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Optimum Diamond Savings (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Optimum Diamond Savings (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 Savings (HMO C-SNP) in 2026, please refer to our full plan details page.
Optimum Diamond Savings (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 Savings (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 Savings (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 Savings (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 Savings (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 $65.00. 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 $5000.00 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 Savings (HMO C-SNP) Medicare plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately with no upfront deductible costs. Under this plan, Tier 1 preferred generic drugs have no copay for one-, two-, or three-month supplies at standard and preferred retail pharmacies. For Tier 2 preferred brand drugs, you will pay a $35 copay for a one-month supply at retail pharmacies, with savings available on three-month mail-order refills. For Tier 3 non-preferred drugs, the one-month copay is $85 at preferred pharmacies and standard mail order, or $90 at standard pharmacies. Tier 4 specialty drugs require a 33% coinsurance for a one-month supply at all available pharmacies. Finally, Tier 5 select diabetic drugs offer a predictable $10 copay for a one-month supply at both standard and preferred pharmacies.
Additional Benefits
The Optimum Diamond Savings (HMO C-SNP) plan offers robust core medical coverage with no copay for primary care doctor visits and a $30 copay for specialists. Inpatient hospital stays require a $195 daily copay for the first seven days and no copay for days eight through 90, while emergency room visits carry a $130 copay. Most outpatient surgical services feature low copays and no coinsurance, and home health services are fully covered with no copay. This plan also includes valuable everyday benefits, offering routine dental, vision, and hearing exams with no copay or coinsurance. Members receive up to $500 annually for prescription hearing aids and a $150 annual allowance for eyewear with a $10 copay. Additionally, the plan provides a $35 monthly allowance for over-the-counter items and covers qualifying chronic illness meals with no copay.
Inpatient Hospital See details
Inpatient hospital services are covered by Optimum Diamond Savings (HMO C-SNP) with no coinsurance, requiring a $195 copay per day for days 1 through 7 and no copay for days 8 through 90 for both acute and psychiatric stays. Prior authorization and referrals are required, and upgrades, additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Optimum Diamond Savings (HMO C-SNP) covers outpatient hospital and observation services with a $195 copay and no coinsurance, and ambulatory surgical center services with a $25 copay and no coinsurance. Outpatient substance abuse services have a copay ranging from $30 to $195 with no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered under the Optimum Diamond Savings (HMO C-SNP) plan with a $55.00 copay and no coinsurance. This benefit requires both a referral and prior authorization.
Ambulance and Transportation Services See details
Optimum Diamond Savings (HMO C-SNP) covers ground ambulance services with a $200 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay or coinsurance for up to 4 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Optimum Diamond Savings (HMO C-SNP) covers emergency services with a $130 copay and no coinsurance, which is waived if admitted to the hospital within 72 hours, and urgently needed services with a $10 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $100,000 maximum benefit with a $500 copay and no coinsurance per service.
Primary Care See details
Optimum Diamond Savings (HMO C-SNP) offers primary care physician services with no copay and no coinsurance, while specialist visits, therapies (physical, occupational, and speech), psychiatric, and mental health sessions require a $30 copay and no coinsurance. Other healthcare professional services range from a $0 to $30 copay, opioid treatment has a $0 to $195 copay, and telehealth is covered with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Optimum Diamond Savings (HMO C-SNP) partially covers preventive services with no copay and no coinsurance, though some benefits require prior authorization and referrals. Covered services include memory fitness, remote access technologies, and kidney disease education, while annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, smoking cessation counseling, enhanced disease management, telemonitoring, home safety devices, and counseling are not covered.
Hearing Services See details
Hearing services are covered by Optimum Diamond Savings (HMO C-SNP), featuring routine hearing exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to $500 per ear annually, though OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Optimum Diamond Savings (HMO C-SNP) offers partially covered vision services with no deductible and no coinsurance. Routine eye exams are covered with no copay (one per year), but other eye exams, individual eyeglass lenses, and individual eyeglass frames are not covered. Covered eyewear options, including contact lenses or eyeglasses (lenses and frames), carry a $10 copay up to a $150 annual maximum.
Dental Services See details
Optimum Diamond Savings (HMO C-SNP) provides partially covered dental services with no copay and no coinsurance for covered benefits like oral exams, cleanings, x-rays, fluoride, restorative services, periodontics, and oral surgery. Sub-services that are not covered include other diagnostic and preventive dental, adjunctive general services, endodontics, implants, orthodontics, maxillofacial prosthetics, and both fixed and removable prosthodontics.
Home Infusion bundled Services See details
Optimum Diamond Savings (HMO C-SNP) covers Home Infusion bundled Services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy and other Part B drugs have a 0% to 20% coinsurance with no copay, while Medicare Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Optimum Diamond Savings (HMO C-SNP) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Optimum Diamond Savings (HMO C-SNP) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic equipment, including supplies and therapeutic shoes, is covered with no copay and no coinsurance, though prior authorization is required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Optimum Diamond Savings (HMO C-SNP), requiring prior authorization and referrals for all services. Outpatient diagnostic tests range from no copay to a $195 copay with 20% coinsurance, lab and X-ray services have no copay but require coinsurance, while diagnostic radiological services require a minimum $25 copay and therapeutic radiological services require 20% coinsurance and a copay.
Home Health Services See details
Optimum Diamond Savings (HMO C-SNP) covers home health services with no copay and no coinsurance. Members should be aware that both a referral and prior authorization are required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Optimum Diamond Savings (HMO C-SNP) with no coinsurance, requiring prior authorization and referrals. While some services are covered, standard cardiac ($30 copay), intensive cardiac ($30 copay), pulmonary ($15 copay), and SET for PAD ($25 copay) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Optimum Diamond Savings (HMO C-SNP) covers Skilled Nursing Facility (SNF) stays with no coinsurance, offering 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 standard Medicare-covered limit are not covered.
Other Services See details
Optimum Diamond Savings (HMO C-SNP) partially covers other services, offering over-the-counter (OTC) items up to $35 monthly and chronic illness meal benefits with no copay and no coinsurance. Acupuncture is not covered under this plan, and the covered meal benefit requires prior authorization and a referral.
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