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Optimum Platinum Plan (HMO)
The Centers for Medicare & Medicaid Services (CMS) publishes annual Star Ratings that reflect how each Medicare Advantage plan performs across a range of metrics, using a system of one to five stars.
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Monthly Premium
Optimum Platinum Plan (HMO) is a HMO plan offered by Optimum HealthCare Inc.
Plan ID: H5594-002
HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.
Medicare beneficiaries may find it helpful to review available Medicare Advantage plans in their area. Medicare Advantage plans are designed to combine the coverage offered from Original Medicare (Medicare Part A and Part B) while also offering additional benefits.
Many Medicare Advantage plans may cover prescription drug coverage as well as additional benefits such as Dental, Vision and Hearing.
Learn more about Medicare Advantage plans such as Optimum Platinum Plan (HMO) - H5594-002 by Optimum HealthCare Inc. as well as other Medicare Advantage plans available in your area.
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Monthly Premium
Basic Costs and Coverage
| Coverage | Cost |
|---|---|
| Monthly Deductible | $-1 |
| Out of Pocket Max |
In-Network: $1000 Out-of-Network: N/A |
| Initial Coverage Limit | $0 |
| Catastrophic Coverage Limit | $2100 |
| Primary Care Doctor Visit | In-Network: $0.00 copay |
| Specialty Doctor Visit | In-Network: $0.00 copay |
| Inpatient Hospital Care | In-Network: $0.00 copay per stay |
| Urgent Care | Urgent Care: $10.00 copay |
| Emergency Room Visit | Emergency Care: $120.00 copay Copay waived if admitted to hospital within 72 hours Worldwide Coverage: This plan covers urgent care and emergency services, including emergency transportation, when traveling outside of the United States for less than six months. This benefi |
| Ambulance Transportation | Ground Ambulance: $200.00 copay Per Trip Air Ambulance:$ 20% coinsurance |
Health Care Services and Medical Supplies
Optimum Platinum Plan (HMO) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).
| Coverage | Cost |
|---|---|
| Chiropractic Services | In-Network: Medicare Covered Chiropractic Services: $0.00 copay |
| Diabetes Supplies, Training, Nutrition Therapy and Monitoring | In-Network: Diabetic Supplies: 0% coinsurance - 20% |
| Durable Medical Equipment (DME) | In-Network: 20% coinsurance |
| Diagnostic Tests, Lab and Radiology Services, and X-Rays | In-Network: Lab Services: $0.00 copay - $50.00 copay X-Rays: $0.00 copay - $75.00 copay Therapeutic Radiological Services: 20% coinsurance Outpatient Diagnostic Procedures/Tests: $0.00 copay - $75.00 copay Diagnostic Radiological Services: $25.00 copay - $75.00 copay |
| Home Health Care | In-Network: $0.00 copay |
| Mental Health Inpatient Care | In-Network: $0.00 copay per stay |
| Mental Health Outpatient Care | In-Network: Individual and Group Sessions: $0.00 copay |
| Outpatient Services / Surgery | In-Network: Outpatient Hospital - Surgery: $75.00 copay Observation Services: $75.00 copay Ambulatory Surgical Center: $0.00 copay |
| Outpatient Substance Abuse Care | In-Network: Individual and Group Sessions: $0.00 copay - $75.00 copay |
| Over-the-counter (OTC) Items | This plan covers certain approved, non-prescription, over-the-counter drugs and health-related items, up to $85 every month. Unused OTC amounts expire at the end of each month. |
| Podiatry Services | In-Network: Medicare Covered Podiatry Services: $0.00 copay |
| Skilled Nursing Facility Care | In-Network: Days 1 - 20: $0.00 per day / Days 21 - 100: $95.00 per day |
Dental Benefits
The following dental services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Dental Care | In-Network: Preventive Dental Services: $0.00 copay This plan covers: 2 oral exams, 2 emergency exams, 2 prophylaxis cleanings, 2 fluoride treatments and dental X-rays every year. Medicare Covered Dental: $0.00 copay Comprehensive Dental Services: $0.00 copay This plan covers up to: 2 resin or amalgam fillings, 2 simple or surgical extractions (in 1 or more visits), 2 periodontal maintenance procedures, 1 periodontal scaling and root planing per quadrant, 1 denture adjustment/reline every year, 1 full mouth debridement every 2 years, and 1 set of complete or partial dentures every five years. |
Vision Benefits
The following vision services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Vision Benefits | In-Network: Medicare Covered Eye Exam: $0.00 copay Routine Eye Exam: $0.00 copay This plan covers 1 routine eye exam(s) every year. Medicare Covered Eye Wear: $0.00 copay Routine Eye Wear: $0.00 copay and $30 This plan covers up to $400 for 1 pair(s) of eyeglasses or contact lenses every |
Hearing Benefits
The following hearing services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Hearing Benefits | In-Network: Medicare Covered Hearing Exam: $0.00 copay Routine Hearing Exam: $0.00 copay for routine hearing exam(s). $0.00 copay for hearing aids up to the maximum plan benefit amount. This plan covers 1 routine hearing exam every year. This plan covers 1 routine hearing aid fitting evaluation and a $750 maximum plan benefit for prescribed hearing aids per ear every year. |
Preventive Services and Health/Wellness Education Programs
The following services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Preventive Services and Health/Wellness Education Programs | In-Network: $0.00 copay for Medicare Covered Preventive Services |