Medicare Frequently Asked Questions

What is a Medicare Advantage (MA) Plan?

Medicare Advantage Plans are health plan options that are part of the Medicare program. If you join one of these plans, you generally get all your Medicare-covered health care through that plan. This coverage can include prescription drug coverage.

Who can join a Medicare Advantage Plan?

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).

If I join a Medicare Advantage Plan am I still enrolled in the Medicare program?

Yes.

If I join a Medicare Advantage Plan do I still have Medicare rights and protections?

Yes.

If I join a Medicare Advantage Plan do I still get Part A and Part B coverage?

Yes.

If I join a Medicare Advantage Plan do I get prescription drug coverage (Part D)?

If you want prescription drug coverage you should enroll in a plan that offers Part D coverage. In most Medicare Advantage Plans, if you want drug coverage, and your plan offers it, you must get it from your Medicare Advantage Plan.

If I join a Medicare Advantage Plan do I get extra benefits?

You may be able to get extra benefits, like some coverage for vision, hearing, dental, and/or health and wellness programs.

When can I join, switch, or drop a Medicare Advantage Plan?

You can join, switch, or drop a Medicare Advantage Plan:

• When you first become eligible for Medicare (three (3) months before you turn age 65 to three (3) months after the month you turn age 65).
• If you get Medicare due to a disability, you can join during the three (3) months before to three (3) months after your 25th month of disability benefits.
• From October 15 to December 7 each year. Your coverage will begin on January 1 of the following year.
• From January 1 to February 14 of each year. You can disenroll from your MA plan and return to Original Medicare. You will then have a special election period (SEP) in which to choose a new Prescription Drug Plan (PDP), if you want one.

There are additional times you join, switch or drop a Medicare Advantage Plan. See Eligibility Information and Enrollment Information.

If I join a Medicare Advantage Plan, can I switch to another plan or drop my plan?

Yes, but only during certain times of the year (see the question above for details).

If I join a Medicare Advantage Plan, what premiums do I have to pay?

You pay the monthly premium that includes coverage for Part A and Part B benefits, prescription drug coverage (Part D, if offered), and any other extra benefits (if offered). You must continue to pay your Medicare Part B premium also.

If I enroll in an Optima Medicare HMO Plan, are prescription drugs covered?

Yes, both Optima Medicare plans have prescription drug coverage.

If I enroll in an Optima Medicare Plan, do I need to choose a primary care doctor?

Yes. The Optima Medicare plans require selection of a primary care physician (PCP).

If I enroll in an Optima Medicare Plan, can I get healthcare from any doctor or hospital?

Optima Medicare members are covered through a network of locally contracted doctors and hospitals. Members need to select a family care doctor from the plan’s network of providers to provide their routine care and help coordinate their care from other network providers.

If I enroll in an Optima Medicare Plan, do I have to see a primary care doctor to get a referral to see a specialist?

No. A referral is not required to see a specialist.