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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 2026, 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 4.5 out of 5 stars in 2026.
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. Additionally, this plan comes with a Part B Premium reduction of $10.00. 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 $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) Medicare plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately. You will pay no copay for Tier 1 preferred generic drugs and Tier 5 select diabetic drugs, whether you fill a one, two, or three-month supply at preferred pharmacies, standard pharmacies, or through standard mail order. For Tier 2 preferred brand drugs, copays start at $5 for a one-month supply, while Tier 3 non-preferred drugs have copays starting at $40 at preferred pharmacies. Specialty medications in Tier 4 require a 33% coinsurance for a one-month supply across preferred pharmacies, standard pharmacies, and standard mail order.
Additional Benefits
The Optimum Diamond (HMO C-SNP) plan offers comprehensive medical coverage with no copay and no coinsurance for inpatient hospital stays, primary care visits, specialist services, and preventive care. Outpatient services feature no coinsurance and a $75 copay for hospital visits, while emergency care requires a $150 copay that is waived upon hospital admission. Additionally, the plan covers home health services and the first 20 days of skilled nursing facility care with no copay or coinsurance. For supplemental care, members benefit from no copay and no coinsurance on routine dental, vision, and hearing exams, which includes a $400 yearly eyewear allowance and up to $750 per ear annually for prescription hearing aids. The plan also covers unlimited transportation to plan-approved locations and provides a monthly $75 over-the-counter allowance with no copay. However, some services like dialysis, durable medical equipment, and select Part B drugs require up to a 20% coinsurance.
Inpatient Hospital See details
Optimum Diamond (HMO C-SNP) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, although prior authorization and referrals are required. This benefit is partially covered as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Optimum Diamond (HMO C-SNP) covers outpatient services with no coinsurance, featuring a $75 copay for outpatient hospital and observation services, and no copay for ambulatory surgical center and blood services. Outpatient substance abuse sessions are covered with no coinsurance and a copay ranging from no copay to $75, though prior authorization and referrals are required for most services.
Partial Hospitalization See details
Optimum Diamond (HMO C-SNP) covers partial hospitalization services with a $25.00 copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Optimum Diamond (HMO C-SNP) covers ambulance services with a $200 copay and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. Transportation services are partially covered, offering unlimited rides to plan-approved health-related locations with no copay or coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Optimum Diamond (HMO C-SNP) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 72 hours, and urgently needed services with a $10 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are covered up to a $100,000 maximum limit with a $500 copay and no coinsurance per service, and none of these costs count toward the plan deductible.
Primary Care See details
Optimum Diamond (HMO C-SNP) primary care benefits are partially covered, offering primary care visits, specialist services, therapies, and mental health care with no copay and no coinsurance. Opioid treatment is covered with no coinsurance and a copay of up to $75, while podiatry and chiropractic services are not covered.
Preventive Services See details
Optimum Diamond (HMO C-SNP) provides partially covered preventive services with no copays and no coinsurance for covered services like Medicare-covered screenings, diabetes self-management training, and kidney disease education. However, several sub-services are not covered under this benefit, including annual physical exams, health education, in-home safety assessments, and weight management programs.
Hearing Services See details
Hearing services are covered by Optimum Diamond (HMO C-SNP) with no copay and no coinsurance for exams and prescription hearing aids, providing up to $750 in coverage per ear every year. However, the benefit is only partially covered as OTC hearing aids, along with inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Optimum Diamond (HMO C-SNP) offers partially covered vision services with no deductible, no copay, and no coinsurance for annual routine eye exams and select eyewear, which features a $400 yearly limit for one pair of eyeglasses or contact lenses. Other eye exam services, individual eyeglass lenses, and individual eyeglass frames are not covered, though eyewear upgrades are available with a $30 copay.
Dental Services See details
Dental services are partially covered by Optimum Diamond (HMO C-SNP) with no copay and no coinsurance for covered services, though prior authorization is required for some benefits. Non-covered services include other diagnostic, other preventive, adjunctive general, endodontics, maxillofacial prosthetics, implants, fixed prosthodontics, and orthodontics.
Home Infusion bundled Services See details
Optimum Diamond (HMO C-SNP) covers home infusion bundled services with no copay, subject to prior authorization. Under this plan, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Optimum Diamond (HMO C-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Optimum Diamond (HMO C-SNP) covers medical equipment, featuring durable medical equipment and prosthetics with no copay and a 20% coinsurance. Diabetic equipment, supplies, and therapeutic inserts are also covered with no copay and no coinsurance, though prior authorization is required for these services.
Diagnostic and Radiological Services See details
Optimum Diamond (HMO C-SNP) covers diagnostic and radiological services, with prior authorization and referrals required for all care. Outpatient X-rays and lab services feature no copay but may carry coinsurance, while other diagnostic procedures and radiological services require copays ranging from $0 to $75 or a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Optimum Diamond (HMO C-SNP) with no copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Optimum Diamond (HMO C-SNP) plan, including intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD).
Skilled Nursing Facility (SNF) See details
Optimum Diamond (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $95 daily copay for days 21 through 100. Prior authorization and referrals are required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Optimum Diamond (HMO C-SNP) partially covers other services, which include over-the-counter (OTC) items up to $75 per month and a meal benefit for chronic illnesses with no copay and no coinsurance. Acupuncture and other miscellaneous services are not covered.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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