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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 2025, 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 5 out of 5 stars in 2025.
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) plan has an enhanced alternative drug benefit. This plan has no deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance for your prescriptions. For example, preferred generic drugs have a $35 copay, while preferred brand drugs have a 33% coinsurance. Once your total drug costs reach $2,000, you enter the next coverage phase.
Additional Benefits
The Optimum Diamond Rewards (HMO C-SNP) plan offers comprehensive coverage with a focus on affordability. This plan includes no copays for primary care, home health services, dental services, and many preventive services. The plan provides coverage for inpatient hospital stays, outpatient services, and emergency services, with varying copays for each. It also offers additional benefits like hearing and vision services, home infusion, medical equipment, and skilled nursing facility care.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered. For days 1-7, there is a $225 copay, and for days 8-90, there is no copay.
Outpatient Services See details
Outpatient Services, including outpatient hospital services and observation services, have a $195 copay. Ambulatory Surgical Center (ASC) Services have a $100 copay, while Outpatient Blood Services have no copay. Outpatient Substance Abuse Services, including individual and group sessions, have a copay between $40 and $195.
Partial Hospitalization See details
Partial Hospitalization is covered under the Optimum Diamond Rewards (HMO C-SNP) plan, with a $55 copay. Prior authorization and a doctor referral are required for this benefit.
Ambulance and Transportation Services See details
The Optimum Diamond Rewards (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, for up to 4 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Optimum Diamond Rewards (HMO C-SNP) plan. Emergency Services have a $100 copay, and Urgently Needed Services have a $10 copay, with no coinsurance for either. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $500 copay.
Primary Care See details
The Optimum Diamond Rewards (HMO C-SNP) plan offers primary care services with no copay. Chiropractic services have a $15 copay, while occupational therapy services have a $35 copay. Physician specialist services have a $40 copay, and individual and group mental health specialty sessions each have a $40 copay. Physical therapy and speech-language pathology services have a $40 copay. Other health care professional services have a copay ranging from $0 to $40, and opioid treatment program services have a copay ranging from $0 to $195. Podiatry services are not covered.
Preventive Services See details
Preventive services are covered, but annual physical exams, health education, in-home safety assessments, personal emergency response systems, 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 benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered. Medicare-covered preventive services and kidney disease education services have no copay, and other preventive services such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visit have no copay.
Hearing Services See details
Hearing Services include no copay for hearing exams, routine hearing exams, and fitting/evaluation for hearing aids, and a $500 maximum plan benefit per year for prescription hearing aids. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Optimum Diamond Rewards (HMO C-SNP) plan covers vision services, including eye exams with no copay, and eyewear with a combined maximum benefit of $100 per year. Contact lenses and eyeglasses (lenses and frames) have a $10 copay, while upgrades have a $30 copay, and eyeglass lenses and frames are not covered.
Dental Services See details
The Optimum Diamond Rewards (HMO C-SNP) plan covers various dental services, including oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, and oral and maxillofacial surgery, all with no copay. Restorative services, adjunctive general services, endodontics, periodontics, 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, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the Optimum Diamond Rewards (HMO C-SNP) plan. The plan has a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and authorization required, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization and a doctor referral required. Diagnostic Procedures/Tests have a coinsurance of at most 20% with a copay between $0 and $195, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $195 with a minimum of $25. 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 Rewards (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 Rewards (HMO C-SNP) plan. Prior authorization and a doctor referral are required, but the plan does not cover any of the sub-services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Optimum Diamond Rewards (HMO C-SNP) plan. For days 1-20, there is no copay, and for days 21-100, the copay is $150.
Other Services See details
The Optimum Diamond Rewards (HMO C-SNP) plan covers over-the-counter items with no copay, up to a maximum of $25 per month. The plan also covers meal benefits with no copay, but requires prior authorization and a doctor's 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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