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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 2025, 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 5 out of 5 stars in 2025.
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.
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 COPD (HMO C-SNP) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, you'll pay a $35 copay for preferred generic drugs at preferred and standard pharmacies, and 33% coinsurance for preferred brand drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, you will pay $0.00.
Additional Benefits
The Optimum Diamond Rewards COPD (HMO C-SNP) plan offers a range of benefits, including inpatient hospital stays with a copay, and outpatient services with varying copays. This plan also covers primary care visits, hearing and vision services, and dental services with no or low copays, while also offering coverage for home health services, and skilled nursing facilities with copays. Emergency services, ambulance, and transportation services are covered, but may require prior authorization and have copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered. For days 1-7, the copay is $225, and there is no copay for days 8-90.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a $195 copay for outpatient hospital services and observation services, and a $100 copay for ambulatory surgical center services. Outpatient substance abuse services have a copay between $40 and $195 for individual and group sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization and a doctor referral. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. 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, up to 4 one-way trips per year, but transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Optimum Diamond Rewards COPD (HMO C-SNP) plan. Emergency Services have a $100 copay, and Urgently Needed Services have a $10 copay, while Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $500 copay.
Primary Care See details
The Optimum Diamond Rewards COPD (HMO C-SNP) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, physician specialist services with a $40 copay, mental health specialty services with a $40 copay, physical therapy and speech-language pathology services with a $40 copay, and opioid treatment program services with a copay ranging from $0 to $195. Routine chiropractic care is not covered, and podiatry services are not covered.
Preventive Services See details
Preventive Services are covered by this plan, 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, Fitness Benefit, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, EKG following Welcome Visit, and Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline) have no copay.
Hearing Services See details
The Optimum Diamond Rewards COPD (HMO C-SNP) plan covers hearing exams and routine hearing exams with no copay, along with fitting/evaluation for hearing aids with no copay, and covers prescription hearing aids with a maximum benefit of $500 per year. However, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
Vision services include eye exams with no copay, and eyewear coverage with a $10 copay for contact lenses and eyeglasses (lenses and frames), and a $30 copay for upgrades. Eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
Dental Services are covered, with no copay for Medicare Dental Services, oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatments, and oral and maxillofacial surgery. 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, and 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 Rewards COPD (HMO C-SNP) plan. The coinsurance is 20%.
Medical Equipment See details
Medical Equipment benefits are covered. Durable Medical Equipment (DME) has a coinsurance of 0-20% and requires authorization. Prosthetics/Medical Supplies have no copay, with coinsurance for Medicare-covered items. Diabetic Equipment is covered, and has a coinsurance of 0-20% for supplies and 20% for therapeutic shoes/inserts.
Diagnostic and Radiological Services See details
The Optimum Diamond Rewards COPD (HMO C-SNP) plan covers diagnostic and radiological services, including lab services with no copay, and diagnostic procedures/tests with a copay of up to $195 and a coinsurance of at most 20%. The plan also covers diagnostic radiological services with a copay of at most $195, therapeutic radiological services with a coinsurance of at most 20%, and outpatient X-ray services with no copay.
Home Health Services See details
Home Health Services are covered by the Optimum Diamond Rewards 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 Rewards COPD (HMO C-SNP) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, with a doctor referral and prior authorization required. For days 1-20, there is no copay, and for days 21-100, the copay is $150.
Other Services See details
Under Other Services, 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 maximum benefit coverage amount of $25.00 every month. Meal benefits are also covered, with no copay, but require prior authorization and a doctor referral.
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