Eligibility Requirements

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 years or older and eligible to receive Social Security benefits?
  • Are you under 65, permanently disabled and have been receiving Social Security disability insurance 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 — Lou Gehrig’s Disease)?

Medicare Advantage Eligibility Requirements

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

  • You have Part A and Part B
  • You live in the service area of the plan
  • You don’t have End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant)*1.

*1 ESRD Language is not applicable for 2021

If you have End-Stage Renal Disease (ESRD), you can only join a Medicare Advantage Plan in certain situations:

  • If you’re already in a Medicare Advantage Plan when you develop ESRD, you can stay in your plan or you may be able to join another Medicare Advantage Plan offered by the same company.
  • If you’re in a Medicare Advantage Plan, and the plan leaves Medicare or no longer provides coverage in your area, you have a one-time right to join another Medicare Advantage Plan.
  • If you have an employer or union health plan or other health coverage through a company that offers one or more Medicare Advantage Plan(s), you may be able to join one of that company’s Medicare Advantage Plans.
  • If you’ve had a successful kidney transplant, you may be able to join a Medicare Advantage Plan.
  • You may be able to join a Medicare Special Needs Plan (SNP) that covers people with ESRD if one is available in your area.

For more information about ESRD, download the booklet “Medicare Coverage of Kidney Dialysis and Kidney Transplant Services” from https://www.medicare.gov/publications/.

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.


Service Area

Expand All

Optima Medicare HMO enrollment is available for residents of several cities/counties in Virginia. We have expanded our 2021 coverage to include more cities and counties in Central/Halifax, Northern Virginia, Roanoke/Alleghany, and Southwest Virginia.

  • Central/Halifax

    • Amelia (new for 2021)
    • Amherst (new for 2021)
    • Appomattox (new for 2021)
    • Brunswick (new for 2021)
    • Buckingham (new for 2021)
    • Campbell (new for 2021)
    • Caroline (new for 2021)
    • Charlotte County
    • Chesterfield (new for 2021)
    • Colonial Heights City (new for 2021)
    • Cumberland (new for 2021)
    • Danville City
    • Dinwiddie (new for 2021)
    • Essex (new for 2021)
    • Fluvanna (new for 2021)
    • Goochland (new for 2021)
    • Halifax County
    • Hanover (new for 2021)
    • Henrico (new for 2021)
    • Hopewell City (new for 2021)
    • King And Queen (new for 2021)
    • King George (new for 2021)
    • King William (new for 2021)
    • Lancaster (new for 2021)
    • Louisa (new for 2021)
    • Lunenburg (new for 2021)
    • Lynchburg City (new for 2021)
    • Mecklenburg County
    • Pittsylvania County
    • Powhatan (new for 2021)
    • Prince Edward (new for 2021)
    • Prince George (new for 2021)
    • Richmond (new for 2021)
    • Richmond City (new for 2021)
    • Southampton (new for 2021)
    • Stafford (new for 2021)
    • Westmoreland (new for 2021)
  • Hampton Roads - Peninsula

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

    • Chesapeake City
    • Franklin City
    • Isle of Wight County
    • Norfolk City
    • Northampton (new for 2021)
    • Portsmouth City
    • Suffolk City
    • Surry County
    • Sussex County
    • Virginia Beach City
  • Northern Virginia

    • Alexandria City
    • Arlington County
    • Clark (new for 2021)
    • Fairfax City
    • Fairfax County
    • Falls Church City
    • Fauquier (new for 2021)
    • Frederick (new for 2021)
    • Loudoun County
    • Manassas City (new for 2021)
    • Manssas Park City (new for 2021)
    • Page (new for 2021)
    • Prince William County
    • Rappahannock (new for 2021)
    • Shenandoah (new for 2021)
    • Warren (new for 2021)
    • Winchester City (new for 2021)
  • Southwest

    • Bland (new for 2021)
    • Bristol (new for 2021)
    • Buchanan (new for 2021)
    • Carroll (new for 2021)
    • Dickenson (new for 2021)
    • Floyd (new for 2021)
    • Galax City (new for 2021)
    • Grayson (new for 2021)
    • Lee (new for 2021)
    • Norton City (new for 2021)
    • Patrick (new for 2021)
    • Russell (new for 2021)
    • Scott (new for 2021)
    • Smyth (new for 2021)
    • Tazewell (new for 2021)
    • Washington (new for 2021)
    • Wise (new for 2021)
    • Wythe (new for 2021)
  • Roanoke/Alleghany

    • Alleghany (new for 2021)
    • Augusta (new for 2021)
    • Bath (new for 2021)
    • Bedford (new for 2021)
    • Botetourt (new for 2021)
    • Buena Vista City (new for 2021)
    • Covington City (new for 2021)
    • Craig (new for 2021)
    • Franklin (new for 2021)
    • Giles (new for 2021)
    • Greene (new for 2021)
    • Harrisonburg City (new for 2021)
    • Henry (new for 2021)
    • Highland (new for 2021)
    • Lexington City (new for 2021)
    • Madison (new for 2021)
    • Martinsville City (new for 2021)
    • Montgomery (new for 2021)
    • Orange (new for 2021)
    • Pulaski (new for 2021)
    • Radford (new for 2021)
    • Roanoke (new for 2021)
    • Roanoke City (new for 2021)
    • Rockbridge (new for 2021)
    • Rockingham (new for 2021)
    • Salem (new for 2021)
    • Staunton City (new for 2021)
    • Waynesboro City (new for 2021)

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