Medicare Plans

Care That Changes With Your Clients' Needs

We’re proud to offer Optima Medicare – plans that give your clients everything Medicare offers plus some extra benefits and preventive services including:

• $0 copay for personal doctor visits
• $0 copay for many generic drugs
• Dental, vision and hearing benefits

Important Changes for 2019

New dental and plan options are available with the 2019 Optima Medicare HMO plans, and enrollment in Optima Community Complete (HMO SNP) is now available:

• Dental Plan Comparison

  Enrollment in dental coverage is only available during the Annual Election Period, or when a new enrollee initially signs up with a plan.

  Plan	Preventive	Preventive Plus	Comprehensive
  Premium	$0.00 / month	+$13.50 / month	+$16.00 / month
  Oral Exams and Cleanings	$0 copay 2 oral exams and cleanings / year	$0 copay 2 oral exams and cleanings / year	$0 copay 2 oral exams and cleanings / year
  X-ray	$0 copay 1 x-ray / year	$0 copay 1 x-ray / year	$0 copay 1 x-ray / year
  Fluoride Treatment	$0 copay 2 treatments / year	$0 copay 2 treatments / year	$0 copay 2 treatments / year
  Maximum Benefit Coverage	None	$750	$1000
  Fillings	None	Yes	Yes
  Extractions	None	Yes	Yes
  Oral Surgery	None	Yes	Yes
  Periodontal Treatment	None	Yes	Yes
  Root Canal	None	Yes	Yes
  Dentures and Denture and Prosthetic Maintenance	None	Yes	Yes
  Crowns	None	Yes	Yes
  Implants	None	None	Yes

• Optima Community Complete (HMO SNP)

  Optima Community Complete (HMO SNP) is a Dual Special Needs Plan (D-SNP) that offers members a more specialized level of care for highly sensitive needs. This type of plan may be available if a member receives Medicaid and is also eligible for Medicare. This coverage is a type of Medicare Advantage plan in that members still get the same great benefits from their Medicaid coverage, plus enhanced care coordination and management of their medical needs.

  Coverage and Eligibility

  Enrollees must:

  • be enrolled in Medicare Part A and Part B
  • receive help from state Medicaid assistance
  • live in our service area

  You can learn more about this plan on the Optima Community Complete website.

Broker Resources

• Scope of Appointment Confirmation Form (PDF, 53KB)

2019 Plans

Optima Community Complete

• Optima Community Complete Enrollment Form (PDF, 106KB)
  For Dual Eligible Special Needs members who are eligible for both Medicare and Medicaid.
• Optima Community Complete - Summary of Benefits (PDF, 3.8MB)
• Optima Community Complete Formulary
• Optima Community Complete Provider Directory

Optima Medicare HMO

• Short Enrollment Form
  For members who are already enrolled and wish to change their coverage options.
• Dental Enrollment Form
  For members who wish to enroll in Optional Dental coverage.
• Online Enrollment Form
  For enrolling new members in Optima Medicare HMO plans, including Optional Dental coverage.
• 2019 Optima Medicare HMO Decision Guide
• 2019 Optima Community Complete - Summary of Benefits
• 2019 Optima Medicare HMO - Summary of Benefits - Peninsula
• 2019 Optima Medicare HMO - Summary of Benefits - Southside
• 2019 Optima Medicare HMO Formulary
  Gold tier formulary for Optima Medicare Prime and Value.
• Optima Medicare HMO Provider Directory