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2013 Plan Finder

Disclaimer

  • Beneficiaries must use network pharmacies to access their prescription drug benefits, except in non-routine, emergency circumstances; quantity limitations and restrictions may apply.
  • Individuals must have both Part A and Part B to enroll.
  • You must use plan providers except in emergency or urgent care situations.
  • If you obtain routine care from out-of-network providers neither Medicare nor Optimum Healthcare will be responsible for the costs.
  • For Special Needs Plans (SNPs): if you are interested in applying for the Optimum Diamond Rewards Plan (SNP-HMO), you must have been diagnosed with Congestive Heart Failure (CHF), Cardiovascular Disease (CVD), or Diabetes Mellitus to qualify for enrollment. If you are applying for Optimum Diamond Rewards COPD Plan (SNP-HMO), you must have been diagnosed with a Chronic Lung Disorder.
  • You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call 1-800-MEDICARE (1-800-633-4227); TTY users should call 1-877-486-2048, 24 hours a day/7 days a week. You may also call the Social Security Office at 1-800-772-1213 between 7 a.m. to 7 p.m., Monday through Friday; TTY users should call 1-800-325-0778 or your state Medicaid Office.
  • 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 1-800-MEDICARE (1-800-633-4227), 24 hours a day/7 days a week, TTY users should call 1-877-486-2048.
  • Members may enroll in the plan only during specific times of the year. Contact Optimum Healthcare for more information.
  • Information provided to us will be used solely for purposes of enrollment or any HIPAA authorized transactions. The Health Plan requires its associates to follow its privacy and security policies and procedures to protect your health information in oral, written, or electronic form. We understand that medical/billing information about you and your health is personal and confidential. We are committed to protecting this information about you. We create enrollment records and may create other records of the care and services you receive at Optimum Healthcare. We need these records to provide you with quality care and to comply with certain legal requirements. We are required by law to protect your personal medical records and other private health information records by keeping it private and following certain rules that dictate whether and when we can use or disclose your information.
  • Potential for Contract Termination - Optimum HealthCare, Inc. has a contract with the Centers for Medicare and Medicaid Services (CMS), the government agency that runs Medicare. This contract renews each year. Optimum HealthCare, Inc. is required to notify beneficiaries that it is authorized by law to refuse to renew its contract with the Centers for Medicare & Medicaid Services (CMS), that CMS also may refuse to renew the contract, and that termination or non-renewal may result in termination of your enrollment. In addition, the plan may reduce its service area and no longer offer services in the area where you reside. In the event this happens, you will receive advance notice.
  • Rights and Responsibilities upon Disenrollment - "Disenrollment" from an Optimum HealthCare, Inc. 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 questions about ending your membership with us, call 1-866-245-5360 (TTY/TDD 1-800-955-8771), Our hours of operation are October 1, 2012 to February 14, 2013 from 8 a.m. to 8 p.m. 7 days a week and from February 15, 2013 to October 14, 2013 from  8 a.m. to 8 p.m. Monday through Friday.
  • Information on aggregate number of grievances , appeals and exceptions - Members can obtain an aggregate number of grievances, appeals and exceptions filed with the plan by calling our customer service department at 1-866-245-5360.