Medicare Learning Center

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.

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.