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Optimum Diamond Savings COPD (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Optimum Diamond Savings 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 Savings COPD (HMO C-SNP) in 2025, please refer to our full plan details page.
Optimum Diamond Savings 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 Savings 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 Savings 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 Savings 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 Savings 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 $50.00. 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 COPD (HMO C-SNP) plan has an enhanced alternative drug benefit with a $0 deductible. During 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 at preferred and standard pharmacies, and standard mail order, while standard generic drugs have an $85 copay at preferred and standard mail order pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Optimum Diamond Savings COPD (HMO C-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, and outpatient services have copays depending on the specific service. The plan also covers ambulance services, emergency services, and offers no copay for primary care physician visits, preventive services, home health services, and many dental services. Additional benefits include coverage for hearing exams and hearing aids, vision services, and durable medical equipment. The plan also includes coverage for diagnostic and radiological services, skilled nursing facility stays, and other services like OTC items and a meal benefit. Some services require prior authorization and a doctor's referral.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered with a $195 copay for days 1-7 and no copay for days 8-90. Additional days and non-Medicare covered stays for both acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a $195 copay, observation services with a $195 copay, ambulatory surgical center (ASC) services with a $25 copay, outpatient substance abuse services with a copay between $30 and $195 depending on the service, and outpatient blood services with no copay. Prior authorization and a doctor referral are required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered with a $55 copay, and requires prior authorization and a doctor's referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Optimum Diamond Savings COPD (HMO C-SNP) plan. Ground ambulance services have a $200 copay, while air ambulance services have a 20% coinsurance; transportation services to a plan-approved health-related location have no copay for up to 4 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $100 copay, and Urgently Needed Services have a $10 copay, and both have no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $500 copay, and all have no coinsurance.
Primary Care See details
The Optimum Diamond Savings COPD (HMO C-SNP) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $30 copay, physician specialist services with a $30 copay, mental health specialty services with a $30 copay for individual and group sessions, physical therapy and speech-language pathology services with a $30 copay, additional telehealth benefits, and opioid treatment program services with a copay between $0 and $195. Podiatry services are not covered.
Preventive Services See details
Preventive Services are covered by the Optimum Diamond Savings COPD (HMO C-SNP) plan, including Medicare-covered preventive services with no copay, and other preventive services. Additional preventive services, including fitness benefits, are covered with no copay.
Hearing Services See details
The Optimum Diamond Savings COPD (HMO C-SNP) plan covers hearing exams, routine hearing exams, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to a maximum of $500 per year, with no copay for Prescription Hearing Aids (all types). Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
The Optimum Diamond Savings COPD (HMO C-SNP) plan covers vision services, including routine eye exams with no copay, and eyewear with no copay and a combined maximum benefit of $150 per year. Contact lenses and eyeglasses have a $10 copay, and upgrades have a $30 copay. Eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
Dental Services includes oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, periodontics, and oral and maxillofacial surgery. Oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, periodontics, and oral and maxillofacial surgery have no copay. Adjunctive general services, endodontics, prosthodontics (removable, fixed), maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Optimum Diamond Savings COPD (HMO C-SNP) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical equipment is covered by the Optimum Diamond Savings COPD (HMO C-SNP) plan. Durable Medical Equipment (DME) has no copay, with a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have no copay and a 20% coinsurance, while Diabetic Equipment has a coinsurance between 0% and 20% depending on the service.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, but a doctor's referral and prior authorization are required. Diagnostic Procedures/Tests have a copay between $0 and $195, and a coinsurance of at most 20%, while Lab Services have no copay. Diagnostic Radiological Services have a copay between $25 and $195, and Therapeutic Radiological Services have a coinsurance of at most 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Optimum Diamond Savings COPD (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 not covered by the Optimum Diamond Savings COPD (HMO C-SNP) plan, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization and a doctor referral are required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require 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
Other Services includes Over-the-Counter (OTC) Items and a Meal Benefit. Over-the-Counter (OTC) Items has no copay, and a maximum plan benefit coverage amount of $35.00 every month. The Meal Benefit has no copay, and requires 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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