Optima Health
Toll-free 1-855-434-3267
TTY 1-800-828-1140 or 711
Monday – Friday | 8 am – 5 pm EST
Optima Health
Toll-free 1-855-434-3267
TTY 1-800-828-1140 or 711
8 am - 8 pm | Monday - Friday

 Common Questions 

Q: What is a Medicare Advantage (MA) 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 (ESRD) (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 (three (3) months before you turn age 65 to three (3) months after the month you turn age 65).
  • If you get Medicare due to a disability, you can join during the three (3) months before to three (3) months after your 25th month of disability benefits.
  • From October 15 to December 7 each year. Your coverage will begin on January 1 of the following year.
  • From January 1 to February 14 of each year. You can disenroll from your MA plan and return to Original Medicare. You will then have a special election period (SEP) in which to choose a new Prescription Drug Plan (PDP), if you want one.

There are additional times you join, switch or drop a Medicare Advantage Plan. See Eligibility Information and Enrollment Information.

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 pay the monthly premium that includes coverage for Part A and Part B benefits, prescription drug coverage (Part D, if offered), and any other extra benefits (if offered). You must continue to pay your Medicare Part B premium also.

Q: If I enroll in an Optima Medicare HMO Plan, are prescription drugs covered?
A: Yes, both Optima Medicare plans have prescription drug coverage.

Q: If I enroll in an Optima Medicare Plan, do I need to choose a primary care doctor?
A: Yes. The Optima Medicare plans require selection of a primary care physician (PCP).

Q: If I enroll in an Optima Medicare Plan, can I get healthcare from any doctor or hospital?
A: Optima Medicare members are covered through a network of locally contracted doctors and hospitals. Members need to select a family care doctor from the plan’s network of providers to provide their routine care and help coordinate their care from other network providers.

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: No. A referral is not required to see a specialist.

Last Updated 9/30/2016 5:44 AM