urgently Needed Services has a $10 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $500 copay, with a maximum plan benefit of $100,000.
Primary Care See details
The Optimum Diamond Rewards (HMO C-SNP) plan offers primary care physician services with no copay, chiropractic services with a $10 copay, occupational therapy services with a $10 copay, physician specialist services with a $10 copay, mental health specialty services with a $10 copay, physical therapy and speech-language pathology services with a $10 copay, and opioid treatment program services with a copay between $0 and $75. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include Medicare-covered services with no copay, and additional services including Fitness Benefit, Remote Access Technologies, and Home and Bathroom Safety Devices, which have a $0 copay. Annual physical exams, Health Education, In-Home Safety Assessment, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Counseling Services, and the Kidney Disease Education Services are not covered.
Hearing Services See details
Hearing services are covered, including 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 covered, with a maximum plan benefit of $750.00 per year, and no copay for 2 visits per year for all types of prescription hearing aids, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
The Optimum Diamond Rewards (HMO C-SNP) plan covers vision services, including eye exams and eyewear, with no copay for eye exams and eyewear. Contact lenses are covered with no copay, and eyeglasses (lenses and frames) are covered with no copay, with a combined maximum benefit of $400 every year; however, eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $0 copay, and other dental services. Oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, and oral and maxillofacial surgery are covered with no copay. However, adjunctive general services, endodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Optimum Diamond Rewards (HMO C-SNP) plan and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Optimum Diamond Rewards (HMO C-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment (DME) with 20% coinsurance and prior authorization required, prosthetics/medical supplies with 20% coinsurance, and diabetic equipment with no copay for diabetic supplies and diabetic therapeutic shoes/inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a doctor referral and prior authorization required. Diagnostic Procedures/Tests have a coinsurance of at most 20% and a copay between $0 and $75, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $75, and Therapeutic Radiological Services have a coinsurance of at most 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Optimum Diamond Rewards (HMO C-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization and a referral are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Optimum Diamond Rewards (HMO C-SNP) plan. Prior authorization and a doctor's referral are required if the services were covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the Optimum Diamond Rewards (HMO C-SNP) plan, requiring prior authorization and a doctor referral. For days 1-20, there is no copay, while days 21-100 have a $125 copay; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Optimum Diamond Rewards (HMO C-SNP) plan covers Over-the-Counter (OTC) items with no copay, and a maximum benefit coverage amount of $90.00 every month; it also covers meal benefits with no copay, but requires prior authorization and a doctor referral. 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 are not covered.
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