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Optimum Diamond Rewards COPD (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Optimum Diamond Rewards COPD (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 COPD (HMO C-SNP) in 2026, please refer to our full plan details page.
Optimum Diamond Rewards COPD (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 COPD (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 COPD (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 COPD (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 COPD (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 COPD (HMO C-SNP) prescription drug plan features a $0 drug deductible, allowing your coverage to begin immediately. For Tier 1 preferred generic drugs, you will pay no copay for a one-month, two-month, or three-month supply at both preferred and standard pharmacies. Tier 2 preferred brand drugs are also highly affordable, starting at a $10 copay for a one-month supply. For Tier 3 non-preferred drugs, one-month copays start at $45 at preferred pharmacies and standard mail order, and $50 at standard pharmacies. Tier 4 specialty medications carry a 33% coinsurance for a one-month supply across all pharmacy options. Ordering a three-month supply of Tier 2 drugs through standard mail order can also save you money with a reduced $20 copay.
Additional Benefits
The Optimum Diamond Rewards COPD (HMO C-SNP) plan offers robust coverage with predictable out-of-pocket costs, featuring no copay and no coinsurance for primary care visits and preventive services. For inpatient hospital stays, members pay a $65 daily copay for days 1 through 5, and no copay for days 6 through 90. Emergency care requires a $60 copay, which is waived if admitted, while specialist visits and urgent care carry a low $10 copay with no coinsurance. This plan also includes valuable everyday benefits, offering no copay and no coinsurance for routine dental, vision, and hearing exams, alongside a $400 annual eyewear allowance and up to $750 per ear annually for hearing aids. Additionally, members benefit from unlimited one-way non-emergency transportation to approved medical locations and a $75 monthly allowance for over-the-counter items with no copay.
Inpatient Hospital See details
Inpatient hospital services are partially covered by the Optimum Diamond Rewards COPD (HMO C-SNP) plan with no coinsurance, requiring a $65 daily copay for days 1 through 5 and no copay for days 6 through 90 for both acute and psychiatric stays. Prior authorization and referrals are required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Optimum Diamond Rewards COPD (HMO C-SNP) covers outpatient services 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 sessions have a copay ranging from $10 to $75 with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Optimum Diamond Rewards COPD (HMO C-SNP) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization and a referral are required to receive these covered services.
Ambulance and Transportation Services See details
Optimum Diamond Rewards COPD (HMO C-SNP) covers ambulance services with a $200 copay for ground transport (no coinsurance) and a 20% coinsurance for air transport (no copay). Transportation services are partially covered, offering unlimited one-way rides to plan-approved health-related locations with no copay or coinsurance, while trips to any health-related location are not covered.
Emergency Services See details
Optimum Diamond Rewards COPD (HMO C-SNP) covers emergency services with a $60 copay and no coinsurance, which is waived if you are admitted to the hospital within 72 hours. Urgently needed services are available for a $10 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $100,000 lifetime maximum with a $500 copay per service and no coinsurance.
Primary Care See details
Optimum Diamond Rewards COPD (HMO C-SNP) covers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, occupational therapy, and mental health services require a $10 copay and no coinsurance. Additional professional and opioid treatment services feature copays up to $75 with no coinsurance, though chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by Optimum Diamond Rewards COPD (HMO C-SNP) with no copay and no coinsurance for covered options like Medicare-covered preventive care, kidney disease education, fitness benefits, and safety devices. Uncovered services under this benefit include annual physical exams, health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, and counseling.
Hearing Services See details
Optimum Diamond Rewards COPD (HMO C-SNP) covers hearing exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $750 per ear annually, though 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 COPD (HMO C-SNP) with no copay, no coinsurance, and no deductible for annual routine eye exams and eyewear, up to a $400 annual limit. While one pair of contact lenses or complete eyeglasses (lenses and frames) is covered yearly, other eye exams, individual eyeglass lenses, and individual eyeglass frames are not covered, and upgrades carry a $30 copay.
Dental Services See details
Optimum Diamond Rewards COPD (HMO C-SNP) partially covers dental services with no copay and no coinsurance for covered benefits like oral exams, cleanings, fluoride, x-rays, restorative services, periodontics, removable prosthodontics, and oral surgery. Sub-services that are not covered under this plan include other diagnostic or preventive dental services, adjunctive general services, endodontics, maxillofacial prosthetics, implants, fixed prosthodontics, and orthodontics.
Home Infusion bundled Services See details
Optimum Diamond Rewards COPD (HMO C-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require no copay and a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis services are covered by Optimum Diamond Rewards COPD (HMO C-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Optimum Diamond Rewards COPD (HMO C-SNP) covers medical equipment with no copay, though prior authorization is required. Durable medical equipment and diabetic supplies feature no coinsurance to 20% coinsurance, while prosthetic devices, medical supplies, and diabetic therapeutic shoes or inserts require 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the Optimum Diamond Rewards COPD (HMO C-SNP) plan, requiring prior authorization and referrals. Lab services and outpatient X-rays feature no copay, while diagnostic tests have a 20% coinsurance and copays up to $75, diagnostic radiology has a minimum $25 copay, and therapeutic radiology requires a 20% coinsurance and a copay.
Home Health Services See details
Home Health Services are covered by Optimum Diamond Rewards COPD (HMO C-SNP) with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Optimum Diamond Rewards COPD (HMO C-SNP) with no coinsurance, though in practice, some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a $10 copay. Prior authorization and a referral are also required for these services.
Skilled Nursing Facility (SNF) See details
Optimum Diamond Rewards COPD (HMO C-SNP) covers Skilled Nursing Facility (SNF) care with no coinsurance, requiring prior authorization and referrals but no prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Optimum Diamond Rewards COPD (HMO C-SNP) partially covers other services, offering over-the-counter (OTC) items with a $75 monthly limit and a meal benefit for chronic illness with no copay and no coinsurance. Acupuncture is not covered, and the meal benefit requires a referral and prior authorization.
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