Medicare with OptumCare
If you qualify for Medicare, you can join a Medicare Advantage plan during the open enrollment period. Check with your health plan to see if they have a contract with an OptumCare network. If so, you can switch to an OptumCare primary care provider any time during the year.
What if your health plan doesn’t have a contract with OptumCare? For most people, open enrollment is the only time you can join or change your Medicare Advantage plan. But, you may be able to join or switch if you qualify for a special election period (SEP).
Most people who qualify for a SEP can change their health plan at any time of year. This would allow you to switch to an OptumCare network and primary care provider. Check with your health plan to see if you qualify for a SEP.OR
That depends on your situation.
You may see an OptumCare doctor simply by making an appointment if you have:
- Original Medicare
- A Medicare Supplement plan
- A PPO plan
- If you pay for your own medical care
You must select an OptumCare primary care provider to become an OptumCare member if you belong to:
- A managed care plan (HMO)
- A Medicare Advantage (Part C) plan
To select an OptumCare provider:
- Check with your health plan to see if they contract with OptumCare. If so, ask to switch to an OptumCare provider.
- Join a Medicare Advantage (Part C) plan that contracts with OptumCare. Choose an OptumCare primary care provider.
- You may get extra services such as dental, vision and wellness programs.
- You don’t need to buy Medigap insurance to cover the extra costs of Medicare Part A and Part B.
- You may have prescription drug coverage as part of your plan.
Most Medicare Advantage plans cover prescription drugs. If your specific plan does not, you can buy Part D separately to help pay for them.OR
You will pay a premium for Part B medical coverage. The government will often deduct this premium from your Social Security check. You might also have a premium that you need to pay for Medicare Advantage.
In addition, you’ll need to pay all costs for services that:
- Medicare says aren’t medically needed
- Aren’t part of your Medicare Advantage plan
A health plan representative or other licensed insurance agent can help you understand your Medicare costs.
Be sure to ask the following questions:
- How much will I pay for my premiums, deductibles and other costs?
- How much will I pay for services like hospital stays or doctor visits?
- Is there a yearly limit on what I have to pay out-of-pocket for medical services?
After you complete your enrollment paperwork, your plan will usually start on the first day of the following month. If you sign up during the open enrollment period, your plan will start on January 1 of the next year.OR
You don’t have to keep your plan forever. You may want to check it each year to see if it still fits your needs. You can make changes once a year during Medicare Open Enrollment.
If you qualify for a Special Enrollment Period (SEP), you can change your health plan at any time. Check with your health plan to see if you might qualify for a SEP.
For more information, call us toll-free at 1-844-758-8986.OR
General Medicare questions
You don’t have to sign up for Medicare if you already have a health plan. However, as you reach age 65, it’s a good idea to compare your current plan against a Medicare health plan.
Sometimes the costs are lower and coverage is the same. Sometimes Medicare might be better than your employer plan, or your spouse’s employer plan. It doesn’t matter if you’re still working or don’t get Social Security income yet.OR
- Visit the Medicare website: www.medicare.gov.
- Call 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day, 7 days a week.
- Call a Medicare Advantage health plan directly, and ask for information about their plans.
- Speak with a licensed insurance agent.
We can connect you with a licensed insurance agent who can answer your questions. The agent will let you know when to apply for Medicare and help you enroll in the plan that’s right for you.
Call us toll-free and we can connect you with a licensed insurance agent in your area.
Optum Sales Support Center
Monday through Friday
8 a.m.–5 p.m. local time
A representative from Optum Sales Support Center can connect you with a licensed insurance agent in your area to review your health insurance plan options.
Optum Sales Support Center connects Medicare beneficiaries with resources including licensed insurance agents that sell Medicare Advantage and Medicare Prescription Drug Plans.OR