Optimum HealthCare Medicare Advantage

Optimum HealthCare Medicare Advantage

Optimum Healthcare is one of the nations most popular providers of Medicare health plans. The health maintenance organization (HMO) is based in Tampa, and was established in 2004.  It’s operated by a group of physicians and offers policies to the residents of more than two dozen Florida counties. They offer four different Medicare health plans depending on where you live. There’s also a company office located in Spring Hill. Optimum Health Care Medicare Advantage plans offer more benefits than the original Medicare and include those with Part B premium reductions, prescription drug plans, and special needs plans (SNP), which are designed for those with chronic conditions. All of the plans come with zero deductibles and offer benefits such as dental, vision, and hearing coverage as well as fitness programs.

Plans with premium reductions for Part B include the Optimum Gold Rewards Plan (POS HMO)Diamond Rewards (POS HMO SNP), and Diamond Rewards COPD (POS HMO SNP). The part D prescription drug coverage plans provide both medical and drug insurance which can help you save on health care on cost.

These include the Optimum Platinum Plan (POS HMO), the Gold Rewards Plan (POS HMO), Diamond Rewards (POS HMO SNP), Diamond Rewards COPD (POS HMO SNP), and the Emerald Partial and Full plan.

To be eligible for the Diamond Rewards plan you need to be diagnosed with cardio vascular disease, diabetes mellitus, or chronic heart failure.

To be eligible for the Diamond Rewards COPD plan you need to be diagnosed with COPD (chronic obstructive pulmonary disease).

For the Emerald Plan you need to be eligible for both Medicare and Medicaid benefits (dual eligible).

The special needs plans are for those with specific chronic diseases. All of your hospital, medical services, and drug coverage come through these policies.

The plans available are the Optimum Diamond Rewards (POS HMO SNP), and Diamond Rewards COPD (POS HMO SNP).

To be eligible for the Diamond Rewards plan you need to be diagnosed with cardio vascular disease, diabetes mellitus or chronic heart failure.

For the Diamond Rewards COPD policy you need to have chronic obstructive pulmonary disease.

Special needs plans for those who are eligible for Medicare and Medicaid are classified either as partial or dual eligible. This will depending your income and other qualifying requirements and will be determined when you enroll with the Centers for Medicaid and Medicare. The plan for those who are dual eligible is the Emerald Partial and Full (HMO SNP).

If you use out-of-network services you’ll be asked to choose a primary care provider to coordinate your health care needs. You may need a referral to visit some doctors and in some instances non-network services are covered. You can always obtain emergency care from the closest health care provider. You’ll find that the rules for Optimum HealthCare POS options differ slightly. To get a quote please visit Medicare Supplement Insurance Quote.


  1. The people in Medicare advised me to contact you for dental plan and vision service. Please advise me.

  2. I need a medicare advantage plan in 34983 for COPD.with vision hearing dental and ex. My wife need a plan for pulmonary emboli.deep vein thrombisis.and a pluged venacava filter. Can u help us?

  3. am enrolled in va health care. can i enroll in medicare advantage plan and use my va doctor instead of an in network doctor?

    • You would need to ask your Va doctor this. Thanks

  4. I have the Optimum Platinum plan. Before I was on Optimum, I had COBRA through BC/BC of Iowa, through my husband’s company. At that time, I went to an orthopedic specialty group for a compression in my cervical spine, for which I had a graft and titanium implant. Since then, I have been diagnosis with osteoporosis of the spine. My current Optimum insurance physician has referred me to an orthopedic surgeon, who said “there is nothing I can do”. I really need to go back to the orthopedic surgeon who operated on my neck (with great success), but my physician says he cannot, as it is “out of network”. I have been presicribed numerous meds with no effect. The only thing that gives me remote relief is IBUB, the OTC kind, 800 mg. How can I get back to my original surgeon…I cannot take all these pills with any relief. I am intolerant of opeates, and don’t want to take them, anyway (I have been given them).

  5. I need to get info on OTC items covered thru Optimum

  6. I went to Hospital in Jan. 2017 for lower abdominal pain that turned out to be a serious infection from a perforated sigmoid colon. The perforation sealed itself, but the area is weakened and could abscess/rupture again at any time. In hospital, consulting doctors (Gastro-intestinal/General Surgeon/Ob-gyn/and hospitalist all said a resection is necessary. Once released, I required a referral to the GI for colonoscopy to assess the damage and if there are further issues to be addressed. The Gen. Surgeon is not in network, but works with both my Primary and the GI. How can I get him approved to do the resection surgery, since he is already up to speed on what needs to be done?

  7. Is this available here in the Philippines?

  8. what does dental cover in st pete fla ???

  9. I would recommend you do much more research before commitment . I have COPD and am left with no way of leaving home no portable oxygen or scooter to get my mail. I am unable to walk 10 feet without sitting down to catch my breath

  10. I am a seasonal and forgot to bring the pamphlet with me to order my OTC products. Where do I find this online?

  11. How do I find out how I can get my Medicare premium not taken out of my social security or at least refunded. I am very low income and only get social security.


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