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Optimum Diamond Rewards COPD (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Optimum Diamond Rewards 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 Rewards COPD (HMO C-SNP) in 2026, please refer to our full plan details page.
Optimum Diamond Rewards 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 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 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 Rewards 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 Rewards 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 Rewards 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 $13.00. 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 $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 COPD (HMO C-SNP) Medicare plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 preferred generic drugs, you will pay no copay for one, two, or three-month supplies at preferred and standard pharmacies, as well as through standard mail order. Tier 2 preferred brand drugs require a $47 copay for a one-month supply, with three-month standard mail orders offering a discounted $94 copay. Tier 3 non-preferred drugs have a $95 copay for a one-month supply at preferred pharmacies and standard mail order, while standard pharmacies charge a $100 copay. For Tier 4 specialty medications, you will pay a 33% coinsurance for a one-month supply across all pharmacy options. This clear copay and coinsurance structure makes it easy to understand your out-of-pocket costs with the Optimum Diamond Rewards COPD (HMO C-SNP) plan.
Additional Benefits
The Optimum Diamond Rewards COPD (HMO C-SNP) plan offers comprehensive medical coverage featuring no copay for primary care visits and routine preventive services. Specialists require a $40 copay, while inpatient hospital stays have a $225 copay for the first seven days and no copay for days eight through ninety. Outpatient hospital services carry a $195 copay, and emergency room visits require a $115 copay, which is waived if you are admitted. This plan also provides valuable dental, vision, and hearing benefits, offering routine exams, cleanings, and hearing aid fittings with no copay. Members also benefit from a $10 copay for covered eyewear up to a $100 annual limit, alongside a $25 monthly over-the-counter allowance and up to four free one-way transportation trips per year.
Inpatient Hospital See details
Optimum Diamond Rewards COPD (HMO C-SNP) partially covers inpatient acute and psychiatric hospital services with no coinsurance, requiring a $225 copay for days 1 through 7 and no copay for days 8 through 90. Prior authorization and referrals are required, and the plan does not cover additional days, non-Medicare-covered stays, or upgrades.
Outpatient Services See details
Optimum Diamond Rewards COPD (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 $40 to $195 copay with no coinsurance, while outpatient blood services have no copay, no deductible, and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Optimum Diamond Rewards COPD (HMO C-SNP) plan with a $55.00 copay and no coinsurance. Prior authorization and a referral are required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the Optimum Diamond Rewards COPD (HMO C-SNP) plan, with ground ambulance services requiring a $200 copay and air ambulance services requiring a 20% coinsurance. Transportation services are partially covered with no copay or coinsurance for up to 4 one-way trips per year to plan-approved locations, though trips to any health-related location are not covered.
Emergency Services See details
Optimum Diamond Rewards COPD (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 with no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $100,000 maximum with a $500 copay per service and no coinsurance.
Primary Care See details
Optimum Diamond Rewards COPD (HMO C-SNP) offers primary care physician services with no copay and no coinsurance, while specialist visits require a $40 copay and no coinsurance. Physical, occupational, and speech therapies are covered with a $35 copay and no coinsurance, but podiatry and chiropractic services are not covered.
Preventive Services See details
Optimum Diamond Rewards COPD (HMO C-SNP) offers partially covered preventive services with no copay and no coinsurance for covered benefits, including kidney disease education, memory fitness, and remote access technologies. However, an annual physical exam and other services, such as health education, in-home safety assessments, personal emergency response systems, and medical nutrition therapy, are not covered.
Hearing Services See details
Optimum Diamond Rewards COPD (HMO C-SNP) hearing services are partially covered with no copay, no coinsurance, and no deductible for Medicare-covered exams, annual routine exams, and fitting evaluations. Prescription hearing aids are covered up to $500 per ear yearly with no copay or coinsurance, but OTC hearing aids and inner, outer, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Optimum Diamond Rewards COPD (HMO C-SNP) offers partially covered vision services with no deductibles and no coinsurance, featuring no copay for one routine annual eye exam. Covered eyewear, including contact lenses and eyeglasses, has a $10 copay up to a $100 yearly maximum, but other eye exams, individual eyeglass lenses, and individual eyeglass frames are not covered.
Dental Services See details
Dental services are partially covered by the Optimum Diamond Rewards COPD (HMO C-SNP) plan with no copay and no coinsurance for covered benefits like oral exams, cleanings, fluoride, x-rays, and oral surgery. Non-covered services include restorative care, endodontics, periodontics, prosthodontics, implants, orthodontics, adjunctive general services, and other diagnostic or preventive dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Optimum Diamond Rewards COPD (HMO C-SNP) with no copay and require prior authorization. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered by Optimum Diamond Rewards COPD (HMO C-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Optimum Diamond Rewards COPD (HMO C-SNP) with no copay, though prior authorization is required. Durable medical equipment and diabetic supplies have coinsurance ranging from no coinsurance up to 20%, while medical supplies, prosthetic devices, and diabetic shoes require a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Optimum Diamond Rewards COPD (HMO C-SNP), requiring prior authorization and referrals for all services. Outpatient X-rays and lab services feature no copay, diagnostic procedures carry a $0 to $195 copay with 20% coinsurance, diagnostic radiology has a minimum $25 copay, and therapeutic radiology requires a 20% coinsurance.
Home Health Services See details
Home health services are covered by Optimum Diamond Rewards COPD (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 COPD (HMO C-SNP) with no coinsurance, though prior authorization and a referral are required. While some services are covered, standard cardiac rehabilitation ($30 copay), intensive cardiac rehabilitation ($30 copay), pulmonary rehabilitation ($15 copay), and supervised exercise therapy for peripheral artery disease ($20 copay) are not covered in practice.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Optimum Diamond Rewards COPD (HMO C-SNP) with no coinsurance, requiring no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. The benefit is partially covered because additional days beyond the Medicare-covered limit are not covered, and both prior authorization and referrals are required.
Other Services See details
Optimum Diamond Rewards COPD (HMO C-SNP) partially covers other services, offering over-the-counter (OTC) items up to $25 monthly and a chronic illness meal benefit 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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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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