Frequently Asked Questions
Get answers to common questions about health insurance and help with understanding your healthcare options. These frequently asked questions will help you learn about Medicare, Medicare Advantage and the coverage you can receive.
What is the difference between a Medicare Advantage plan and a Medicare supplement policy?
When you first sign-up for Medicare, you will have Original Medicare unless you enroll in a plan like a Medicare Advantage plan. Original Medicare generally pays 80% of covered inpatient and outpatient medical costs leaving the insured responsible for the deductibles and 20%.
A Medicare Supplement Policy generally covers the deductibles and the 20% not covered by Original Medicare for covered services, depending on the supplement.
A Medicare Advantage Plan is another way to get your Medicare coverage. Optima Health offers Medicare Advantage plans.
Optima Medicare Advantage plans also include Part D prescription drug coverage. Unlike Original Medicare only or Original Medicare combined with a Medicare Supplement policy, no separate Part D prescription plan is necessary. Medicare Advantage plans often offer services not covered by Original Medicare and Supplement policies such as dental, vision, hearing, transportation, and wellness benefits.
What does your preventive care cover?
- Annual wellness visit
- Colonoscopy screening exam
- View plans in your area for more details.
Does your Medicare Advantage plan have dental, vision, and hearing benefits?
- Oral exams
- Fluoride treatments
Optional supplemental dental coverage is available at a monthly premium.
Optima Medicare Advantage plans include the following vision services:
- Annual eye exam
- Allowance for glasses and/or contact lenses
Optima Medicare Advantage plans cover the following hearing services:
- Annual hearing exam
- One set of hearing aids (every 3 years)
- Hearing aid batteries (up to 3 year supply)
There are copayments and limitations for some of the dental, vision, and hearing benefits described above. View plans in your area for more details.
When I travel, will any out-of-network medical care be covered under my Optima Medicare HMO Plan?
Optima Medicare Advantage plans include coverage for emergency services when you are outside of the service area. Emergency services are covered within the United States and its territories as well as worldwide. If you have an unexpected illness or injury when outside of the service area, you should call the After Hours Nurse Advice Line at the number on your Member ID card. In any life-threatening emergency, always go to the closest emergency department or call 911.
Remember, Optima Health may review all emergency department care after the fact, to determine if a medical emergency did exist. If an emergency did not exist, you may be responsible for payment for all services.
Do I still have to pay for Medicare Part B?
Yes. You must continue to pay your monthly Medicare Part B premium when you are enrolled in a Medicare Advantage plan.
Last Updated: 10/1/2019