Medicare Learning Center

Medicare Basics by Optima Health

Are You New to Medicare?

Please take a moment to watch this video about Original Medicare – Part A and Part B, Medicare Advantage plans – Part C, and prescription drug coverage – Part D. This video explains the transition to a Medicare health insurance plan, services you will receive, and what eligibility requirements qualify you for coverage.

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Medicare Enrollment Periods

There are several enrollment periods for Medicare. Each year there is an annual election period October 15 through December 7, when everyone can change their plan. Coverage takes effect January 1. There are also special election periods during the year when individuals can enroll in a Medicare plan. Special election periods occur for example when you lose employer coverage, when you turn 65, and if you have a special situation such as you move out of the service area of your current plan.

Enrollment Periods
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Original Medicare vs. Medicare Advantage

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.

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Turning Age 65?

If you are turning age 65, you have a seven-month initial election period to enroll. This includes the three months before your birth month, the month you turn 65, and the three months after your birth month.

Enrollment Periods
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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
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Frequently Asked Questions

Get answers to common questions about Medicare Advantage and understand your Optima Medicare plan options.

Questions and Answers

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.

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?

Medicare Advantage Eligibility Requirements

You can generally join a Medicare Advantage plan if you meet these conditions:

  • 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 should be eligible for Optima Community Complete (HMO D-SNP).

  • 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

Service Area

Optima Medicare HMO

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Optima Medicare HMO enrollment is available for residents of several cities/counties in Virginia. We expanded our coverage to include more cities and counties in Central/Halifax, Northern Virginia, Roanoke/Alleghany, and Southwest Virginia.

  • Central/Halifax

    • Albemarle
    • Amelia
    • Amherst
    • Appomattox
    • Brunswick
    • Buckingham
    • Campbell
    • Caroline
    • Charlotte
    • Charlottesville City
    • Chesterfield
    • Colonial Heights City
    • Cumberland
    • Danville City
    • Dinwiddie
    • Emporia City
    • Essex
    • Fluvanna
    • Goochland
    • Greensville
    • Halifax
    • Hanover
    • Henrico
    • Hopewell City
    • King And Queen
    • King George
    • King William
    • Lancaster
    • Louisa
    • Lunenburg
    • Lynchburg City
    • Mecklenburg
    • Middlesex
    • Nelson
    • New Kent
    • Northumberland
    • Nottoway
    • Petersburg City
    • Pittsylvania
    • Powhatan
    • Prince Edward
    • Prince George
    • Richmond
    • Richmond City
    • Southampton
    • Stafford
    • Westmoreland
  • Hampton Roads - Peninsula

    • Charles City
    • Gloucester
    • Hampton City
    • James City
    • Mathews
    • Newport News City
    • Poquoson City
    • Williamsburg City
    • York
  • Hampton Roads - Southside

    • Accomack
    • Chesapeake City
    • Franklin City
    • Isle Of Wight
    • Norfolk City
    • Northampton
    • Portsmouth City
    • Suffolk City
    • Surry
    • Sussex
    • Virginia Beach City
  • Northern Virginia

    • Alexandria City
    • Arlington
    • Clarke
    • Culpeper
    • Fairfax
    • Fairfax City
    • Falls Church City
    • Fauquier
    • Frederick
    • Loudoun
    • Manassas City
    • Manassas Park City
    • Page
    • Prince William
    • Rappahannock
    • Shenandoah
    • Warren
    • Winchester City
  • Roanoke/Alleghany

    • Alleghany
    • Augusta
    • Bath
    • Bedford
    • Botetourt
    • Buena Vista City
    • Covington City
    • Craig
    • Franklin
    • Giles
    • Greene
    • Harrisonburg City
    • Henry
    • Highland
    • Lexington City
    • Madison
    • Martinsville City
    • Montgomery
    • Orange
    • Pulaski
    • Radford
    • Roanoke
    • Roanoke City
    • Rockbridge
    • Rockingham
    • Salem
    • Staunton City
    • Waynesboro City
  • Southwest

    • Bland
    • Bristol City
    • Buchanan
    • Carroll
    • Dickenson
    • Floyd
    • Galax City
    • Grayson
    • Lee
    • Norton City
    • Patrick
    • Russell
    • Scott
    • Smyth
    • Tazewell
    • Washington
    • Wise
    • Wythe

Optima Community Complete (HMO D-SNP)

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Optima Community Complete (HMO D-SNP) enrollment is available for residents of most cities and counties in Virginia.

  • Covered Cities and Counties

    • Accomack
    • Albemarle
    • Alexandria City
    • Alleghany
    • Amelia
    • Amherst
    • Appomattox
    • Arlington
    • Augusta
    • Bath
    • Bedford
    • Bland
    • Botetourt
    • Bristol City
    • Brunswick
    • Buchanan
    • Buckingham
    • Buena Vista City
    • Campbell
    • Caroline
    • Carroll
    • Charles City
    • Charlotte
    • Charlottesville City
    • Chesapeake City
    • Chesterfield
    • Clarke
    • Colonial Heights City
    • Covington City
    • Craig
    • Culpeper
    • Cumberland
    • Danville City
    • Dickenson
    • Dinwiddie
    • Emporia City
    • Essex
    • Fairfax
    • Fairfax City
    • Falls Church City
    • Fauquier
    • Floyd
    • Fluvanna
    • Franklin
    • Franklin City
    • Frederick
    • Fredericksburg City
    • Galax City
    • Giles
    • Gloucester
    • Goochland
    • Grayson
    • Greene
    • Greensville
    • Halifax
    • Hampton City
    • Hanover
    • Harrisonburg City
    • Henrico
    • Henry
    • Highland
    • Hopewell City
    • Isle Of Wight
    • James City
    • King And Queen
    • King George
    • King William
    • Lancaster
    • Lee
    • Lexington City
    • Loudoun
    • Louisa
    • Lunenburg
    • Lynchburg City
    • Madison
    • Manassas City
    • Manassas Park City
    • Martinsville City
    • Mathews
    • Mecklenburg
    • Middlesex
    • Montgomery
    • Nelson
    • New Kent
    • Newport News City
    • Norfolk City
    • Northampton
    • Northumberland
    • Norton City
    • Nottoway
    • Orange
    • Page
    • Patrick
    • Petersburg City
    • Pittsylvania
    • Poquoson City
    • Portsmouth City
    • Powhatan
    • Prince Edward
    • Prince George
    • Prince William
    • Pulaski
    • Radford
    • Rappahannock
    • Richmond
    • Richmond City
    • Roanoke
    • Roanoke City
    • Rockbridge
    • Rockingham
    • Russell
    • Salem
    • Scott
    • Shenandoah
    • Smyth
    • Southampton
    • Spotsylvania
    • Stafford
    • Staunton City
    • Suffolk City
    • Surry
    • Sussex
    • Tazewell
    • Virginia Beach City
    • Warren
    • Washington
    • Waynesboro City
    • Westmoreland
    • Williamsburg City
    • Winchester City
    • Wise
    • Wythe
    • York