Medicare Advantage · HMO
Optimum HealthCare, Inc.
Plan year 2026

Optimum Gold Rewards Plan H5594-026 (HMO)

4.5 · 2026 Star Rating · source: CMS · Ratings are updated annually
Monthly premium
$0
+ your Part B premium
Max out-of-pocket
$4,200
in-network annual cap
Primary care
$0
per visit copay
Specialist
$40
per visit

Your costs at a glanceIn-network, for the 2026 plan year

Rx deductible
$0
Inpatient hospital
Days 1-7: $195/day, Days 8-90: $0/day
Inpatient mental health
Days 1-7: $195/day, Days 8-90: $0/day
Outpatient surgery
$195
Emergency room
$150
Urgent care
$20

What's included, and what it's actually worth6 benefits included. Tap any card for the detail

OTC allowance

$45/month OTC allowance
Prepaid card$45/month OTC allowance

Hearing

$500/yr hearing aid allowance
Hearing aid allowance$500/yr hearing aid allowance
This is a supplemental benefit with plan-specific limits. See plan documents for details.

Vision

$100/yr eyewear allowance
Eyewear allowance$100/yr eyewear allowance
This is a supplemental benefit with plan-specific limits. See plan documents for details.
See more details about this plan
Doctor Visits: PCP$0 copay
In-network$0 copay per visit
Doctor Visits: Specialist$40 copay
In-network$40 copay per visit
Inpatient Hospital$195/day, days 1–7
In-networkDays 1-7: $195/day, Days 8-90: $0/day
Outpatient Surgery$195 copay
In-network$195 copay per procedure
Mental HealthDays 1-7: $195/day, Days 8-90: $0/day
Inpatient psychiatricDays 1-7: $195/day, Days 8-90: $0/day
Fitness$0 fitness benefit
Transportation6 one-way trips/year
Trips per year6 one-way trips/year
MealsMeal benefit

Your coverageCheck your coverageFrom the doctors and prescriptions you added

Your plan's drug tiers30-day retail · after any applicable deductible

Tier 1
$0
Preferred Generic
Tier 2
$10
Generic
Tier 3
$50
Preferred Brand
Tier 4
33%
Non-Pref Brand

Our take

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.
Highly rated by CMS (4.5 stars).

Things to know before you enroll

Network restriction — you’ll need to use in-network providers except in emergencies.
Limited coverage while traveling outside the plan’s service area.
Questions? Talk to a licensed agent at1-866-764-3312 (TTY: 711)

Plan documents

Plan questions

Common questions about Optimum Gold Rewards Plan (HMO)

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 vision ($100/yr eyewear allowance), hearing ($500/yr hearing aid allowance), over-the-counter (OTC) ($45/month OTC allowance), and fitness ($0 fitness benefit). 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 2026?

The published 2026 monthly plan premium for Optimum Gold Rewards Plan (HMO) is $0. The standard Part B premium is $202.90/month in 2026 for most people; assistance may pay it for some members. The listed Part D deductible is $0. The in-network medical out-of-pocket maximum is $4,200; 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. 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 $10, Tier 3 at $50, 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 vision ($100/yr eyewear allowance) and hearing ($500/yr hearing aid allowance). It also lists over-the-counter (OTC) ($45/month OTC allowance). The current data does not list dental as offered benefits. 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 2026 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

More plan options

Browse the full 2026 Medicare Advantage with drug coverage directory. This plan is offered in Florida. Plan availability can vary by county.

Helpful next steps

Optimum Gold Rewards Plan H5594-026 (HMO) — 2026 Costs & Benefits