Using your Added Benefits for Medicare
Did you know plans offered by Optima Medicare are all-in-one plans? That means dental, vision, hearing, and other added benefits are built into our plans to give you more! Read the information below and learn how to use and access your Added Benefits.
2021 Added Benefits
Both preventive and comprehensive dental services are available with your Optima Medicare plan. Plus, you will have access to our quality dental network.
- Preventive Dental - covers cleanings, fluoride treatments, x-rays, and oral exams with a $0 copay.
- Comprehensive Dental - covers fillings, extractions, and many additional enhanced services.
Over-the-Counter (OTC) Product Allowance
Your Optima Medicare plan can help keep more money in your pocket when you take advantage of your OTC quarterly allowance.
Purchase a wide selection of drugs, supplies, and healthcare products that are provided without a prescription through the plan’s catalog of items. You must spend your allowance each quarter. Leftover funds cannot be carried over to the next quarter.
Order by phone at 1-877-438-7521, or order online (This link will open a new browser tab or window and takes you to a website that is not owned or operated by Optima Health).
You have a $0 copay for your routine annual eye exam, plus an allowance toward the cost of glasses or contact lenses. All vision services are offered through EyeMed® providers.
Routine Transportation for Medical Needs
We provide rides for you to and from health-related locations, such as doctor appointments and the pharmacy. Just call Optima Medicare Member Services at 1-800-927-6048 72 hours (3 business days) in advance to arrange transportation.
Non-medical transportation is available for members with chronic conditions to plan-approved locations such as church, grocery stores, senior centers, and plan-sponsored events. Trip limits vary by plan. Members are required to provide 72 hours (3 business days) notice to arrange transportation. Just call Optima Medicare Member Services at 1-800-927-6048 for assistance with scheduling.
Hearing Exams and Aids
You have a $0 copay for your routine hearing exam, plus free fittings, and a free hearing aid up to a $500 value for each ear (12-month warranty). All hearing services are offered through NationsHearing® providers.
Annual Wellness Visit
Your Annual Wellness Visit is an important part of planning for your current and future health and is available at no cost to you as an Optima Medicare member. During this visit, you and your provider will map out a personalized prevention plan to keep you healthy. This can involve things such as cancer screenings, preventive screenings, immunizations, and advance care planning.
The Annual Wellness Visit is one of the eligible activities included in our 2021 Healthy Rewards Program. Learn more about rewards and incentives.
Annual Physical Exam
During an Annual Physical Exam, your Primary Care Provider (PCP) reviews your current health history. The Annual Physical Exam benefit includes comprehensive physical examination and evaluation of the status of chronic diseases. This is available at no cost to you and is a more in-depth look at your current health than an Annual Wellness Visit, but both types of appointments should always be scheduled.
Limit of one Annual Physical Exam per calendar year.
Plus, you can earn a reward by completing the Annual Physical Exam through the 2021 Healthy Rewards Program. Learn more about rewards and incentives.
Enhanced Disease Management
- Get everyday support for your type 2 diabetes from the comfort of your home with Onduo. Onduo Virtual Diabetes Program*1 is a virtual care center that provides eligible members with daily access to diabetes tools and experts. Activate your benefit today by calling 1-833-HiOnduo (1-833-446-6386) or by going to onduo.com/optimawelcome1 (This link will open a new browser tab or window and takes you to a website that is not owned or operated by Optima Health). Enter your personal code when prompted. Your personal code can be found in your Onduo welcome letter.
- COPD360 is a home-based enhanced disease management program for members with a diagnosis of Chronic Obstructive Pulmonary Disease (COPD) who had an inpatient admission caused by COPD and used home oxygen within the last 12 months. Prior authorization required.
- Only available for Optima Medicare Value (HMO) and Optima Medicare Prime (HMO) members in the Hampton Roads region.
- To see if you are eligible and want to learn more, contact Optima Medicare Member Services at 1-800-927-6048.
1: OnDuo is offered as a part of your healthcare enhanced benefits. A deductible may apply for some members.
Telehealth through MDLIVE® Benefit
Optima Medicare provides you with the flexibility of accessing high-quality care from anywhere at any time.
This means you can have a “virtual visit” with a board-certified doctor or licensed therapist from anywhere, by video conference or smartphone. It is secure and convenient.
- Telehealth doctors can diagnose, treat, and write prescriptions for routine medical conditions.
- Telehealth appointments with a counselor or psychiatrist.
- Expanded options offered through participating healthcare providers.
- Telehealth through MDLIVE® is available 24 hours a day, every day, including holidays.
- Telehealth doctors can assist with many non-emergency medical conditions and can diagnose, treat, and even prescribe medication when appropriate.
Qualifying members can receive meals after being discharged from an inpatient facility, such as a hospital or skilled nursing facility. You will get up to two meals per day for up to 28 days delivered to your home, for free. Prior authorization is required by the health plan.
24/7 Nurse Advice Line
For illnesses or injuries that happen after hours or when your doctor’s office is closed, you can call the 24/7 Nurse Advice Line at 1-800-394-2237. You will be put in contact with a professional nurse trained in emergency or acute care. They will be able to assess your medical situation, advise you as to where to seek care, and suggest self-care options until you can see your doctor.
Please note: The nurse will not have access to your medical records, cannot diagnose medical conditions, order lab work, write prescriptions, order home health services, or initiate hospital admissions.
In an emergency, always go to the closest emergency room or call 911.
Optima Medicare cares about helping you live an active lifestyle. That is why your added benefits include a fitness reimbursement. You can get reimbursed from $360 to $500 a year based on your Optima Medicare plan type.
- This amount varies by plan:
- Value – up to $360/year
- Prime – up to $500/year
- Classic – up to $400/year
- This benefit can be applied to:
- gym membership fees
- personal training sessions at a gym ONLY
(in-home personal training sessions are NOT reimbursed)
- fitness classes
- EXCLUDED from reimbursement are:
- equipment purchases and equipment rental fees
- weight loss programs
- other items not directly related to the fitness activity
- Members must submit for reimbursement within 365 days of incurring the expense.
- Members must submit a receipt or other documentation showing the cost incurred in addition to the fitness reimbursement form.
- This amount varies by plan:
Personal Emergency Response System (PERS)
PERS connects eligible members to help with just a push of a button. Eligible members receive a PERS in-home monitoring device that can get them help quickly, 24 hours a day. Eligible members must have a working landline and/or cellular phone coverage to take part in this benefit. Prior authorization is required.