Optimum HealthCare Medicare Plans in Florida

Is an Optimum HealthCare Medicare Advantage Plan Right for You? 🤔

Optimum HealthCare Medicare Advantage plans may be a great fit if you:

• ✓ Are enrolled in Original Medicare (Parts A and B)
• ✓ Want the simplicity of fewer bills to pay
• ✓ Want to keep premiums and copays as low as possible
• ✓ Want to combine medical and prescription coverage in one easy plan
• ✓ Want access to benefits that Original Medicare doesn’t cover—like extra dental, vision, and hearing

🧠 New to Medicare? Start with our comprehensive Guide to the Four Parts of Medicare.

What Are Medicare Advantage Part C Plans? 📋

Medicare Part C, also called Medicare Advantage (MA), is an alternative to Original Medicare offered by private insurance companies like Optimum HealthCare. Medicare Advantage Plans include all the benefits of Parts A and B, which cover hospital and medical costs. Most MA plans also include Medicare Part D (prescription drug coverage). These plans combine health insurance and prescription drug coverage in one convenient and low-cost plan.

Optimum HealthCare Medicare Advantage Plans work like traditional HMOs — a plan type you may already be familiar with. All Optimum HealthCare Medicare Advantage Plans come with preventive care benefits to help keep you healthy and active.

Types of Optimum HealthCare Medicare Advantage Plans Available in Tampa Bay 🏥

Optimum HealthCare offers several types of Medicare Advantage plans in the Tampa Bay area, including Hillsborough, Pinellas, Pasco, and Polk Counties:

Optimum HealthCare HMO Plans (Health Maintenance Organization) 🌟

Optimum HealthCare’s HMO plans provide comprehensive coverage through their leading network of doctors and healthcare providers in the Tampa Bay area.

Key Features:

• Monthly premiums as low as $0: Many Optimum HMO plans are available with no monthly premium (you still pay your Part B premium to Medicare)
• Low copay doctor visits: Affordable copays for primary care and specialist visits
• Primary Care Physician (PCP): You’ll choose a primary care physician who coordinates your care and provides referrals to specialists when needed
• Network-Based Care: Use doctors and healthcare providers within the Optimum HealthCare network for routine care (emergency care is covered everywhere)
• Prescription Drug Coverage: Most plans include Part D prescription drug coverage built-in
• Comprehensive Benefits: Includes hearing, vision, and dental benefits that Original Medicare doesn’t cover
• Preventive Care: Routine screenings and preventive services to help you stay healthy

Best For: Medicare beneficiaries who want affordable, coordinated care through a network of trusted providers and prefer the guidance of a primary care physician.

Available In: Hillsborough, Pinellas, Pasco, and Polk Counties (specific plan availability varies by ZIP code)

🤔 Learn more about HMO vs PPO plans to see which is right for you.

Optimum HealthCare Special Needs Plans (SNP) 💚

Optimum HealthCare offers specialized Medicare Advantage plans designed for people with specific health conditions or circumstances.

Dual Eligible Special Needs Plans (D-SNP) 💰

Optimum HealthCare’s Dual Eligible Special Needs Plans (D-SNP) are specifically designed for people who have both Medicare and Medicaid.

Who Qualifies:

You must be eligible for both:

• Medicare (Part A and/or Part B)
• Medicaid (full Medicaid benefits or assistance with Medicare premiums and cost-sharing)

Key Features:

• Most plans have premiums for $0 with no medical copays or deductibles
• HMO plans with prescription drug coverage included
• Medicare coverage and prescription drug coverage combined in one plan
• Additional benefits to help keep you healthy
• Comprehensive dental, vision, and hearing coverage
• Care coordination to help manage your healthcare needs

Additional Benefits Often Include:

• Transportation to medical appointments
• Over-the-counter (OTC) allowance for health products
• Personal care services
• Fitness programs

Enhanced Benefits for D-SNP Members with Chronic Conditions (SSBCI):

If you qualify for a D-SNP and have one or more chronic conditions, you may be eligible for Special Supplemental Benefits for the Chronically Ill (SSBCI), which can include:

• Healthy Food Benefits: Grocery allowances, produce cards, or meal delivery programs for nutritious foods
• Utility Assistance: Help paying electric, gas, and water bills

Best For: Medicare beneficiaries who also have Medicaid and want comprehensive benefits with little to no out-of-pocket costs.

Chronic Special Needs Plans (C-SNP) 💊

Chronic Special Needs Plans are Medicare Advantage plans for people with specific chronic or disabling conditions. Optimum HealthCare C-SNP plans offer specialized care management and benefits designed specifically for your condition.

Qualifying Conditions:

You may be eligible for an Optimum HealthCare C-SNP if you have one or more chronic conditions such as:

• Cardiovascular disorders (including congestive heart failure)
• Diabetes
• Chronic lung disorders (such as COPD)
• End-stage renal disease (ESRD)
• Stroke or other neurological disorders
• Autoimmune disorders

What Makes C-SNP Different:

• Disease-Specific Care Coordination: Dedicated care teams who specialize in managing your specific chronic condition
• Tailored Benefits: Extra benefits and services designed for your condition
• Model of Care: Evidence-based treatment protocols for your chronic condition
• Care Management Programs: Proactive support to help manage your condition
• Lower Costs: Often feature reduced copays for condition-related care

SSBCI Benefits for C-SNP Members:

All C-SNP members qualify for Special Supplemental Benefits for the Chronically Ill (SSBCI), which may include:

• Home health monitoring devices (blood pressure monitors, glucose meters, pulse oximeters)
• Condition-specific supplies and nutritional counseling
• Rehabilitation programs (cardiac, pulmonary, etc.)
• Transportation to specialist appointments
• Healthy food and produce cards (grocery allowances)
• Utility assistance (electric, gas, water bills)

About SSBCI Benefits: Special Supplemental Benefits for the Chronically Ill (SSBCI) address social determinants of health—like food security, housing safety, and utility access—because these factors directly impact your ability to manage chronic conditions effectively.

Best For: Medicare beneficiaries with qualifying chronic conditions who want specialized care coordination and condition-specific benefits.

✅ Think you might qualify for an Optimum Special Needs Plan? Let’s find out! Schedule your free consultation.

What Benefits Are Included with Optimum HealthCare Medicare Advantage Plans? 🎁

Optimum HealthCare Medicare Advantage plans offer comprehensive benefits to help keep you healthy and active. Many plans are available with $0 additional monthly premium (you still pay your Part B premium to Medicare).

Core Medical Benefits 🏥

• All Medicare Part A (hospital) and Part B (medical) benefits
• $0 cost preventive services: Annual wellness visits, screenings, vaccines, and more
• Doctor visits and specialist care
• Hospital stays and outpatient services
• Emergency and urgent care
• Lab tests and diagnostic services

Prescription Drug Coverage 💊

• Medicare Part D prescription drug coverage included in most plans
• Extensive pharmacy network across Florida (4,700+ network pharmacies statewide)
• Mail-order pharmacy options for convenience

Over-the-Counter (OTC) Benefits 🛒

• Generous monthly allowance for over-the-counter health products (amount varies by plan)
• Order online or over the phone
• Shipped to your home at no extra cost
• Choose from pain relief, vitamins, first aid, eye care, diabetes care, and more (19 total categories)

Dental Coverage 🦷

• Comprehensive dental benefits built into the plan
• Preventive services like cleanings and exams
• Restorative services like fillings and extractions

Vision Coverage 👓

• Routine eye exams
• Allowance for eyeglasses or contact lenses

Hearing Benefits 👂

• Hearing exams
• Hearing aid coverage (varies by plan)

Fitness Programs 💪

• $0 cost SilverSneakers® Fitness Membership – access to gyms and fitness classes nationwide
• Home fitness kits available
• Active Fitness benefit: Up to $500 yearly facility allowance for golf, tennis, or swimming (select plans)

Part B Premium Refund 💰

• Select 2026 plans offer monthly Part B Premium refund up to $185
• Money credited directly to your Social Security check each month
• Helps offset or eliminate your Medicare Part B premium

Personal Emergency Response System (PERS) 🚨

• 24/7 monitoring for emergency assistance (select 2026 plans)
• Lightweight, wearable, shower-safe pendant button
• Peace of mind for you and your family

Everyday Options Allowance (C-SNP & D-SNP Plans) 🛍️

• Monthly allowance of $70-$200 on select 2026 C-SNP and D-SNP plans
• Can be used for food, produce, utilities, and assistive devices
• Eligibility confirmation required

Why Choose Optimum HealthCare? ⭐

• 4.5-Star Rating from CMS: Award-winning Medicare Advantage plans recognized for quality, care, and member satisfaction
• Low or $0 Premiums: Many plans available with no monthly premium
• Comprehensive Coverage: Medical, prescription, dental, vision, and hearing in one plan
• Extensive Provider Network: 1,800+ primary care offices, 12,000+ specialist offices, and 4,700+ pharmacies statewide
• Wide Service Area: Available in 24 Florida counties including all of Tampa Bay
• Specialized Care: Special Needs Plans for those with chronic conditions or dual eligibility
• Extra Benefits: Generous OTC allowance, SilverSneakers, Part B giveback
• Preventive Focus: $0 cost preventive care to keep you healthy
• Simplified Billing: One plan, fewer bills, easier to manage
• Part of Wellpoint: Backed by a trusted national healthcare company

Optimum HealthCare Service Areas in Florida 🗺️

Optimum HealthCare serves 24 counties across Florida, including:

• Brevard County
• Broward County
• Charlotte County
• Citrus County
• Collier County
• Hernando County
• Hillsborough County (Tampa, Brandon, Riverview)
• Indian River County
• Lake County
• Lee County
• Manatee County
• Marion County
• Martin County
• Orange County (Orlando)
• Osceola County
• Palm Beach County
• Pasco County (New Port Richey, Wesley Chapel)
• Pinellas County (St. Petersburg, Clearwater, Largo)
• Polk County (Lakeland, Winter Haven)
• St. Lucie County
• Sarasota County
• Seminole County
• Sumter County
• Volusia County

Comparing Optimum HealthCare Medicare Advantage vs. Original Medicare with Medigap

Feature	Optimum Medicare Advantage	Original Medicare + Medigap
Monthly Premium	As low as $0	Part B premium + Medigap premium + Part D premium
Prescription Coverage	Usually included	Requires separate Part D plan
Dental, Vision, Hearing	Included	Not covered
Provider Network	Must use network providers (HMO/POS)	Any doctor accepting Medicare
Referrals	May be required	Not required
Out-of-Pocket Maximum	Yes – protects against high costs	No – Medigap pays set percentages
Best For	Those wanting low premiums and extra benefits	Those wanting complete provider freedom

🛡️ Compare Medicare Supplement vs Medicare Advantage to see which fits your needs.

When Can I Enroll in an Optimum HealthCare Medicare Plan? 📆

Initial Enrollment Period (IEP)

When you first become eligible for Medicare (typically at age 65), you have a 7-month window:

• 3 months before your 65th birthday month
• Your birthday month
• 3 months after your birthday month

Annual Enrollment Period (AEP)

October 15 – December 7 each year. Changes become effective January 1.

Medicare Advantage Open Enrollment Period

January 1 – March 31 each year. You can switch from one Medicare Advantage plan to another or drop your Medicare Advantage plan and return to Original Medicare.

Special Enrollment Periods (SEP)

Certain qualifying events allow you to enroll or change plans outside of normal enrollment periods:

• Moving to a new service area
• Losing other health coverage
• Qualifying for Medicaid
• Chronic condition Special Needs Plans qualification

📅 Don’t miss critical enrollment deadlines! Review our complete Medicare enrollment guide.

Why Choose HealthPlan4U for Your Optimum HealthCare Medicare Plan? 🌟

As an independent licensed insurance broker in Tampa Bay, Timothy Gibson represents Optimum HealthCare and multiple other major carriers. This means:

• ✓ Unbiased Advice: We compare Optimum plans against other carriers to find your best option
• ✓ No Cost to You: Our services are completely free – insurance companies pay us
• ✓ Local Expertise: 16+ years of experience serving Hillsborough, Pinellas, Pasco, and Polk Counties
• ✓ Personalized Service: One-on-one consultations to review your specific needs
• ✓ Ongoing Support: Annual plan reviews and assistance with claims or coverage questions
• ✓ Medicare Enrollment Specialists: We handle the enrollment process from start to finish

🧠 Learn what your Medicare broker should be doing for you.

Get a Free Optimum HealthCare Medicare Plan Comparison 📋

Ready to explore Optimum HealthCare Medicare plans in your area? Contact HealthPlan4U today for a free, no-obligation consultation:

📞 Call: 813-501-5011
📧 Email: tim@healthplan4u.com
🌐 Website: www.healthplan4u.com/contact

We’ll help you compare:

• Optimum HealthCare HMO plans
• Optimum HealthCare D-SNP plans (for dual eligibles)
• Optimum HealthCare C-SNP plans (for chronic conditions)
• Plans from other top-rated carriers

Schedule Your Free Medicare Plan Review 🗓️

During your consultation, we will:

• Review your current coverage and healthcare needs
• Compare Optimum HealthCare plans available in your ZIP code
• Check if your doctors and medications are covered
• Calculate your total estimated costs for each plan option
• Help you enroll in the plan you choose

Important Disclosures ⚠️

Optimum HealthCare is a Medicare Advantage HMO and POS organization with a Medicare contract. Enrollment in Optimum HealthCare depends on contract renewal.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums, and/or member cost-share may change on January 1 of each year.

For Medicare Advantage plans: You must continue to pay your Medicare Part B premium. Plans with $0 premium are not available in all areas.

HealthPlan4U (TRG Life and Health Insurance) is an independent insurance agency and is not affiliated with or endorsed by Optimum HealthCare or the federal Medicare program. We represent multiple Medicare carriers including but not limited to Optimum HealthCare, Humana, United Healthcare, and Devoted Health.

Licensed in Florida | License #: L111402
Service Areas: Hillsborough County, Pinellas County, Pasco County, Polk County