Español Medicare Plans Members Providers Agents & Brokers OTC Quick Links Member Login Enrollment Center If you're eligible for Medicare, Optimum HealthCare Medicare Advantage Plans are focused on you! Great coverage, great benefits... many at no cost to you! Floridians choose Optimum HealthCare to help them live a healthier, more enjoyable retirement. Unlike other companies, Optimum HealthCare focuses solely on Medicare Advantage HMO Plans - in fact, it's all they do! So Optimum HealthCare knows what matters most to members. Find a Plan that fits your needs Some of the best reasons to join! Benefits offered at $0 Cost Find out more about all the ways to Enroll Find Providers and Pharmacies Find Covered Drugs Learn More About Medicare and Medicare Advantage $0 Monthly Plan Premium on most plans $0 Co-pays on Primary Care visits $0 Preventive Services $0 Co-Pays on Tier 1 Preferred Generics on Most Plans with Drug Coverage $0 Silver Sneakers Fitness Memberships Comprehensive Dental, Vision and Hearing Benefits Low-cost Hospital Stays Plus UP TO $148.50 of your Part B premium refunded back to you each month based on plan selection UP TO $125 each month in Over-the-Counter Health Care items based on plan selection Important Plan Information Individuals must have both Part A and Part B to enroll. You can be in only one Medicare Advantage Plan at a time; enrollment in this Plan will automatically end your enrollment in another Medicare Health Plan or Prescription Drug Plan. For MA-Only Plan, you understand that if you don’t have Medicare prescription drug coverage, or creditable prescription drug coverage (as good as Medicare’s), you may have to pay a late enrollment penalty if you enroll in Medicare prescription drug coverage in the future. Enrollment in this Plan is generally for the entire year. Once you enroll, you may leave this Plan or make changes only at certain times of the year when an enrollment period is available (Example: October 15 – December 7 of every year), or under certain special circumstances. The Plan serves a specific service area. If you move out of the area that the Plan serves, you need to notify the Plan so you can disenroll and find a new Plan in your new area. Once you are a member of the Plan, you have the right to appeal Plan decisions about payment or services if you disagree. The rules you must follow to get coverage are listed in the Evidence of Coverage. You understand that people with Medicare aren’t usually covered under Medicare while out of the country except for limited coverage near the U.S. border. You understand that beginning on the date your coverage begins, you must get all of your health care from the Plan, except for emergency or urgently needed services or out-of-area dialysis services. Services authorized by the Plan and other services contained in your Evidence of Coverage document (also known as a member contract or subscriber agreement) will be covered. Without authorization, NEITHER MEDICARE NOR THE PLAN WILL PAY FOR THE SERVICES. For Chronic Special Needs Plans (SNP): These Plans are available to anyone who has been diagnosed with one or more of the following disorders: Cardiovascular Disease (CVD); Chronic Heart Failure (CHF); Diabetes Mellitus; Chronic Obstructive Pulmonary Disease (COPD) For Dual Special Needs Plans (DSNP): This Plan is available to anyone who has both medical assistance from the state and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the Plan for further details. People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If you qualify, Medicare could pay up to seventy-five (75) percent or more for your drug costs including monthly prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify will not be subject to the coverage gap or late enrollment penalty. Many people are eligible for these savings and don’t even know it. For more information about Extra Help, contact your local Social Security Office or call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778. You can also apply for extra help online at www.socialsecurity.gov/medicare/prescriptionhelp/ Rights and Responsibilities upon Disenrollment - "Disenrollment" from the Plan means ending your membership with us. Disenrollment can be voluntary (your choice) or, in limited circumstances, involuntary (not your choice). You might leave one of our Plans because you decide that you want to leave. During specified times (October 15 – December 7), you can choose to disenroll from your current Medicare Plan. Some situations require you to leave. For example, if you move out of our geographic service area, are absent from our service area for more than six consecutive months or if we no longer offer the Plan in your geographic area. Usually, to end your membership in our Plan, you simply enroll in another health Plan during one of the election periods. One exception is when you want to switch from our Plan to Original Medicare without a Medicare prescription drug Plan. In this situation, you must contact Member Services and ask to be disenrolled from our Plan. If you have any questions regarding your disenrollment please contact the Plan. Release of Information: By joining this Medicare health Plan, you acknowledge that the Plan will release your information to Medicare and other Plans as is necessary for treatment, payment and health care operations. You also acknowledge that the Plan will release your information including your prescription drug event data to Medicare, who may release it for research and other purposes which follow all applicable Federal statutes and regulations. Last updated 10/27/2021 Helpful Links CMS Model Electronic Complaint Form The Medicare Beneficiary Ombudsman Unable to view PDFs? Click here Benefits During Disasters and Catastrophic Events Click here for Multi-Language Interpreter Service Servicios de interpretación en varios idiomas (Multi-Language Insert) | (Inserción de varios idiomas) Section 1557 Notice of Non-Discrimination: English | Spanish Hours From October 1 to March 31, we are open 7 days a week from 8 a.m. to 8 p.m. EST. From April 1 to September 30, we are open Monday through Friday, 8 a.m. to 8 p.m. EST. Telephone Toll Free 1-866-245-5360 TTY/TDD: 711 Mailing Address P.O. Box 151137 ATTN: Optimum Healthcare Tampa, FL 33684 Service Cities SERVING THE FOLLOWING AREAS IN FLORIDA: Brevard County Broward County Citrus County Charlotte County Collier County Hernando County Hillsborough County Indian River County Lake County Lee County Marion County Manatee County Martin County Orange County Osceola County Palm Beach County Pasco County Pinellas County Polk County Saint Lucie County Sarasota County Seminole County Sumter County Volusia County Website Disclaimer Optimum HealthCare, Inc. is an HMO with a Medicare contract and a contract with the state of Florida Medicaid program. Enrollment in Optimum HealthCare, Inc. depends on contract renewal. This Information is not a complete description of benefits. Call 1-866-245-5360 (TTY: 711) for more information. Medicare beneficiaries may also enroll in Optimum HealthCare through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. Every year, Medicare evaluates plans based on a 5-star rating system. Optimum Healthcare, Inc. has been approved by the National Committee for Quality Assurance (NCQA) to operate as a Chronic Condition Special Needs Plan (C-SNP) through 2022 and a Dual Special Needs Plan (D-SNP) until 2024 based on a review Optimum Healthcare, Inc.’s Model of Care. Optimum HealthCare, Inc. complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Optimum HealthCare, Inc. cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo. Optimum HealthCare, Inc. konfòm ak lwa sou dwa sivil Federal ki aplikab yo e li pa fè diskriminasyon sou baz ras, koulè, peyi orijin, laj, enfimite oswa sèks. Español (Spanish): ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-866-245-5360 (TTY: 711). Kreyòl Ayisyen (French Creole): ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-866-245-5360 (TTY: 711). These materials may be made available in alternate formats (e.g., large print, Braille) to individuals with disabilities, upon request. RETURN TO TOP Toll Free 1-866-245-5360 TTY/TDD: 711 OTC Home | About Us | Careers | Contact | Privacy Policy H5594_Website ©2021 Optimum HealthCare Inc.