Optima Medicare (PPO)
Common Questions
Q: What is a Medicare Advantage Plan?
A: Medicare Advantage Plans are health plan options that are part of the Medicare program. If you join one of these plans, you generally get all your Medicare-covered health care through that plan. This coverage can include prescription drug coverage.
Q: Who can join a Medicare Advantage Plan?
A: You can generally join a Medicare Advantage Plan if you meet these conditions:
- You have Part A and Part B
- You live in the service area of the Plan
- You don’t have End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).
Q: If I join a Medicare Advantage Plan am I still enrolled in the Medicare program?
A: Yes.
Q: If I join a Medicare Advantage Plan do I still have Medicare rights and protections?
A: Yes.
Q: If I join a Medicare Advantage Plan do I still get Part A and Part B coverage?
A: Yes.
Q: If I join a Medicare Advantage Plan do I get prescription drug coverage (Part D)?
A: If you want prescription drug coverage you should enroll in a plan that offers Part D coverage. In most Medicare Advantage Plans, if you want drug coverage, and your plan offers it, you must get it from your Medicare Advantage Plan.
Q: If I join a Medicare Advantage Plan do I get extra benefits?
A: You may be able to get extra benefits, like some coverage for vision, hearing, dental, and/or health and wellness programs.
Q: When can I join, switch, or drop a Medicare Advantage Plan?
A: You can join, switch, or drop a Medicare Advantage Plan:
- When you first become eligible for Medicare (3 months before you turn age 65 to 3 months after the month you turn age 65).
- If you get Medicare due to a disability, you can join during the 3 months before to 3 months after your 25th month of disability benefits.
- From November 15 to December 31 each year. Your coverage will begin on January 1 of the following year.
- From January 1 to March 31 of each year. However, you can’t add or change to a plan with prescription drug coverage during this time unless you already have Medicare prescription drug coverage.
Q: If I join a Medicare Advantage Plan, can I switch to another plan or drop my plan?
A: Yes, but only during certain times of the year (see the question above for details).
Q: If I join a Medicare Advantage Plan, what premiums do I have to pay?
A: You generally still pay the monthly premium (if they charge one) that includes coverage for Part A and Part B benefits, prescription drug coverage (Part D, if offered), and any other extra benefits (if offered).
Q: If I enroll in an Optima Medicare Plan, are prescription drugs covered?
A: Yes, if you choose an Optima Medicare Plan with prescription drug coverage -- either Optima Medicare Preferred Plus or Optima Medicare Value Plus.
Q: If I enroll in an Optima Medicare Plan, do I need to choose a primary care doctor?
A: No.
Q: If I enroll in an Optima Medicare Plan, can I get healthcare from any doctor or hospital?
A: Yes. An Optima Medicare Plan has an extensive network of doctors and hospitals, but you can use out-of-network providers for covered services, usually for a slightly higher cost.
Q: If I enroll in an Optima Medicare Plan, do I have to see a primary care doctor to get a referral to see a specialist?
A: In most cases, no.
Q: If I enroll in an Optima Medicare Plan, what else do I need to know about this type of plan?
A: You may be able to get extra benefits for an additional premium.
What Would You Like to Do Now?
Enroll Now -- a Medicare Advisor can help,
call toll-free 1-866-806-0333 (TTY/TTD 1-800-225-7784)
Register for a free Optima Medicare (PPO) Meeting
Request a free Enrollment Kit and Decision Guide