Using your Extra Benefits
Did you know plans offered by Optima Medicare are all-in-one plans? That means dental, vision, hearing, and other extra benefits are built into our plans to give you more! Read the information below and learn how to use and access your Extra Benefits1.
2023 Extra Benefits
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Dental Services
Both preventive and comprehensive dental services are available with your Optima Medicare plan. Plus, you will have access to a quality dental network through our partner, DentaQuest.
Preventive Dental - covers cleanings, fluoride treatments, X-rays, and oral exams with a $0 copay.
Comprehensive Dental - covers fillings, extractions, and many additional enhanced services.
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Over-the-Counter (OTC) Product Allowance
Your Optima Medicare plan can help keep more money in your pocket when you take advantage of your OTC quarterly allowance.
Purchase a wide selection of non-prescription drugs, supplies, and healthcare products through the plan’s catalog of items. You must spend your allowance each quarter. Leftover funds cannot be carried over to the next quarter.
Order online or by phone at 1-877-438-7521 (TTY: 711), 8 a.m.–8 p.m., 7 days a week.
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Monthly Grocery Card Allowance
Eligible members can shop for a variety of brand-name and generic health foods with a monthly grocery allowance.2 Use your allowance to shop in stores, or order non-perishable groceries online through your NationsBenefits® member portal or by phone by calling 1-877-438-7521 (TTY: 711), 8 a.m.–8 p.m., 7 days a week. If you order your groceries online or by phone, they will be delivered to your home within two days at no charge.
Your grocery allowance will reload on the first day of the month and expires on the last day of every month.
Retail stores where you can use your card include:
- Food Lion
- Harris Teeter
- Kroger
- Walmart
2Members with chronic condition(s) that meet certain criteria may be eligible for this special supplemental benefit. This benefit is not available to Optima Medicare Prime (HMO) or Optima Medicare Savings (HMO) members
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Vision Services
You have a $0 copay for your routine annual eye exam, plus an allowance toward the cost of glasses or contact lenses. All vision services are offered through Community Eye Care.
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Transportation Benefit
Routine Transportation for Medical Needs
We provide rides for you to and from health-related locations, such as doctor appointments and the pharmacy.
Non-medical Transportation2
Non-medical transportation is available for members with chronic conditions to plan-approved locations such as churches, grocery stores, senior centers, and plan-sponsored events. Trip limits vary by plan.
To Arrange Transportation
Members can arrange transportation through our partner, Verida, by calling 1-866-381-4860 (TTY: 711), Monday through Friday from 6 a.m. to 6 p.m. Please call at least three business days in advance to arrange transportation.
2Members with chronic condition(s) that meet certain criteria may be eligible for this special supplemental benefit. This benefit is not available to Optima Medicare Prime (HMO) or Optima Medicare Savings (HMO) members.
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Hearing Exams and Aids
You have a $0 copay for your routine hearing exam, plus free fittings, and a set of hearing aids up to a $2,000 allowance every 12 months. Your benefit also includes a 12-month warranty, one-time replacement coverage, and up to a one-year supply of hearing aid batteries. All hearing services are offered through NationsHearing® providers.
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Annual Wellness Visit
Your Annual Wellness Visit is an important part of planning for your current and future health and is available at no cost to you as an Optima Medicare member. During this visit, you and your provider will map out a personalized prevention plan to keep you healthy. This could include preventive screenings, immunizations, and advance care planning.
The Annual Wellness Visit is one of the eligible activities included in our Healthy Rewards Program. Learn more about rewards and incentives.
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Annual Physical Exam
During an Annual Physical Exam, your Primary Care Provider (PCP) reviews your current health history. The Annual Physical Exam benefit includes a comprehensive physical examination and evaluation of the status of chronic diseases. This is available at no cost to you and is a more in-depth look at your current health than an Annual Wellness Visit. Both types of appointments should always be scheduled and can be completed on the same visit – just let your provider know when you make the appointment.
Limit of one Annual Physical Exam per calendar year.
This exam may include diagnostic tests and additional cost share may apply if these tests are performed.
You can earn a reward by completing the Annual Physical Exam through the Healthy Rewards Program. Learn more about rewards and incentives.
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Enhanced Disease Management
- Get everyday support for your type 2 diabetes from the comfort of your home with Onduo. Onduo Virtual Diabetes Program3 is a virtual care center that provides eligible members with daily access to diabetes tools and experts. You will receive an invitation letter from Onduo. Once you receive the letter, activate your benefit by calling 1-833-446-6386 or by going to onduo.com/optimawelcome1 (This link will open a new browser tab or window and takes you to a website that is not owned or operated by Optima Health). Enter your personal code when prompted. Your personal code can be found in your Onduo welcome letter.
- COPD360 is a home-based enhanced disease management program for members with a diagnosis of Chronic Obstructive Pulmonary Disease (COPD) who had an inpatient admission caused by COPD and used home oxygen within the last 12 months. Prior authorization is required.
- To see if you are eligible and want to learn more, contact Optima Medicare member services at 1-800-927-6048 (TTY:711).
3Onduo is offered as a part of your healthcare enhanced benefits. A deductible may apply for some members.
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Virtual Visits
Virtual Visits are appointments via secure phone or video using your computer or smartphone. Choose a board-certified doctor or licensed therapist from the nation’s largest virtual provider network. You can see the next available doctor on call, or choose your preferred provider. You can search by provider specialty, gender, speaking language, and more. Appointments are available 24 hours a day, 7 days a week, 365 days a year with a $0 copay.
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Meals After Hospital or Skilled Nursing Facility Stays
Qualifying members can receive meals after being discharged from an inpatient facility, such as a hospital or skilled nursing facility. You will get up to 56 ready-to-heat meals for up to 28 days delivered to your home, for free. Prior authorization is required by the health plan.
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24/7 Nurse Advice Line
For illnesses or injuries that happen after hours or when your doctor’s office is closed, you can call the 24/7 Nurse Advice Line at 1-800-394-2237 (TTY: 711). You will talk with a professional nurse trained in emergency or acute care. They will be able to assess your medical situation, advise you as to where to seek care, and suggest self-care options until you can see your doctor.
Please note: The nurse will not have access to your medical records, cannot diagnose medical conditions, order lab work, write prescriptions, order home health services, or initiate hospital admissions.
In an emergency, always go to the closest emergency room or call 911.
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SilverSneakers®
Get active with SilverSneakers® fitness programs. This benefit includes:
- SilverSneakers LIVE™ online classes and workshops
- On-demand workout videos in the SilverSneakers OnDemand™ library
- SilverSneakers GO™ mobile app with digital workouts
- Free membership at over 15,000 fitness locations in your community and nationwide
For more information, contact SilverSneakers® at 1-866-584-7389 (TTY: 711), Monday through Friday, 8 a.m. to 8 p.m.
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Personal Emergency Response System (PERS)
PERS connects eligible members to help with just a push of a button. Eligible members receive a PERS in-home monitoring device that can get them help quickly, 24 hours a day. Eligible members must have a working landline and/or cellular phone coverage to take part in this benefit. Prior authorization is required.
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Routine Foot Care
Optima Medicare Value, Optima Medicare Salute, and Optima Community Complete members can visit a podiatrist for preventive treatments such as removal of corns, warts, calluses, and nail care. Number of visits and copays vary by plan.*
*Refer to your Evidence of Coverage for extra benefits specific to your plan.
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Chiropractic Services
Coverage for routine chiro chiropractic care for therapeutic manipulation is offered some plans.*
*Refer to your Evidence of Coverage for extra benefits specific to your plan.
1 Please refer to your Evidence of Coverage for extra benefits specific to your plan.