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Optimum HealthCare, Inc.

Plan ID: H5594-28-0

Optimum Diamond Rewards (HMO C-SNP)

2024 Optimum Diamond Rewards (HMO C-SNP) H55940280 is a Medicare Advantage plan with drug coverage. It has received a 5-out-of-5 star rating from CMS for 2024.

Learn more about Optimum Diamond Rewards (HMO C-SNP) H5594 - 028 - 0, including the health and drug services it covers, by reading our easy-to-use guide. Or contact a licensed insurance agent for help now.

5 / 5 stars for 2024

$0.00 /mo

Monthly premium

$0

Health deductible

$0

Drug deductible

$0

Out-of-pocket maximum

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Call to enroll

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Get personalized help from a licensed insurance agent
1-877-649-2073 TTY 711. 8am-11pm EST. 7 days a week!

Overview Icon

Plan Overview

2024 Optimum Diamond Rewards (HMO C-SNP) H55940280 is a HMO offered in Select Counties in Florida by Optimum HealthCare, Inc.. It has a monthly premium of $0.00 and includes a Part B premium discount of $164.90.

Important:

2024 Optimum Diamond Rewards (HMO C-SNP) H5594028 0 is a Chronic or Disabling Condition Special Needs Type plan. You can only enroll in this plan if you meet specific criteria.

Premium Breakdown

Standard Part B Premium

$174.70

Part B premium reduction

- $164.90

Monthly Plan Premium

$0.00

Total Premium:

$9.80

Note:

The standard Part B premium for 2024 is $174.70. Your Part B premium may differ based on factors including late enrollment, income, and disability status. Higher-income beneficiaries may pay an income-related monthly adjustment amount (IRMAA). The Part B premium is required to be paid by everyone enrolled in Medicare Part B.

Special needs plan type

Yes

Out-of-pocket maximum

$0

Conditions Covered

Cardiovascular Disorders, Chronic Heart Failure, Diabetes

Plan Organization:

Optimum HealthCare, Inc.

Plan Type:

HMO

Location:

Select Counties in Florida

Drugs Covered:

Yes

Drug Formulary:

Pharmacies:

Doctor Choice:

Plan Doctors for Most Services

Doctors Link:

Deductibles

The amount you must pay each year before your plan starts to pay for covered services or drugs.

Health deductible

$0

Drug deductible

$0

Sign up for Optimum Diamond Rewards (HMO C-SNP)

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Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 TTY 711. 8am-11pm EST. 7 days a week

Drug Coverage Icon

Drug Coverage

Optimum Diamond Rewards (HMO C-SNP) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Benefit Type

Enhanced Alternative

Prescription drug deductible

$0

Increased initial coverage limit

No

Additional gap coverage

Yes

Part D Premium Reduction

This plan's premium may be reduced for you if you qualify for the low-income subsidy (also known as LIS or "Extra help"). The following is what you'll pay for with LIS.

Part D

LIS 25%

LIS 50%

LIS 75%

LIS Full

$0.00

$0.00

$0.00

$0.00

$0.00

Initial Coverage Phase

After you pay your $0.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $4,660.00. Once you reach that amount, you will enter the next coverage phase.

30 Days
60 Days
90 Days

Tier

Preferred Pharmacy

Standard Pharmacy

Preferred Mail

Standard Mail

1. Preferred Generic

-

$0.00 copay

-

$0.00 copay

2. Standard Generic

-

$15.00 copay

-

$15.00 copay

3. Preferred Brand

-

$55.00 copay

-

$55.00 copay

4. Non-Preferred Drug

-

33%

-

33%

5. Specialty Tier

-

$10.00 copay

-

$10.00 copay

Gap Coverage Phase

After your total drug costs (including what this plan has paid and what you have paid) reach $4,660.00, you will pay no more than the amounts below for any drug tier until you reach $7,400.00.

30 Days
60 Days
90 Days

Tier

Preffered Pharmacy

Standard Pharmacy

Preffered Mail

Standard Mail

Preferred Generic

-

$0.00 copay

-

$0.00 copay

Select Diabetic Drugs

-

$10.00 copay

-

$10.00 copay

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7,400.00, you will pay no more than the greater of the two amounts listed below for generic and brand-name drugs.

Generic Drugs

$4.15 copay or 5% (whichever costs more)

Brand-name

$10.35 copay or 5% (whichever costs more)

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Additional Benefits

Optimum Diamond Rewards (HMO C-SNP) also provides the following benefits.

Note:

Limits, Authorizations, and Referrals may apply for the benefits below. Contact the plan for details.

Additional Coverage Icon

Comprehensive dental

Non-routine services
$0 copay
Limit IconExclamation IconReferral Icon
Diagnostic services
Not covered
Limit Icon
Restorative services
$0 copay
Limit IconExclamation IconReferral Icon
Endodontics
Not covered
Limit Icon
Periodontics
$0 copay
Limit IconExclamation IconReferral Icon
Extractions
$0 copay
Limit IconExclamation IconReferral Icon
Prosthodontics, other oral/maxillofacial surgery, other services
Not covered
Limit Icon
Additional Coverage Icon

Preventive dental

Oral exam
$0 copay
Limit Icon
Cleaning
$0 copay
Limit Icon
Fluoride treatment
$0 copay
Limit Icon
Dental x-ray(s)
$0 copay
Limit Icon
Additional Coverage Icon

Diagnostic procedures/lab services/imaging

Diagnostic tests and procedures
$0-75 copay or 20% coinsurance
Exclamation IconReferral Icon
Lab services
$0-50 copay
Exclamation IconReferral Icon
Diagnostic radiology services (eg, MRI)
$25-75 copay
Exclamation IconReferral Icon
Outpatient x-rays
$0-75 copay
Exclamation IconReferral Icon
Additional Coverage Icon

Doctor visits

Primary
$0 copay
Specialist
$10 copay per visit
Exclamation IconReferral Icon
Additional Coverage Icon

Emergency care/Urgent care

Emergency
$120 copay per visit (always covered)
Urgent care
$10 copay per visit (always covered)
Additional Coverage Icon

Foot care (podiatry services)

Foot exams and treatment
$10 copay
Exclamation IconReferral Icon
Routine foot care
Not covered
Additional Coverage Icon

Ground ambulance

Service
$150 copay
Additional Coverage Icon

Hearing

Hearing exam
$0 copay
Fitting/evaluation
$0 copay
Limit Icon
Hearing aids
$0 copay
Limit Icon
Additional Coverage Icon

Inpatient hospital coverage

Service
$65 per day for days 1 through 5 $0 per day for days 6 through 90
Exclamation IconReferral Icon
Additional Coverage Icon

Outpatient hospital coverage

Service
$75 copay per visit
Exclamation IconReferral Icon
Additional Coverage Icon

Outpatient prescription drugs

Optimum Diamond Rewards (HMO C-SNP) does not provide this type of benefit.

Additional Coverage Icon

Optional benefits

Optimum Diamond Rewards (HMO C-SNP) does not provide this type of benefit.

Additional Coverage Icon

Medical equipment/supplies

Durable medical equipment (eg, wheelchairs, oxygen)
20% coinsurance per item
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Prosthetics (eg, braces, artificial limbs)
20% coinsurance per item
Exclamation Icon
Diabetes supplies
$0 copay
Exclamation Icon
Additional Coverage Icon

Medicare Part B drugs

Chemotherapy
0-20% coinsurance
Exclamation Icon
Other Part B drugs
0-20% coinsurance
Exclamation Icon
Part B Insulin drugs
$35 copay
Exclamation Icon
Additional Coverage Icon

Mental health services

Inpatient hospital - psychiatric
$65 per day for days 1 through 5 $0 per day for days 6 through 90
Exclamation IconReferral Icon
Outpatient group therapy visit with a psychiatrist
$10 copay
Exclamation IconReferral Icon
Outpatient individual therapy visit with a psychiatrist
$10 copay
Exclamation IconReferral Icon
Outpatient group therapy visit
$10 copay
Exclamation IconReferral Icon
Outpatient individual therapy visit
$10 copay
Exclamation IconReferral Icon
Additional Coverage Icon

Preventive care

Service
$0 copay
Exclamation IconReferral Icon
Additional Coverage Icon

Rehabilitation services

Occupational therapy visit
$10 copay
Exclamation IconReferral Icon
Physical therapy and speech and language therapy visit
$10 copay
Exclamation IconReferral Icon
Additional Coverage Icon

Skilled Nursing Facility

Service
$0 per day for days 1 through 20 $125 per day for days 21 through 100
Exclamation IconReferral Icon
Additional Coverage Icon

Transportation

Service
$0 copay
Limit Icon
Additional Coverage Icon

Vision

Routine eye exam
$0 copay
Limit Icon
Other
Not covered
Limit Icon
Contact lenses
$0 copay
Limit Icon
Eyeglasses (frames and lenses)
$0 copay
Limit Icon
Eyeglass frames
Not covered
Limit Icon
Eyeglass lenses
Not covered
Limit Icon
Upgrades
$30 copay
Limit Icon
Additional Coverage Icon

Wellness programs (eg, fitness, nursing hotline)

Service
Covered
Overview Icon

Plan Providers

Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.

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