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Optimum Diamond (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Optimum Diamond (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 (HMO C-SNP) in 2025, please refer to our full plan details page.
Optimum Diamond (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 (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 (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 (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 (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 $1000.00 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 (HMO C-SNP) plan has an enhanced alternative drug benefit. The plan has no deductible. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For preferred generic drugs, you'll pay a $5 copay at most pharmacies. For non-preferred drugs, there is no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Optimum Diamond (HMO C-SNP) plan offers comprehensive coverage with a focus on outpatient and primary care services. Many services, including inpatient hospital stays, primary care visits, and dental services, have no copay. The plan also includes benefits like hearing and vision services, with no copay for hearing exams and routine eye exams. Emergency services, ambulance services, and some outpatient services come with copays and coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered with no copay. 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 $75 copay, observation services with a $75 copay, ambulatory surgical center services with no copay, and outpatient substance abuse services with a copay between $0 and $75 for individual and group sessions. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Optimum Diamond (HMO C-SNP) plan, requiring prior authorization and a doctor referral, with a $25 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, and transportation services to plan-approved health-related locations. Ground ambulance services have a $200 copay, while air ambulance services have a 20% coinsurance. Transportation services to plan-approved health-related locations have no copay, while transportation to any other health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Optimum Diamond (HMO C-SNP) plan. Emergency Services have a $120 copay, Urgently Needed Services have a $10 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $500 copay.
Primary Care See details
The Optimum Diamond (HMO C-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy, and speech-language pathology services have no copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services are covered, with some services requiring prior authorization and a doctor referral. Medicare-covered zero dollar preventive services are covered, as are additional preventive services. The plan does not cover annual physical exams, health education, in-home safety assessments, 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, additional sessions of smoking and tobacco cessation counseling, and counseling services. Personal Emergency Response System (PERS), Fitness Benefits, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
The Optimum Diamond (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 $750 per year, with no copay for all types of prescription hearing aids, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear, with no copay for routine eye exams, contact lenses, and eyeglasses (lenses and frames), and a $30 copay for upgrades. This plan covers one routine eye exam and two pairs of contact lenses or eyeglasses (lenses and frames) per year, with a combined maximum of $400 for all eyewear. Eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
Dental Services are covered under the Optimum Diamond (HMO C-SNP) plan. Medicare Dental Services, Oral Exams, Dental X-Rays, Prophylaxis (Cleaning), Fluoride Treatment, Periodontics, Prosthodontics (removable), and Oral and Maxillofacial Surgery have no copay, while Adjunctive General Services, Endodontics, Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), 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 (HMO C-SNP) plan. You are responsible for a 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits are covered, with a 20% coinsurance for Durable Medical Equipment, Prosthetic Devices, and Medical Supplies. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
The Optimum Diamond (HMO C-SNP) plan covers diagnostic and radiological services. Diagnostic Procedures/Tests have a copay of up to $75 and a coinsurance of at least 20%, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at least $25 and up to $75. Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Optimum Diamond (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 (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 by the Optimum Diamond (HMO C-SNP) plan, but require prior authorization and a doctor's referral. There is no copay for days 1-20, and a $95 copay for days 21-100, while additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Optimum Diamond (HMO C-SNP) plan covers Over-the-Counter (OTC) Items with no copay and a maximum benefit coverage amount of $90.00 per month. This plan also covers meal benefits with no copay, though a doctor referral and prior authorization are required. 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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