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Medicare Advantage · HMO · 2027

Optimum Gold Rewards Plan (HMO)

Optimum HealthCare, Inc. H5594-0264.5 CMS rating for 2027
Is it offered where you live?

At a glance: $0 monthly premium and $0 primary care visits.

Monthly premium
$0
Part B premium separate
Yearly limit
$4,450
Most you’d pay for in-network care
Hearing
$500/yr
Hearing aid allowance
Doctor visits
$0
Primary care · specialists $40

Check this plan for you

Referral needed to see a specialist

Add your doctors and prescriptions to see how they work with this plan.

Your doctors
Not checked yetSee if they’re in this plan’s network
Your prescriptions
Not checked yetSee your drug tier and monthly cost
Extra benefits
7 includedHearing · OTC allowance · Vision · Dental · Fitness · Transportation · Meals

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TTY: 711 · Monday to Friday, 8:00 AM to 6:00 PM CST

Costs and copays

Deductibles, yearly limit, visits, hospital stays and drug tiers
DeductiblesMedical · $0 for drugs
$0
Yearly limitIn-network care, not counting drugs
$4,450
Primary doctorPer visit
$0
SpecialistPer visit · referral needed
$40
Hospital stayPer stay
Days 1-7: $195/day, Days 8-90: $0/day
Inpatient mental healthHospital stay
Days 1-7: $195/day, Days 8-90: $0/day
Outpatient surgeryPer procedure
$195
Emergency roomPer visit
$150
Urgent carePer visit
$20
Tier 1 · Preferred Generic30-day supply at a retail pharmacy
$0
Tier 2 · Generic30-day supply at a retail pharmacy
$47
Tier 3 · Preferred Brand30-day supply at a retail pharmacy
$95
Tier 4 · Non-Pref Brand30-day supply at a retail pharmacy
33%

Our take

Where this plan shines, and what to know

Where this plan shines

  • This plan has a $0 monthly premium.
  • This plan’s out-of-pocket maximum is below the national median.
  • See your primary doctor for $0.
  • No separate drug deductible.
  • No separate medical deductible.
  • Highly rated by CMS (4.5 stars).

Things to know before you enroll

  • You’ll need to use in-network providers except in emergencies.
  • Limited coverage while traveling outside the plan’s service area.

Similar plans

Other Medicare Advantage plans offered in Florida

Common questions

6 answers about this plan

What does Optimum Gold Rewards Plan (HMO) cover?

Optimum Gold Rewards Plan (HMO) is a Medicare Advantage plan that the current plan record identifies as including Part D prescription drug coverage. The plan record also identifies Part D prescription drug coverage. Its published drug benefit lists 4 formulary tiers. Published supplemental benefits include dental (Preventive & comprehensive dental ($0 copay)), vision ($100/yr eyewear allowance), hearing ($500/yr hearing aid allowance), and over-the-counter (OTC) ($37/month OTC allowance). Review the plan documents for covered services, limits, and rules. Coverage can change each plan year.

Learn about Medicare Advantage

How much does Optimum Gold Rewards Plan (HMO) cost in 2027?

The published 2027 monthly plan premium for Optimum Gold Rewards Plan (HMO) is $0. Any Medicare premiums you owe are separate from the listed plan premium. The listed medical deductible is $0. The listed Part D deductible is $0. The in-network medical out-of-pocket maximum is $4,450; it does not include Part D drug spending. Published visit costs include primary care $0 and specialist visits $40. These figures are plan data, not a personal yearly-cost estimate.

Understand Medicare drug-cost limits

Can I use my current doctors with Optimum Gold Rewards Plan (HMO)?

CMS lists Optimum Gold Rewards Plan (HMO) as a HMO plan. The plan record says specialist referrals are required. A network label alone does not confirm that a specific doctor participates. Use the doctor lookup tool, then confirm with the doctor's office and the plan before receiving care. Provider networks and member costs can change. Emergency care and travel coverage can follow different network rules.

Check your doctors

Does Optimum Gold Rewards Plan (HMO) cover my prescriptions?

Optimum Gold Rewards Plan (HMO) has 4 published formulary tiers in the current plan record. Published preferred-pharmacy 30-day retail costs include Tier 1 at $0, Tier 2 at $47, Tier 3 at $95, and Tier 4 at 33%. The listed Part D deductible is $0. A tier listing does not confirm that a specific prescription is covered. Check each medication against the plan's current formulary, restrictions, pharmacy network, and costs before enrolling.

Check your prescriptions

What dental, vision, and hearing benefits does Optimum Gold Rewards Plan (HMO) include?

The current plan record for Optimum Gold Rewards Plan (HMO) lists dental (Preventive & comprehensive dental ($0 copay)), vision ($100/yr eyewear allowance), and hearing ($500/yr hearing aid allowance). It also lists over-the-counter (OTC) ($37/month OTC allowance). Benefit allowances, frequency, eligibility, and participating providers can have additional limits, so review the Summary of Benefits or Evidence of Coverage for the complete rules.

When can I enroll in Optimum Gold Rewards Plan (HMO)?

Optimum Gold Rewards Plan (HMO) is a 2027 Medicare Advantage plan. The Annual Enrollment Period runs from October 15 through December 7, with changes taking effect January 1. The Medicare Advantage Open Enrollment Period runs from January 1 through March 31 for people already enrolled in Medicare Advantage. A qualifying circumstance may create a Special Enrollment Period outside those dates. Confirm the enrollment window and effective date that apply to you before changing coverage.

Review Medicare enrollment periods

Plan documents

Summary of Benefits

Talk to a licensed agent

Talk with a licensed advisor

A licensed agent can review this plan and other plans in your area that fit your needs.

TTY: 711 · Monday to Friday, 8:00 AM to 6:00 PM CST

Optimum Gold Rewards Plan H5594-026 (HMO) — 2027 Costs & Benefits