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Optimum Diamond Rewards (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Optimum Diamond Rewards (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 (HMO C-SNP) in 2026, please refer to our full plan details page.
Optimum Diamond Rewards (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 FL. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Optimum Diamond Rewards (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 (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 (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 (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.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $6800.00 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 (HMO C-SNP) prescription drug plan offers a $0 drug deductible, meaning your coverage begins immediately with no upfront costs. Tier 1 preferred generic drugs feature no copay for one-, two-, or three-month supplies at both preferred and standard pharmacies. For Tier 2 preferred brand drugs, you will pay a $47 copay for a one-month supply, with savings available for three-month mail orders. Tier 3 non-preferred drugs require a $95 copay at preferred pharmacies and standard mail order, or a $100 copay at standard pharmacies for a one-month supply. Specialty drugs in Tier 4 require a 33% coinsurance, while Tier 5 select diabetic drugs are highly accessible with a low $10 copay for a one-month supply.
Additional Benefits
The Optimum Diamond Rewards (HMO C-SNP) plan offers comprehensive medical coverage with no copay for primary care visits, home health services, and covered preventive care. For hospital needs, inpatient stays require a $225 copay for the first seven days and no copay thereafter, while outpatient hospital services carry a $195 copay. Emergency room visits have a $115 copay, which is waived if you are admitted, and specialist visits require a $40 copay. Routine dental cleanings, oral exams, and routine hearing and vision exams are covered with no copay or coinsurance. The plan also includes a $25 monthly allowance for over-the-counter items with no copay, alongside prescription hearing aid coverage of up to $500 per ear annually. Durable medical equipment and dialysis services require a 20% coinsurance, while diabetic supplies are fully covered with no copay or coinsurance.
Inpatient Hospital See details
Optimum Diamond Rewards (HMO C-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $225 copay for days 1 through 7 and no copay for days 8 through 90 per stay. This benefit is partially covered because additional days, room upgrades, and non-Medicare-covered stays are not covered, and both referrals and prior authorizations are required.
Outpatient Services See details
Optimum Diamond Rewards (HMO C-SNP) covers outpatient services with no coinsurance, featuring a $195 copay for outpatient hospital and observation services and a $100 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a copay between $40 and $195 with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Optimum Diamond Rewards (HMO C-SNP) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Optimum Diamond Rewards (HMO C-SNP) covers ambulance services with a $200 copay for ground transport and a 20% coinsurance for air transport, both requiring prior authorization. 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 Rewards (HMO C-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 72 hours. Urgently needed services require a $10 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $100,000 maximum benefit with a $500 copay per service and no coinsurance.
Primary Care See details
Optimum Diamond Rewards (HMO C-SNP) covers primary care physician visits with no copay and no coinsurance, while specialist, psychiatric, and mental health services require a $40 copay and no coinsurance. Physical, occupational, and speech-language therapy are covered with a $35 copay and no coinsurance, but podiatry and chiropractic services are not covered.
Preventive Services See details
Optimum Diamond Rewards (HMO C-SNP) partially covers preventive services with no copays and no coinsurance for covered benefits, which include Medicare-covered zero-dollar preventive services, kidney disease education, diabetes self-management, glaucoma screenings, memory fitness, and remote access technologies. However, several services are not covered, including annual physical exams, health education, weight management programs, and in-home safety assessments.
Hearing Services See details
Hearing Services are partially covered by Optimum Diamond Rewards (HMO C-SNP), featuring no copays, no coinsurance, and no deductibles for routine hearing exams and fitting evaluations. Prescription hearing aids are covered up to $500 per ear annually with no copay or coinsurance, but OTC hearing aids as well as inner-ear, outer-ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Optimum Diamond Rewards (HMO C-SNP) offers partially covered vision services, featuring one annual routine eye exam with no copay, no coinsurance, and no deductible, while other eye exam services are not covered. Covered eyewear benefits, including contact lenses and eyeglasses, have a $10 copay, no coinsurance, and no deductible up to a $100 yearly maximum, although separate eyeglass lenses and frames are not covered.
Dental Services See details
Dental services are partially covered by Optimum Diamond Rewards (HMO C-SNP), featuring no copay and no coinsurance for covered services such as oral exams, cleanings, fluoride, x-rays, and oral surgery. However, several sub-services are not covered, including restorative, endodontic, periodontic, prosthodontic, implant, and orthodontic services.
Home Infusion bundled Services See details
Optimum Diamond Rewards (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 drugs carry a 0% to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by Optimum Diamond Rewards (HMO C-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Optimum Diamond Rewards (HMO C-SNP) covers durable medical equipment and prosthetics with no copay and 20% coinsurance, while diabetic equipment and supplies are covered with no copay and no coinsurance. Prior authorization is required for these covered medical equipment benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Optimum Diamond Rewards (HMO C-SNP), requiring prior authorizations and referrals for all services. Diagnostic procedures and tests have copays ranging from $0 to $195 and a 20% coinsurance, while lab and outpatient X-ray services feature no copay but require coinsurance. Diagnostic radiological services require a copay starting at $25, and therapeutic radiological services carry a 20% coinsurance and applicable copays.
Home Health Services See details
Home Health Services are covered under the Optimum Diamond Rewards (HMO C-SNP) with no copay and no coinsurance, although prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Optimum Diamond Rewards (HMO C-SNP) with no coinsurance, but in practice only some services are covered because cardiac ($30 copay), intensive cardiac ($30 copay), pulmonary ($15 copay), and SET for PAD ($20 copay) rehabilitation are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Optimum Diamond Rewards (HMO C-SNP) with no coinsurance, featuring no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization and referrals are required, a prior three-day hospital stay is not required for admission, and additional days beyond the standard 100 days are not covered.
Other Services See details
Optimum Diamond Rewards (HMO C-SNP) partially covers other services, offering chronic illness meal benefits and up to $25 monthly for over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture is not covered under this plan, and the meal benefit requires a referral and prior authorization.
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