Medicare Learning Center
What is a Medicare Advantage plan?
Original Medicare is the standard hospital (Part A) and medical (Part B) individual coverage offered by the federal government. Original Medicare does not cover some routine services, such as vision and dental.
Medicare Advantage (Part C) plans are offered through private insurance companies, such as Optima Health. The plans offer a full range of benefits beyond the Part A and Part B coverage you get from Original Medicare.
As an extra convenience, many Medicare Advantage plans can also include Medicare Part D prescription drug coverage and important supplemental benefits. It eliminates the need for a Medicare Supplement (Medigap) policy. Every Medicare Advantage plan is regulated by the government to ensure you get everything Original Medicare offers and more.
Part A: Hospital
- Inpatient hospital stay
- Skilled nursing facility
- Hospice care
- Skilled home health
Part B: Medical
- Doctors' services
- Outpatient care
- Medical supplies
- Preventive services
- Some drugs (specific criteria)
Part C: Medicare Advantage
- Combines Parts A and B with Managed Care
Part D: Prescription coverage
- Prescription drugs
Optima Medicare versus Original Medicare
To ensure all of your needs are met, most of the Medicare Advantage plans offered by Optima Medicare are comprehensive plans that feature hospital, medical, and prescription drug coverage. Plus, you'll get supplemental benefits and better protection from out-of-pocket costs.
|Part A (Hospital insurance)||Yes||Yes|
|Part B (Doctor and medical insurance)||Yes||Yes|
|Part D (Prescription drug coverage)||Yes||No|
|More predictable out-of-pocket costs||Yes||No|
|Dental and vision benefits||Yes||No|
|Fitness and wellness programs||Yes||No|
|Virtual doctor appointments||Yes||No|
Benefits vary by plan and region.
Medicare eligibility requirements
To be entitled to Medicare, you must be a U.S. citizen or a permanent legal resident, and answer yes to at least one (1) of the following questions:
- Are you age 65 or older and eligible to receive Social Security benefits?
- Are you under age 65, permanently disabled, and have been receiving Social Security Disability Insurance (SSDI) payments for at least two (2) years?
- Do you receive continuing dialysis for permanent kidney failure or need a kidney transplant?
- Do you have Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease?
You can join a Medicare Advantage plan if:
- You have Medicare Part A and Part B.
- You live in the service area of the plan.
Important note: federal government rules require that if you join a Medicare Advantage plan like Optima Medicare, and you want Medicare prescription drug coverage, you must get that drug coverage from your Medicare Advantage plan. In addition, Medicare has special rules that dictate when you can join, change, or leave a Medicare Advantage plan.
Am I eligible for Optima Community Complete (HMO D-SNP)?
If you are eligible for Medicare (either by age or by disability) and get help from Medicaid and live in our service area, you could be eligible for Optima Community Complete.
- You must be enrolled in Medicare Part A and Part B.
- You receive help from state Medicaid assistance
- And you live in the service area.
Medicare enrollment periods
We make enrolling easy. Learn what times of the year you can enroll in Medicare.Enrollment Periods
Receive help with prescription drug costs
People with limited resources and income may qualify for Extra Help to pay for their prescription drug costs. Extra Help is referred to as a low income subsidy (LIS) and helps pay for a part of your Part D monthly premium, annual deductible, and copayments.Learn About Extra Help
Frequently asked questions
Get answers to common questions about Medicare Advantage and understand your Optima Medicare plan options.Questions and Answers
Learning about the basics of Medicare now will help you make important decisions later. You can look forward to retirement with confidence by learning about your Medicare options.Watch Videos
Understanding Medicare Coverage for Caregivers
We help caregivers make the most out of Medicare coverage when selecting the right plan for a spouse, parent, friend, or relative. A caregiver may assist a Medicare recipient with the enrollment process. Enrolling and making medical decisions on behalf of someone requires a Power of Attorney.
Caregivers can receive guidance on what to arrange by contacting Medicare at 1-800-MEDICARE (1-800-633-4227) or Optima Health at 757-552-7174 or 1-800-648-8420.
Last Updated: 1/4/2023