Optimum Emerald Partial (HMO D-SNP) Costs & Coverage, Hillsborough County, Florida
Optimum Emerald Partial (HMO D-SNP) Costs & Coverage, Hillsborough County, Florida
Discover how Optimum Emerald Partial (HMO D-SNP) stands out as a 2025 Special Needs Plan (SNP), offering tailored coverage to fit your individual needs. This page provides a comprehensive look at the plan’s benefits and costs, helping you make an informed choice.
Delivery of healthcare services and costs by Optimum HealthCare, Inc. are different than Original Medicare. This private health insurance option, available to qualified individuals in Hillsborough County, FL, may include additional benefits that are not provided by Medicare Part A and Part B.
As of May 31, 2025, plan enrollments topped 2,349 members, with 558 in Hillsborough County, Florida.
Optimum Emerald Partial Overview
| Plan ID H5594-016-0 Overview | |
|---|---|
| Health Plan ID: | H5594-016-0 |
| Medicare Advantage Plan Type: | HMO D-SNP |
| Plan Year: | 2025 |
| Monthly Premium: | $19.50 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | $500.00 (In-Network) |
| Part B Give Back: | $0.00/mo |
| Part D Drug Plan Benefit: | Enhanced, $590.00 deductible |
| Additional Benefits: | Vision, Hearing |
| Availability: | Hillsborough County, FL |
| Insured By: | Optimum HealthCare, Inc. |
What You Need to Know
- This is a Medicare Special Needs Plan, with a HMO D-SNP provider network, exclusively for people with Medicare and Medicaid benefits (dual-eligible).
- This is not a zero-dollar D-SNP cost-sharing plan. Members have small copays on some Medicare-approved healthcare services.
- To qualify, you must live in Hillsborough County and have both Medicare Part A and Part B. Plus, you must qualify for full Medicaid.
- Optimum Emerald Partial includes a Medicare Part D prescription drug plan.
- The annual Part D deductible is $590.00.
- If you qualify for the Social Security "Extra Help" program, you can get financial assistance to help pay your Medicare Part D monthly premium, annual deductible, and prescription copayments.
- Optimum Emerald Partial provides the same coverage benefits as Medicare Part A and Part B (Original Medicare) and includes some extra benefits not covered by Original Medicare.
- If you are not qualified to enroll, one of the traditional Medicare Advantage plans available in Hillsborough County, Florida might be your best option.
- 2024 costs and benefits for Optimum Emerald Partial will be available in early October. Get Notification.
| We're Here to Help You Enroll |
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Premiums, deductibles, and copays can differ significantly between plans. It’s crucial to compare these costs carefully and consider how they align with your personal financial situation and healthcare needs.
Find out the costs for visiting your primary care doctor and specialists, as well as coverage for wellness and preventive programs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Primary: | $0 Copay |
| Specialist: | $0 Copay Prior Authorization Required, Referral Required |
Review the costs for emergency services, urgent care, ambulance services, inpatient hospital stays, and skilled nursing facility care.
| Service | Enrollee Cost |
|---|---|
| Emergency room care: | $0 Copay |
| Urgent care: | $0 Copay |
| Ground ambulance: | $0 Copay |
| Inpatient hospital care: | $0.00 per stay |
| Skilled Nursing Facility: | $0.00 per stay |
This section covers Medicare-approved foot care services, including exams and routine foot care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Foot Exams and Treatments (Medicare-covered): | $0 Copay Prior Authorization Required, Referral Required |
| Routine Foot Care: | Not Covered |
Understand the coverage for Medicare-approved chiropractic services and routine chiropractic care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Medicare-covered chiropractic: | $0 Copay Prior Authorization Required, Referral Required |
| Routine chiropractic: | $0 Copay Prior Authorization Required, Referral Required |
This section explains the costs for mental health services, including individual and group therapy, and inpatient care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Outpatient individual therapy: | $0 Copay |
| Outpatient group therapy: | $0 Copay |
| Inpatient psychiatric hospital care: | $0.00 per stay |
See the cost details for rehabilitation services, including physical therapy, speech therapy, and occupational therapy.
| Service | Enrollee Cost (in-network) |
|---|---|
| Physical therapy and speech and language therapy: | $0 Copay Prior Authorization Required, Referral Required |
| Occupational therapy: | $0 Copay Prior Authorization Required, Referral Required |
Learn about the costs associated with medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diabetes supplies: | $0 Copay Prior Authorization Required |
| Durable medical equipment: | $0 Copay Prior Authorization Required |
| Prosthetics: | Not Covered |
This section outlines the costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diagnostic radiology services: | $0 Copay Prior Authorization Required, Referral Required |
| Lab services: | $0 Copay Prior Authorization Required, Referral Required |
| Outpatient x-rays: | $0 Copay Prior Authorization Required, Referral Required |
| Diagnostic tests and procedures: | $0 Copay Prior Authorization Required, Referral Required |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Chemotherapy: | $0 Copay |
| Other Part B drugs (Medicare-covered): | $0 Copay |
This section details the dental services covered under your plan including Medicare-covered preventive dental, oral exams, x-rays, dental cleanings, and comprehensive dental.
| Service | Member Cost (in-network) |
|---|---|
| Medicare Covered Preventive Dental | $0 Copay Prior Authorization Required |
| Oral exam | |
| Dental x-rays | |
| Cleaning | |
| Periodontics | |
| Endodontics | |
| Restorative Services |
This section outlines the coverage for hearing-related services, including exams, fittings, and hearing aids.
| Service | Member Cost (in-network) |
|---|---|
| Fitting/evaluation | $0 Copay |
| Hearing aids | Covered Limits may apply |
| Hearing exam | $0 Copay |
Learn about the costs for vision-related services, including eye exams, eyeglasses, and contact lenses.
| Service | Member Cost (in-network) |
|---|---|
| Medicare-covered eye exam (in-network) | $0 Copay |
| Routine eye exam (in-network) | $0 Copay 1 Every year |
| Eyewear benefits | Eyeglasses: Yes Contact Lenses: Yes Eyeglass Lenses: No Eyeglass Frames: No Eyewear Upgrades: No |
Maximum eyewear benefit: | $400.00 Every year |
Certain preventive services are covered 100% by Optimum Emerald Partial as a Part B benefit.
Part D Prescription Drug Costs & Benefits
Prescription Drug Plan Premium
The following table outlines the prescription drug plan premium details of this plan.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $19.50 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $19.50 |
| Low Income Premium Subsidy: | $20.30 |
| Low Income Premium Subsidy CMS Pays: | $19.50 |
| Low Income Subsidy Premium: | $0.00 |
For more information about the Low Income Subsidy, refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $590.00. This is the amount you must pay at the pharmacy before Optimum HealthCare, Inc. begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Optimum Emerald Partial has out-of-pocket costs that you must pay when you pick up your prescriptions. The following table shows you those costs.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | 24.00% | 24.00% |
| Preferred Brand | 25.00% | 25.00% |
| Non-Preferred Drug | 25.00% | 25.00% |
| Specialty Tier | 25.00% | 25.00% |
| Supplemental Drugs* | $0.00 | $0.00 |
| *Deductible does not apply. | ||
Optimum Emerald Partial has a total monthly premium of $19.50 in Hillsborough County, including prescription coverage. Don’t forget, your Medicare Part B premium is also required.
CMS Star Ratings for Plan H5594-016-0 – 2025
| CMS Measure | Star Rating (out of 5) |
|---|---|
| 2025 Overall 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 |
If you are new to Medicare or Medicare Advantage plans, the following information will help you understand the enrollment process and restrictions.
Optimum Emerald Partial comes with an annual health plan deductible of $0.00. This amount does not include the prescription drug deductible (if applicable), which is described further down.
This Optimum HealthCare, Inc. plan has a Maximum Out-of-Pocket (MOOP) limit of {plan_moop}. Medicare Advantage plans, unlike Original Medicare, must establish a yearly MOOP limit for inpatient and outpatient services. After you’ve reached this amount through copayments, all of your Medicare Part A and Part B services will be covered at no extra cost for the remainder of the year. Note that MOOP does not cover monthly premiums, prescriptions, or other supplemental benefits.
5-Star Rating Marks
Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates Medicare Advantage HMO D-SNPs across nine broad categories using a 5-star rating system. These star ratings provide insight into the quality of care and service you can expect from this Optimum HealthCare, Inc. plan.
Here are some of the most frequently asked questions people have about plan ID H5594-016-0:
Optimum Emerald Partial is a Preferred Provider Organization (PPO) plan. As a member of this PPO plan, you typically access care through in-network providers, but you have the flexibility to see out-of-network providers if needed. Keep in mind that visits to non-network providers may result in higher out-of-pocket costs.
[partd_coverage] [/partd_coverage]Medicare Special Needs Plan Enrollment Periods
After determining your eligibility for Optimum Emerald Partial , it’s important to be aware of the Medicare Enrollment Periods, which determine when you can enroll in or change your plan. Depending on your circumstances, one of the following periods will apply:
- Initial Enrollment Period (IEP): The first time you can enroll in Medicare, typically around your 65th birthday.
- Annual Enrollment Period (AEP): Occurs yearly and allows you to make changes to your Medicare coverage.
- Special Enrollment Periods (SEPs): Special circumstances, such as moving or losing other coverage, may qualify you to enroll outside of the usual periods.
Contact Optimum HealthCare, Inc.
| Contact Type | Details |
|---|---|
| Website: | Optimum HealthCare, Inc. Plan Page |
| Providers: | Optimum HealthCare, Inc. Providers Page |
| Formulary: | Optimum HealthCare, Inc. Formulary Page |
| Pharmacy: | Optimum HealthCare, Inc. Pharmacy Page |
| New Member Health Plan Help: | (833)668-2305 |
| New Member Health Plan TTY: | 711 |
| New Member Part D Help: | (833)668-2308 |
| New Member Part D TTY Users: | 711 |
If you're eligible for Medicare but haven't enrolled or need to verify your enrollment status, visit the Social Security Administration website. For more information about Medicare Advantage, visit medicare.gov.
- Optimum HealthCare, Inc., http://www.YourOptimumHealthcare.com, Last Accessed June 1, 2025
- CMS.gov, "Dual Eligible Special Needs Plans (D-SNPs)", Last Accessed January 20, 2023
- Medicare.gov, "Understanding Medicare Advantage Plans", Last Accessed 25 May, 2025
- NCOA.org, "5 Steps to Choosing the Right Medicare Plan for You", Last Accessed 25 May, 2025
- CMS.gov, Landscape Source Files, Last Accessed October 15, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed October 15, 2024
- CMS.gov, Plan Benefits Package, Last Accessed October 15, 2024
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County, Last Accessed June 6, 2025
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