Rewards and Incentives for Medicare Members

A great way to stay healthy and earn money.

As a valued Optima Medicare member, you can earn rewards for completing health-related activities that promote your health and wellbeing. Your rewardscan be used to purchase items using your prepaid flex card.

Earning rewards is easy!

Call

Call your doctor to schedule the preventive screening, exam, or vaccination.

Visit

Go to your appointment and complete the preventive screening, exam, or vaccination.

Claim

Your doctor will submit a claim to us showing you completed the preventive screening, exam, or vaccination.

Receive

We process your reward! Processing your reward will take eight 8–10 weeks after we receive the claim from your doctor.

Your Prepaid Flex Card

Your prepaid flex card works just like a prepaid credit card. As an Optima Medicare member, upon earning your first reward, you will receive your reloadable prepaid flex card in the mail.

There are two types of rewards you can earn. Grocery rewards can be used for approved grocery items at approved locations. Standard rewards can be used to buy almost anything. You cannot use rewards to buy tobacco, alcohol, or firearms.

Be sure to keep your prepaid flex card in a safe place! As you earn more rewards, the reward money will be added to your account, and you can keep using the same card all year.

Healthy Rewards¹ and Grocery Allowance²,³ are offered as two standalone programs on the same card. You can pay for eligible items with your funds through one centralized card.

Healthy Rewards Program

Annual Wellness Visit - $25 reward

The Annual Wellness Visit⁴ is an appointment with someone from your primary care provider’s team. At this appointment you can discuss any health issues you are having as well as plan for all preventive screenings, tests, and vaccines you might need over the next few years.

Eligibility: All members enrolled in Optima Medicare Value (HMO), Optima Medicare Prime (HMO), Optima Medicare Salute (HMO), Optima Medicare Engage (HMO C-SNP), or Optima Community Complete (HMO D-SNP)

Reward type: Grocery

Annual Physical Exam - $25 reward

The Annual Physical Exam is another great way for you to engage with your doctor. During an Annual Physical Exam, your provider reviews your current health history and completes a comprehensive physical exam and evaluation of chronic diseases, if applicable.

Eligibility: All members enrolled in Optima Medicare Value (HMO), Optima Medicare Prime (HMO), Optima Medicare Salute (HMO), Optima Medicare Engage (HMO SNP), or Optima Community Complete (HMO D-SNP)

Reward type: Standard

Health Risk Assessment - $25

The Health Risk Assessment (HRA)⁵ is a questionnaire that evaluates a member’s lifestyle and health status, as well as identifies possible health risks factors. Your Care Coordinator will work with you to develop a plan to help you reach your health goals.
You can easily complete your HRA by calling the Optima Medicare Outreach Team at 1-833-771-1427 (TTY: 711)., October 1 – March 31, 7 days a week, 8 a.m. – 8 p.m. and April 1 – September 30, Monday – Friday, 8 a.m. – 8 p.m..

Your HRA must be completed within 90 days of enrollment, and then annually after the first year of enrollment.

Eligibility: Members enrolled in Optima Community Complete (HMO D-SNP)

Reward type: Grocery

Bone Density Scan- $25 reward

A bone density scan measures how strong your bones are. The test will tell you if you have osteoporosis (or weak bones), and it can help you understand your risk of breaking a bone in the future.

Eligibility: Female members ages 65+ enrolled in Optima Medicare Value (HMO), Optima Medicare Prime (HMO), Optima Medicare Salute (HMO), Optima Medicare Engage (HMO SNP), or Optima Community Complete (HMO D-SNP)

Reward type: Standard

Breast Cancer Screening (Mammogram) - $25 reward

Regular mammograms can help detect breast cancer early, when it is easiest to treat. For most women, a mammogram is the best way to detect breast cancer. According to the Susan G. Komen Foundation, the five-year breast cancer survival rate for those diagnosed early (Stage 1) is 98-100%.

Eligibility: All members enrolled in Optima Medicare Value (HMO), Optima Medicare Prime (HMO), Optima Medicare Salute (HMO), Optima Medicare Engage (HMO SNP), or Optima Community Complete (HMO D-SNP)

Reward type: Standard

Colon Cancer Screening - $25 reward

According to the Centers for Disease Control and Prevention, regular screening is key to preventing colorectal cancer. For questions about which colorectal cancer screening is best for you, contact your doctor to learn your options. There are different types of screenings available, such as a colonoscopy or an at-home stool testing kit. For questions about which colorectal cancer screening is best for you, please contact your provider.

Eligibility: All members enrolled in Optima Medicare Value (HMO), Optima Medicare Prime (HMO), Optima Medicare Salute (HMO), Optima Medicare Engage (HMO SNP), or Optima Community Complete (HMO D-SNP)

Reward type: Standard

Diabetic HbA1c Test - $10 reward

Managing your diabetes includes regular screenings to ensure you are staying as healthy as possible. The HbA1c test measures how much of your hemoglobin is coated with sugar. The higher your level, the greater your chance for diabetes related complications down the road.

Eligibility: Members with diabetes who are enrolled in Optima Medicare Value (HMO), Optima Medicare Prime (HMO), Optima Medicare Salute (HMO), Optima Medicare Engage (HMO C-SNP), or Optima Community Complete (HMO D-SNP)

Reward type: Standard

Diabetic Eye Exam - $10 reward

Diabetic retinopathy is a common diabetes complication, and it is a leading cause of blindness in adults in the United States. If you have diabetes, you should check your eye health each year, even if you do not wear eyeglasses. This will help you protect and preserve your vision.

Reward type: Standard

Diabetic Kidney Function Test - $10 reward

Diabetes can damage the kidneys. Kidney function testing, such as the urine protein (microalbumin) screening, is important to ensure your kidneys are functioning optimally.

Reward type: Standard

Medication Therapy Management (Comprehensive Medication Review)^1,4 - $50 reward

If you are eligible, for the Medication Management Program, Express Scripts (ESI) will contact you on behalf of Optima Medicare to ask if you are interested in completing a Comprehensive Medication Review. This review is a special opportunity for you to talk one-on-one with a clinical pharmacist about all of your medications, including over-the-counter drugs. Participating in the review can help you make sure you are taking all of your medications safely and identify any possible medication interactions your physician may need to know about.
If you take eight or more medications for more than one chronic health condition and want to see if you are eligible for a Medication Therapy Management program, contact the ESI Pharmacy Help Desk at 1-800-922-1557 (TTY: 711) Monday – Friday, 8 a.m. – 5 p.m.

Eligibility: Eligible members enrolled in Optima Medicare Value (HMO), Optima Medicare Prime (HMO), Optima Medicare Engage (HMO C-SNP), or Optima Community Complete (HMO D-SNP)

Reward type: Grocery

Frequently Asked Questions

How does the rewards program work?

What are the eligibility criteria?

All Optima Medicare and Optima Community Complete members are eligible for at least four the Annual Wellness Exam and Annual Physical Exam. Some members may qualify for additional rewards, such as Breast Cancer Screening, Colorectal Cancer Screening, Bone Density Scan, Health Risk Assessment, or Medication Therapy Management. Members with diabetes can also earn a reward for completing a Diabetic Eye Exam, a Diabetic Kidney Function Test, or Diabetic HbA1c Testing.

If you are enrolled in Optima Community Complete (HMO D-SNP) and want to complete the Health Risk Assessment (HRA), you can complete your HRA by phone at 1-833-771-1427 (TTY:711), October 1 – March 31, 7 days a week, 8 a.m. – 8 p.m. and April 1 – September 30, Monday – Friday, 8 a.m. – 8 p.m.

If you are enrolled in an eligible plan and if you take eight or more medications for more than one chronic health condition and want to see if you are eligible for a Medication Therapy Management program, contact the ESI Pharmacy Help Desk at 1-800-922-1557 (TTY: 711) Monday – Friday, 8 a.m. –5 p.m.

What is the prepaid flex card?

Why should I participate in the Healthy Rewards Program?

How can I ask about my eligibility or to check the status of my earned rewards?

Disclaimers

¹Processing your reward takes 8–10 weeks after we receive the claim from the doctor. Rewards cannot be used to buy tobacco or alcohol. Rewards cannot be converted to cash. You can only receive one reward per applicable service per plan year. Services must be completed in 2023 using in-network providers. Rewards do not apply to the Optima Medicare Savings (HMO) plan. Optima Medicare Salute (HMO) members are not eligible for Medication Therapy Management.

²Members with a chronic condition(s) that meet certain criteria may be eligible for this special supplemental benefit. Benefits vary by plan. This benefit is not available to members.

³Refer to your Evidence of Coverage (EOC) for benefit eligibility, copayments, and allowances at optimamedicare.com/documents.

⁴The reward given for completing the Annual Wellness Visit, Health Risk Assessment, and Medication Therapy Management program has additional restrictions and can only be used for grocery items.

⁵The HRA reward is only for Optima Community Complete (HMO D-SNP) members.

Annual Wellness Visit, Health Risk Assessment, Medication Therapy Management are grocery rewards and can only be used to purchase approved grocery item at approved locations. All other rewards are standard and can be used to purchase nearly anything.
Rewards are not available to Optima Medicare Savings (HMO) members. Optima Medicare Salute (HMO) members are not eligible for MTM. Check additional eligibility notes for each reward.