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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 2025, 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 5 out of 5 stars in 2025.
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 $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 $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) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay for your prescriptions. For preferred generic drugs, the copay is $15, while standard generic drugs have a $55 or $60 copay depending on the pharmacy. For preferred brand drugs, you'll pay 33% coinsurance. After your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Optimum Diamond Rewards COPD (HMO C-SNP) plan offers a range of benefits with varying costs. The plan provides coverage for inpatient hospital stays with a copay of $65 for days 1-5 and no copay for days 6-90. Outpatient services, including doctor visits and outpatient services, often have copays. Additional benefits include coverage for ambulance services, with a $200 copay for ground and 20% coinsurance for air, and no copay for transportation to health-related locations. The plan also covers hearing and vision services, with no copay for exams and eyewear. The plan also provides dental services with no copay for many services, and covers home health services with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered. For days 1-5, there is a $65 copay, and for days 6-90, there is no copay. Additional days and non-Medicare-covered stays for both Acute and Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $75 copay, Observation Services with a $75 copay, Ambulatory Surgical Center (ASC) Services with a $25 copay, and Outpatient Substance Abuse Services with a copay between $10 and $75 for individual and group sessions. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization and a doctor referral. You will pay a $55 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services. Ground ambulance services have a $200 copay, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location are covered with no copay, while transportation services to any other health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $120 copay, Urgently Needed Services have 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 COPD (HMO C-SNP) plan covers primary care physician services with no copay, and chiropractic services with a $10 copay. Occupational therapy services, physician specialist services, physical therapy, and speech-language pathology services each have a $10 copay, while individual and group sessions for mental health and psychiatric services have a $10 copay as well. Other health care professional services have a copay between $0 and $10, and opioid treatment program services have 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 preventive services that may have a copay. The plan does not cover annual physical exams, health education, in-home safety assessments, 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, or enhanced disease management, and telemonitoring services, and counseling services. The plan covers Personal Emergency Response Systems (PERS), Fitness Benefits, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, Kidney Disease Education Services, Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKGs following a Welcome Visit with no copay.
Hearing Services See details
Hearing services include hearing exams with no copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to a maximum of $750 per year. However, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams and eyewear, with no copay for eye exams and eyewear. Routine eye exams, contact lenses and eyeglasses (lenses and frames) are covered with no copay, while eyeglass lenses and frames are not covered; upgrades have a $30 copay.
Dental Services See details
Dental services include no copay for oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatments, periodontics, and oral and maxillofacial surgery. 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 COPD (HMO C-SNP) plan. The plan has a $35 copay for Medicare Part B Insulin Drugs, and coinsurance applies for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs.
Dialysis Services See details
Dialysis Services are covered by the Optimum Diamond Rewards COPD (HMO C-SNP) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment is covered, with Durable Medical Equipment (DME) requiring prior authorization and a coinsurance between 0% and 20%, and Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies - Non-Medicare benefit, Medicare-covered Prosthetic Devices, and Medicare-covered Medical Supplies are covered with a 20% coinsurance, and Diabetic Equipment has a coinsurance for both Medicare-covered Diabetic Supplies (0-20%) and Medicare-covered Diabetic Therapeutic Shoes or Inserts (20%).
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a copay of up to $75 and a coinsurance of at least 20%, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at least $25, up to $75. Therapeutic Radiological Services have at least 20% coinsurance, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered under the Optimum Diamond Rewards COPD (HMO C-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization and a referral are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Optimum Diamond Rewards COPD (HMO C-SNP) plan. Prior authorization and a doctor referral are required for the services, but the plan does not cover any of the sub-services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, with prior authorization and a doctor's referral required. There is no copay for days 1-20, and a $125 copay for days 21-100; additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include Over-the-Counter (OTC) Items and Meal Benefits. Over-the-Counter (OTC) Items have no copay and a maximum plan benefit of $85.00 every month, while Meal Benefits have no copay and require 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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