Medicare with OptumCare
When can I join a Medicare plan with OptumCare?Text
If you are eligible for Medicare, you can join a Medicare 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.
If your health plan does not have a contract with OptumCare, open enrollment is the only time you can join or change your Medicare Advantage health plan — unless 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.CLOSE
Do I need to have Medicare Advantage to become an OptumCare member?Text
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.
What are the benefits of a Medicare Advantage plan?Text
- You may get extra services such as dental, vision and wellness programs.
- You don’t need to buy Medigap (additional insurance) to cover the extra costs of Medicare Part A and Part B.
- You may have prescription drug coverage as part of your plan.
Are prescription drugs covered in Medicare Advantage?Text
Most Medicare Advantage plans include prescription drug coverage. If your specific plan does not, you can buy Part D separately to help pay for prescription drugs.CLOSE
How much does Medicare Advantage cost?Text
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 an additional 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 necessary
- Aren’t part of your Medicare Advantage plan benefits
A health plan representative or other licensed insurance agent can help you understand the rules that may affect your 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?
How do I decide if I want to enroll in Medicare?Text
You don’t have to enroll in Medicare if you already have a health plan. However, once you’re eligible for Medicare, it’s a good idea to compare your current health plan against a Medicare health plan.
Sometimes the costs are lower and coverage is the same. Sometimes Medicare might be better than your employer coverage, or your spouse’s employer coverage. It doesn’t matter if you are still working or aren’t receiving your Social Security income yet.CLOSE
How can I learn more about my Medicare options so I can pick the right plan for me?Text
- Review the CMS 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 for information about the plans they offer.
- 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, at 1-844-368-9557 and we can connect you with a licensed insurance agent in your area.CLOSE
When will my Medicare Advantage plan start?Text
After you complete your enrollment paperwork, your plan will usually go into effect on the first day of the following month. If you enroll during the open enrollment period, your plan will be effective on January 1 of the next year.CLOSE
Once I enroll in Medicare, do I need to stay on it forever?Text
You’re not committed to your Medicare plan forever. Review your coverage 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 of the year. 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.CLOSE