Optimum Emerald Full (HMO D-SNP) By Optimum HealthCare, Inc
Optimum Emerald Full (HMO D-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 Emerald Full (HMO D-SNP) H5594-017 is a Dual Eligible Special Needs Plan (D-SNP). A Dual Eligible SNP is for beneficiaries who are eligible for both Medicare and Medicaid. If you have Medicare and get help from Medicaid you can join any Medicare SNP you qualify for or switch plans at any time.
2022 Medicare Special Needs Plan Details
| Plan Name: | Optimum Emerald Full (HMO D-SNP) |
|---|---|
| Plan ID: | H5594-017 |
| Special Needs Type: | Dual-Eligible |
| Provider: | Optimum HealthCare, Inc |
| Plan Year: | 2022 |
| Plan Type: | Local HMO |
| Monthly Premium C+D: | $34.30 |
| Part C Premium: | $0.00 |
| Part D (Drug) Premium: | $34.30 |
| Part D Supplemental Premium | $0.00 |
| Total Part D Premium: | $34.30 |
| Drug Deductible: | $480.00 |
| 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 Emerald Full (HMO D-SNP) H5594-017 is available to residents in Florida, and all Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage. Optimum Emerald Full (HMO D-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 Emerald Full (HMO D-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.
H5594-017 Part-D Deductible and Premium
Optimum Emerald Full (HMO D-SNP) has a monthly drug premium of $34.30 and a $480.00 drug deductible. This Optimum HealthCare, Inc plan offers a $34.30 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 $34.30 . 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.
Premium Assistance
The Low Income Subsidy (LIS) helps people with Medicare pay for prescription drugs, and lowers the costs of Medicare prescription drug coverage. Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The Optimum Emerald Full (HMO D-SNP) medicare insurance offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $8.60 for 75% low income subsidy $17.10 for 50% and $25.70 for 25%.
| Full LIS Premium: | $0.00 |
|---|---|
| 75% LIS Premium: | $8.60 |
| 50% LIS Premium: | $17.10 |
| 25% LIS Premium: | $25.70 |
H5594-017 Formulary or Drug Coverage
Optimum Emerald Full (HMO D-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 Emerald Full (HMO D-SNP) H5594-017 Formulary here.
| Drug Tier | Copay Preferred Pharmacy |
Copay Nonpreferred Pharmacy |
|---|---|---|
| Tier 1 | NA | $10 |
| Tier 2 | NA | $45 |
| Tier 3 | NA | $95 |
| Tier 4 | NA | 25% |
Reviews for Optimum Emerald Full (HMO D-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 Emerald Full (HMO D-SNP) Plans Performance
| Total Rating | ||
|---|---|---|
| Complaints about Health Plan | ||
| Members Leaving the Plan | ||
| Health Plan Quality Improvement |
Health Plan Customer Service Rating for Optimum Emerald Full (HMO D-SNP)
| Total Customer Service Rating | ||
|---|---|---|
| Timely Decisions About Appeals | ||
| Reviewing Appeals Decisions | ||
| Call Center, TTY, Foreign Language |
Optimum Emerald Full (HMO D-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 Emerald Full (HMO D-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.