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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 2025, 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 5 out of 5 stars in 2025.
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 $4750.00 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) plan has an "Enhanced Alternative" drug benefit. This plan has no deductible, so you will not need to pay anything before your drug coverage begins. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have a $35 copay, while preferred brand drugs have a 33% coinsurance. Once your total drug costs reach $2000, you enter the next coverage phase.
Additional Benefits
The Optimum Diamond Savings (HMO C-SNP) plan offers a wide range of benefits with varying costs. Inpatient hospital stays have a $195 copay for days 1-7, and no copay for days 8-90. Outpatient services have copays ranging from $0 to $195. Preventive, hearing, and vision services, including routine eye exams, have no copay. Dental services, including oral exams and cleanings, also have no copay. Additionally, the plan covers home health services, lab services, and diabetic supplies with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered by the Optimum Diamond Savings (HMO C-SNP) plan. For days 1-7, the copay is $195, and for days 8-90, there is no copay.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a $195 copay, and observation services, with a $195 copay. Ambulatory Surgical Center (ASC) services have a $25 copay, and outpatient substance abuse services have a copay between $30 and $195 for individual and group sessions. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Optimum Diamond Savings (HMO C-SNP) plan. This benefit requires prior authorization and a doctor referral, and has a copay of $55.
Ambulance and Transportation Services See details
The Optimum Diamond Savings (HMO C-SNP) plan covers ambulance and transportation 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, with a limit of 4 one-way trips per year, but transportation services to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Optimum Diamond Savings (HMO C-SNP) plan. Emergency Services have a $100 copay, Urgently Needed Services have a $10 copay, and Worldwide Emergency Services have a $500 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The Optimum Diamond Savings (HMO C-SNP) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay, and require prior authorization and a doctor referral; however, routine chiropractic care is not covered. Occupational therapy has a $30 copay and requires authorization and a referral. Specialist, mental health, psychiatric, physical therapy, and speech-language pathology services have a $30 copay, and psychiatric and physical therapy services require authorization and a referral. Other health care professional services have a copay between $0 and $30, and opioid treatment program services have a copay between $0 and $195.
Preventive Services See details
Preventive Services are covered, including services not usually covered by Medicare plans. Medicare-covered preventive services, and additional preventive services such as Fitness Benefit and Remote Access Technologies, have no copay. Some preventive services, such as annual physical exams, health education, and others, are not covered.
Hearing Services See details
The Optimum Diamond Savings (HMO C-SNP) plan covers hearing exams with no copay. Routine hearing exams and fitting/evaluation for hearing aids are covered with no copay for one visit per year. Prescription hearing aids (all types) are covered with no copay for two visits per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The Optimum Diamond Savings (HMO C-SNP) plan covers vision services, including routine eye exams with no copay. This plan also covers eyewear with a $0 copay for Medicare-covered benefits, contact lenses with a $10 copay, eyeglasses (lenses and frames) with a $10 copay, and upgrades with a $30 copay.
Dental Services See details
The Optimum Diamond Savings (HMO C-SNP) plan covers dental services, including oral exams, dental x-rays, cleanings, fluoride treatments, periodontics, and oral and maxillofacial surgery, all with no copay. However, the plan does not cover adjunctive general services, endodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but 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 Savings (HMO C-SNP) plan. You will pay 20% coinsurance.
Medical Equipment See details
Medical equipment is covered, including Durable Medical Equipment (DME) with a 20% coinsurance and authorization required, and Prosthetics/Medical Supplies with a 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests with a copay up to $195 and at least 20% coinsurance, and lab services with no copay. Diagnostic radiological services have a copay up to $195, with a minimum copay of $25, and therapeutic radiological services have at least 20% coinsurance. Outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered by the Optimum Diamond Savings (HMO C-SNP) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but some services are not covered, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization and a doctor referral are required, and the copay information is available in the plan details.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered under the Optimum Diamond Savings (HMO C-SNP) plan, requiring prior authorization and a doctor's referral. For days 1-20, there is no copay, and for days 21-100, the copay is $150.
Other Services See details
Under the Optimum Diamond Savings (HMO C-SNP) plan, 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. Over-the-counter items are covered with no copay, and a $45 maximum plan benefit coverage amount every month. The meal benefit is covered with no copay, but requires prior authorization and a doctor referral.
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