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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 2026, 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 4.5 out of 5 stars in 2026.
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 $185.00. 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 $1750.00 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) offers a $0 drug deductible, meaning your prescription drug coverage begins immediately. Tier 1 preferred generic drugs feature no copay for up to a three-month supply at both preferred and standard pharmacies. For Tier 2 preferred brand drugs, you will pay a $15 copay for a one-month supply, with standard mail order offering a reduced $30 copay for a three-month supply. Tier 3 non-preferred drugs carry a copay of $55 at preferred pharmacies or $60 at standard pharmacies for a one-month supply. Tier 4 specialty medications require a 33% coinsurance for a one-month supply across all pharmacy types. Tier 5 select diabetic drugs are available at a low cost of $10 for a one-month supply, with additional savings available on three-month supplies ordered through standard mail.
Additional Benefits
The Optimum Diamond Rewards (HMO C-SNP) plan offers comprehensive medical coverage with highly competitive out-of-pocket costs, featuring no copay or coinsurance for primary care visits and covered preventive services. Specialist visits require a low $10 copay, while inpatient hospital stays are structured with a $65 daily copay for the first five days and no copay for days six through 90. Emergency room visits carry a $150 copay, which is waived if you are admitted within 72 hours, and urgent care is available for a $10 copay. In addition to core medical care, this plan provides valuable everyday benefits including routine dental, vision, and hearing exams with no copay, no coinsurance, and no deductible. Members also enjoy no copay for diabetic supplies, home health care, and an over-the-counter item allowance of up to $80 per month. For specialized needs like durable medical equipment and dialysis, the plan features a 20% coinsurance with no copay.
Inpatient Hospital See details
Inpatient hospital care is covered by Optimum Diamond Rewards (HMO C-SNP) with no coinsurance and a copay of $65 per day for days 1 through 5, and no copay for days 6 through 90 for both acute and psychiatric stays. This benefit is partially covered because additional days, upgrades, and non-Medicare-covered stays are not covered, and both referrals and prior authorizations are required.
Outpatient Services See details
Optimum Diamond Rewards (HMO C-SNP) outpatient services are covered with no coinsurance, featuring a $75 copay for outpatient hospital and observation services, and a $25 copay for ambulatory surgical center services. Outpatient substance abuse services require a $10 to $75 copay with no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Optimum Diamond Rewards (HMO C-SNP) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Optimum Diamond Rewards (HMO C-SNP) covers ground ambulance services with a $200 copay and coinsurance, and air ambulance services with a 20% coinsurance and a copay. Transportation services are partially covered with no copay or coinsurance for unlimited one-way trips to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Optimum Diamond Rewards (HMO C-SNP) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 72 hours. Urgently needed services require a $10 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $500 copay per service and no coinsurance up to a $100,000 maximum limit.
Primary Care See details
Optimum Diamond Rewards (HMO C-SNP) offers primary care physician services with no copay and no coinsurance, while specialists, mental health, and physical therapy services feature a $10 copay and no coinsurance. Chiropractic services are partially covered, with routine and other chiropractic services not covered, while podiatry is not covered and opioid treatment ranges from a $0 to $75 copay with no coinsurance.
Preventive Services See details
Preventive services are partially covered by Optimum Diamond Rewards (HMO C-SNP) with no copays and no coinsurance for covered benefits, including kidney disease education, glaucoma screenings, and a memory fitness benefit. However, several services are not covered under this plan, such as an annual physical exam, health education, and nutritional or dietary benefits.
Hearing Services See details
Optimum Diamond Rewards (HMO C-SNP) covers routine hearing exams and fitting evaluations with no copay, no coinsurance, and no deductible. Prescription hearing aids are partially covered with no copay or coinsurance up to a $750 annual maximum per ear, but inner ear, outer ear, over-the-ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Optimum Diamond Rewards (HMO C-SNP), offering no copay, no coinsurance, and no deductible for one routine eye exam and one pair of contact lenses or eyeglasses (lenses and frames) per year up to a $400 limit. Other eye exam services, individual eyeglass lenses, and individual eyeglass frames are not covered, though upgrades are covered with a $30 copay.
Dental Services See details
Dental services are partially covered by Optimum Diamond Rewards (HMO C-SNP) with no copay and no coinsurance for covered benefits such as exams, cleanings, x-rays, fluoride, restorative care, periodontics, and oral surgery. Non-covered sub-services include other diagnostic, other preventive, adjunctive general, endodontics, prosthodontics, maxillofacial prosthetics, implants, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Optimum Diamond Rewards (HMO C-SNP) with no copay and no coinsurance, though prior authorization is required. Medicare Part B insulin drugs require a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Optimum Diamond Rewards (HMO C-SNP) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Optimum Diamond Rewards (HMO C-SNP) covers durable medical equipment and prosthetics with no copay and a 20% coinsurance, subject to prior authorization. Diabetic equipment, supplies, and therapeutic shoes or inserts are also covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under Optimum Diamond Rewards (HMO C-SNP), requiring prior authorization and referrals. Lab services and outpatient X-rays have no copay but require coinsurance, while diagnostic tests carry a $0 to $75 copay and 20% minimum coinsurance. Diagnostic radiological services require a minimum $25 copay, and therapeutic radiological services require a copay and a 20% minimum coinsurance.
Home Health Services See details
Home Health Services are covered by Optimum Diamond Rewards (HMO C-SNP) with no copay and no coinsurance, although a referral and prior authorization are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Optimum Diamond Rewards (HMO C-SNP) with no coinsurance, where some services are covered but cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and require a $10 copay. Prior authorization and referrals are required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Optimum Diamond Rewards (HMO C-SNP) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization and referrals are required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Optimum Diamond Rewards (HMO C-SNP), featuring over-the-counter (OTC) items and a chronic illness meal benefit with no copays and no coinsurance, while acupuncture is not covered. The OTC benefit provides up to $80 per month, and the meal benefit requires prior authorization and a referral.
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* 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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