Optimum HealthCare

What Optimum HealthCare does

Optimum HealthCare, Inc. is a Florida-based Medicare Advantage HMO that designs, distributes, and administers health plans for Medicare-eligible beneficiaries across 24 Florida counties. Founded around 2010, the company currently serves over 75,000 members through three core plan variants: a standard Medicare Advantage HMO, a Chronic Condition Special Needs Plan (C-SNP) for members with diabetes, cardiovascular disease, chronic/congestive heart failure, and COPD, and a Dual Special Needs Plan (D-SNP) for Medicare/Medicaid dual-eligible beneficiaries. The company is contracted with CMS under a Medicare Advantage HMO agreement and with the state of Florida Medicaid program, and was awarded a 4.5-star CMS quality rating for 2026 and NCQA Model of Care approvals to operate C-SNP through 2026 and D-SNP through 2027.

The underlying platform combines an HMO delivery model anchored by a Florida provider network (1,800+ primary care offices, 12,000+ specialist offices, 4,700+ network pharmacies) with member-facing technology — a member portal for account management, an OTC online ordering system covering 260+ items with monthly allowance management, a provider/pharmacy search tool, and a Medicare plan comparison tool. Distribution is sales-led via licensed insurance agents operating by phone, through scheduled appointments, and at four concierge offices in Largo, New Port Richey, Ocala, and Spring Hill, with additional enrollment available through the CMS Medicare Online Enrollment Center and the company's website (available in English and Spanish).

Revenue is generated primarily through CMS Medicare Advantage capitation payments and Florida Medicaid capitation for dual-eligible members, supplemented by member premiums for supplemental benefits (vision, dental, prescription drugs). Plans are predominantly offered at $0 additional monthly premium beyond standard Medicare Part B, with monetizable supplemental benefits including OTC allowances of $35-$130/month, SilverSneakers fitness memberships, Part B Premium refunds up to $185/month on select 2026 plans, Everyday Options Allowances of $70-$200/month on select SNP plans, and Personal Emergency Response Systems. In April 2026, Infosys announced a $465 million acquisition of Optimum HealthCare (part of a $560 million combined transaction with Stratus), with closing expected by June 2026, signaling a strategic shift toward technology-led scaling under an IT services parent.

Name

Optimum HealthCare

Legal name

Optimum HealthCare, Inc.

Website

https://youroptimumhealthcare.com

Company type

Private

Founded year

2010

Operating status

Operating

Headcount range

11–50 employees

Short description

Optimum HealthCare is a Florida-based Medicare Advantage HMO serving 75,000+ members across 24 counties with standard MA, C-SNP, and D-SNP plans, earning a 4.5-star CMS rating for 2026 and recently agreed to be acquired by Infosys for $465 million.

Ownership category

akta.pro rank

Product category

Medicare Advantage Insurance

NAICS

Direct Health and Medical Insurance Carriers (524114), Direct Life, Health, and Medical Insurance Carriers (52411)

SIC

Hospital & Medical Service Plans (6324)

akta.pro primary industry

Medicare Advantage HMOs (HMO/HMO-POS) (HLAEAMAH)

akta.pro secondary industries

MA HMO Plans (HLAEACAA), MA-PD Plans (Medicare Advantage with Prescription Drug Coverage) (FSAIAGAG), MA Chronic Condition Management & Supplemental Benefits (SSBCI) (HLAEACAI), D-SNP Quality, Stars, HEDIS & Compliance (HLAEAFAJ)

Keywords

• Medicare Advantage plans
• HMO health insurance
• Special needs plans
• Prescription drug coverage
• Medicare supplements

Headquarters

HQ city

Tampa

HQ country

United States

HQ region

North America

Offices6 records

Markets served

GTM type

B2C

Offering type

Services

Cost components

Personnel, Operations, Marketing or Sales, Technology or R&D, Infrastructure, Supply Chain

Revenue model

1. Medicare Advantage Plan Premiums: Optimum HealthCare operates as an HMO with Medicare contracts, generating revenue through Medicare Advantage plan premiums paid by the federal government (Part C) and member premiums for supplemental benefits such as prescription drugs, vision, and dental coverage.
2. Florida Medicaid Contract: Optimum HealthCare holds a contract with the state of Florida Medicaid program, providing additional revenue streams for serving dual-eligible beneficiaries.

Pricing tiers

Go-to-market motion1 record

Distribution channels4 records

Marketing channels5 records

Core offering

Optimum HealthCare is a Florida-based Medicare Advantage HMO that sells Medicare Advantage health plans covering hospitalization (Part A), medical insurance (Part B), and prescription drug coverage (Part D), along with supplemental benefits such as OTC allowances, vision, dental, fitness memberships, and Part B premium refunds. It also operates specialized Chronic Condition Special Needs Plans (C-SNP) and Dual Special Needs Plans (D-SNP) for members with chronic conditions or dual Medicare/Medicaid eligibility, distributing plans through licensed agents, concierge offices, and the CMS Medicare Online Enrollment Center across 24 Florida counties.

Product overview

Optimum HealthCare is a Florida-based Medicare Advantage HMO offering a comprehensive portfolio of health plans and supplemental benefits. The core product is the Medicare Advantage Plan (HMO with Medicare contract and Florida Medicaid contract), which is available in three main variants: the standard Medicare Advantage Plan, the Chronic Condition Special Needs Plan (C-SNP) for members with diabetes, cardiovascular disease, chronic heart failure, or COPD, and the Dual Special Needs Plan (D-SNP) for dual-eligible Medicare/Medicaid members. The plans include numerous add-on modules and supplemental benefits including Over-the-Counter (OTC) allowances ($35-$130/month), SilverSneakers fitness membership, Part B Premium refunds (up to $185/month), Everyday Options Allowance ($70-$200/month for eligible plans), Personal Emergency Response System (PERS), Active Fitness benefit ($500/year), and dental/vision coverage. The company serves over 75,000 members across 24 Florida counties.

Differentiator

Problem solved

Functional benefit

Products and services

• Medicare Advantage Plans HMO-based Medicare Advantage health plans covering hospital insurance (Part A), medical insurance (Part B), and typically prescription drug coverage (Part D), offered with $0 additional monthly premium on most plans and supplemental benefits such as OTC allowances, vision, dental, and SilverSneakers fitness membership. Designed for Medicare-eligible seniors and qualifying individuals in 24 Florida counties.
• Chronic Condition Special Needs Plan (C-SNP) Specialized Medicare Advantage plan for members with chronic conditions such as diabetes, cardiovascular disease, chronic heart failure, and chronic pulmonary disease, providing disease management support, care coordination, and tailored benefits including the Everyday Options Allowance. NCQA-approved through 2026.
• Dual Special Needs Plan (D-SNP) Medicare Advantage plan for members who qualify for both Medicare and Medicaid benefits, offering coordinated care across both programs and specialized benefit structures including the Everyday Options Allowance. Focus areas include high-risk pregnancy for the dual-eligible population. NCQA-approved through 2027.
• Over-the-Counter (OTC) Benefits Monthly allowance of $35 to $130 based on plan and county, enabling members to order non-prescription health products including first aid supplies, analgesics, vitamins, antacids, and diabetic supplies through the member portal or OTC Order Line, shipped to home at no extra cost. Unused allowance does not roll over.
• SilverSneakers Fitness Membership Complimentary fitness membership provided through Tivity Health, offering access to participating gyms and fitness facilities, with home fitness kits also available for members.
• Part B Premium Refund Select 2026 plans offer a monthly Part B Premium refund up to $185, added directly to the member's Social Security check, reducing the net cost of Medicare coverage for eligible enrollees.
• Everyday Options Allowance Monthly allowance of $70 to $200 for select 2026 C-SNP and D-SNP plans, usable on food, produce, utilities, and assistive devices for chronically ill members. Eligibility confirmation required by phone.
• Personal Emergency Response System (PERS) 24/7 emergency monitoring service with a lightweight, wearable, shower-safe pendant button available on select 2026 plans, providing immediate access to emergency assistance for members at home.
• Active Fitness Benefit Up to $500 yearly facility allowance for golf, tennis, or swimming activities provided to eligible members on select 2026 plans. Unused funds do not roll over.
• Dental and Vision Coverage Supplemental dental and vision benefits not covered by original Medicare, available through Medicare Advantage plan options to reduce out-of-pocket costs for routine and specialty care.

Quantifiable outcome

• 4.5-star CMS quality rating for 2026
• +2 more outcomes

Named customers3 records

Segments3 records

Ideal customer profiles3 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature4 records

Partnerships

Five partnerships are on record, tiered core and minor.

• Elevance Health (Parent Company)coreStrategic or Co-development PartnerOptimum HealthCare is part of the Elevance Health (formerly Anthem) family of companies. The parent company provides medical and corporate policies, and members can access careers through the Elevance Health careers portal.
• Tivity Health (SilverSneakers)coreTechnology or IntegrationSilverSneakers fitness program is provided by Tivity Health, an independent company. SilverSneakers and the SilverSneakers shoe logotype are registered trademarks of Tivity Health, Inc. The program provides fitness membership at no cost to Optimum HealthCare members.
• Carelon Behavioral Health OptionsminorStrategic or Co-development PartnerCarelon Behavioral Health Options provides delegated behavioral health services and continually reviews and adopts clinical guidelines that meet standards for guideline rigor and transparency.
• CMS (Centers for Medicare & Medicaid Services)coreStrategic or Co-development PartnerOptimum HealthCare operates as an HMO with a Medicare contract from CMS, providing Medicare Advantage plans. The company is also contracted with the state of Florida Medicaid program.
• Florida Medicaid ProgramcoreStrategic or Co-development PartnerOptimum HealthCare holds a contract with the state of Florida Medicaid program, enabling the company to serve dual-eligible beneficiaries.

Scale indicators6 records

Recent moves6 records

Expansion highlights5 records

Broad incumbents

• Humana: Largest US Medicare Advantage insurer with dominant Florida presence via its CarePlus subsidiary; competes head-on with Optimum across HMO plans, SNPs, and supplemental benefits in overlapping Florida counties.
• Cigna Healthcare: Major national health insurer expanding MA HMO footprint in Florida with comparable supplemental benefit packages and SNP products.
• Aetna (CVS Health): National MA carrier offering Medicare Advantage HMO plans in Florida counties overlapping Optimum, leveraging CVS retail footprint for distribution.
• UnitedHealthcare (AARP Medicare): National MA market leader offering Medicare Advantage HMO/POS plans throughout Florida with massive scale, AARP co-branding, and broad provider network directly comparable to Optimum's offering.

Emerging players

• Devoted Health: Tech-enabled Medicare Advantage HMO plan with growing Florida presence; targets the same senior demographic with similar supplemental-benefit-heavy product design.
• Clover Health: Medicare Advantage HMO plan leveraging software platform for care management; serves overlapping Florida geographies with similar SNP-eligible population focus.
• Alignment Healthcare: Tech-forward MA plan with Florida expansion strategy focused on HMO products and heavy supplemental benefits; represents the next-generation competitor to plans like Optimum.

Direct peers

• Simply Healthcare (Elevance Health): Florida-focused Medicare and Medicaid plan owned by Optimum's former parent Elevance Health; offers near-identical MA HMO products, dual-eligible SNPs, and provider-network model.
• CarePlus Health Plans: Humana-owned Medicare Advantage HMO subsidiary focused exclusively on Florida; almost identical product set, geographic concentration, and SNP strategy to Optimum.
• Florida Blue (GuideWell): Blue Cross Blue Shield of Florida; the state's incumbent not-for-profit health plan offering Medicare Advantage HMO products across overlapping Florida counties, competing directly for the same senior population.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks7 records

Key highlights7 records

Customer concentration

• Facebookfacebook.com/Optimum-Healthcare-101808956833664

Compliance5 records

Revenue estimate

Valuation estimate

Number of profiles

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Optimum HealthCare