Optimum Diamond Rewards COPD (HMO C-SNP) By Optimum HealthCare, Inc



Optimum Diamond Rewards COPD (HMO C-SNP) is a 2022 Medicare Advantage Special Needs Plan plan by Optimum HealthCare, Inc. This plan from Optimum HealthCare, Inc works with Medicare to give you significant coverage beyond original Medicare. If you decide to sign up you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Optimum HealthCare, Inc and not Original Medicare. All Medicare SNPs also provide Medicare additional Part-D drug coverage. Optimum Diamond Rewards COPD (HMO C-SNP) H5594-035 is a Chronic Condition SNP (C-SNP). A Chronic Condition SNP is for beneficiaries with the following severe or disabling chronic conditions: Cardiovascular Disorders and Chronic Heart Failure. If you have Medicare and you develop certain severe or disabling conditions you can join a Medicare SNP designed to serve people with those conditions at any time.



2022 Medicare Special Needs Plan Details

Plan Name:
Optimum Diamond Rewards COPD (HMO C-SNP)
Plan ID:
H5594-035
Special Needs Type: Chronic or Disabling Condition
Provider: Optimum HealthCare, Inc
Plan Year:2022
Plan Type: Local HMO
Monthly Premium C+D: $0
Chronic Condition:Cardiovascular Disorders and Chronic Heart Failure
Part C Premium: $0.00
Part D (Drug) Premium: $0.00
Part D Supplemental Premium $0.00
Total Part D Premium: $0.00
Drug Deductible: $0.00
Tiers with No Deductible: 0
Benchmark: not below the regional benchmark
Type of Medicare Health Plan: Enhanced Alternative
Drug Benefit Type: Enhanced
Gap Coverage: No Gap Coverage


The Optimum Diamond Rewards COPD (HMO C-SNP) H5594-035 is available to residents in Florida, and all Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage. Optimum Diamond Rewards COPD (HMO C-SNP) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you need special care for a physician specialist, your primary care physician will make the arrangements and tell you where you can go in the network. You will need your PCPs okay, called a referral. Without getting a referral or services received from out-of-network providers are not typically covered by the plan.



Gap Coverage

In 2022 once you and your plan provider have spent $4430 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for brand-name drugs and 25% on generic drugs unless your plan offers additional coverage. This Optimum HealthCare, Inc plan offer additional coverage through the gap.




Optimum Diamond Rewards COPD (HMO C-SNP) Part-C Premium

Optimum HealthCare, Inc plan charges a $0.00 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.



H5594-035 Part-D Deductible and Premium

Optimum Diamond Rewards COPD (HMO C-SNP) has a monthly drug premium of $0.00 and a $0.00 drug deductible. This Optimum HealthCare, Inc plan offers a $0.00 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0.00 this Premium covers any enhanced plan benefits offered by Optimum HealthCare, Inc above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $0.00 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.



Optimum HealthCare, Inc Gap Coverage

In 2022 once you and your plan provider have spent $4430 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Optimum HealthCare, Inc plan offer additional coverage through the gap.



H5594-035 Formulary or Drug Coverage

Optimum Diamond Rewards COPD (HMO C-SNP) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price. You can see complete 2022 Optimum Diamond Rewards COPD (HMO C-SNP) H5594-035 Formulary here.

Drug Tier Copay
Preferred
Pharmacy
Copay
Nonpreferred
Pharmacy
Tier 1 NA $0
Tier 2 NA $35
Tier 3 NA $85
Tier 4 NA 33%
*Initial Coverage Phase and 30 day supply







Reviews for Optimum Diamond Rewards COPD (HMO C-SNP) H5594



2021 Overall Rating
Part C Summary Rating
Part D Summary Rating
Staying Healthy: Screenings, Tests, Vaccines
Managing Chronic (Long Term) Conditions
Member Experience with Health Plan
Complaints and Changes in Plans Performance
Health Plan Customer Service
Drug Plan Customer Service
Complaints and Changes in the Drug Plan
Member Experience with the Drug Plan
Drug Safety and Accuracy of Drug Pricing


Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancer Screening
Annual Flu Vaccine
Monitoring Physical Activity


Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Functional Status Assessment
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Rheumatoid Arthritis
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy


Member Experience with Health Plan

Total Experience Rating
Getting Needed Care
Getting Appointments
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination


Member Complaints and Changes in Optimum Diamond Rewards COPD (HMO C-SNP) Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement


Health Plan Customer Service Rating for Optimum Diamond Rewards COPD (HMO C-SNP)

Total Customer Service Rating
Timely Decisions About Appeals
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language


Optimum Diamond Rewards COPD (HMO C-SNP) Drug Plan Customer Service Ratings

Total Rating
Call Center, TTY, Foreign Language


Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement


Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs


Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR
Statin with Diabetes


Coverage Area for Optimum Diamond Rewards COPD (HMO C-SNP)



Source: CMS.

Plans as of September 1, 2021.

Notes: Data are subject to change. All contracts for 2022 have not been finalized. For 2022, enhanced alternative plans may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part Part D benefit.

Includes 2022 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.

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