Orlando Harmon
Virginia's Medicaid program offers affordable health care to eligible residents, including low-income individuals, pregnant women, people with disabilities, and children. The state has an annual renewal process for Medicaid coverage, and individuals have the right to choose their health plan. Virginia Medicaid currently offers five Managed Care Organizations (MCOs), each with its own network of doctors and providers. Individuals can enroll in a plan online, through a mobile app, or by phone during the open enrollment period. This article will provide a step-by-step guide to changing your Medicaid insurance in Virginia, covering topics such as eligibility, plan selection, and the enrollment process.
| Characteristics | Values |
|---|---|
| Medicaid Insurance in Virginia | Available for low-income elderly residents, disabled people, pregnant women, infants, children, and adults |
| Virginia Medicaid Plan | Offers health coverage at no-cost or low-cost through the UnitedHealthcare Community Plan |
| Cardinal Care | Available at no extra cost for eligible families, pregnant women, infants, children, and adults |
| Enrollment | Online, by mobile app, or by phone during open enrollment |
| Renewal | Annual renewal, with automatic renewal if all information is available |
| Transition | Those no longer eligible for Medicaid can transition to other coverage, such as an employer's plan, Medicare, or a Marketplace plan |
| Health Plan Choice | Individuals have the right to choose their preferred health plan for Medicaid coverage |
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What You'll Learn
Medicaid eligibility and enrollment
Medicaid is a health care program for low-income persons of all ages. In Virginia, Medicaid offers several programs that help seniors live at home or in the community. These include the Commonwealth Coordinated Care Plus Waiver (CCC+), a managed care program, and the Program of All-Inclusive Care for the Elderly (PACE), which combines the benefits of Medicaid and Medicare.
In addition to seniors, Medicaid eligibility in Virginia includes:
- Pregnant people with household incomes up to 148% of poverty (coverage continues for 12 months postpartum)
- Adults under 65 with incomes up to 138% of the federal poverty level (FPL)
- Children with household incomes up to 200% of FPL
Virginia's Medicaid and FAMIS programs also cover children, pregnant women, and adults. FAMIS, or Family Access to Medical Insurance Security, provides health coverage for uninsured pregnant women who are not eligible for Medicaid but have household incomes up to 205% of poverty.
To enroll in Medicaid in Virginia, you can apply online, over the phone, or by mailing a paper application. Online applications can be submitted at www.commonhelp.virginia.gov or marketplace.virginia.gov. Paper applications can be mailed or dropped off at your local Department of Social Services (DSS) office. If you are applying for Medicaid for someone who is medically needy or requires nursing or community-based care, you may need to complete additional forms.
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Annual renewal
Virginia Medicaid health coverage must be renewed annually. This is called an annual renewal. If your local Department of Social Services (DSS) has all the information required to complete your renewal, it will be automatically processed. You will receive a letter in the mail notifying you of the continuation of your coverage for another year.
However, if your renewal cannot be completed automatically, you will receive a paper renewal form in the mail. This indicates that you must take action to renew your health coverage. Failure to complete your renewal will result in the loss of your Medicaid health coverage.
You can renew your coverage by phone, mail, or in person. To renew by phone, call Cover Virginia at 1-855-242-8282 (TTY: 1-888-221-1590). This call is free. Alternatively, you can fill out the paper renewal form and return it to your local DSS. Ensure that you notify Cover Virginia within ten days of any changes to your information, such as your address or phone number.
To renew your coverage online, visit Cover Virginia's website. You will need to provide information about yourself and your family, including recent pay stubs or proof of other income. Keeping your information up to date is essential for maintaining your benefits and services.
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Choosing a health plan
Plan Options:
Firstly, familiarize yourself with the available options. Virginia Medicaid offers several health plans, including the UnitedHealthcare Community Plan, Cardinal Care, and FAMIS. Each plan has its own unique features, benefits, and eligibility requirements.
Coverage and Benefits:
Different health plans cover different services and benefits. Consider your specific healthcare needs and priorities. For example, if you require specialized care for a pre-existing condition, ensure that the chosen plan covers it. Some plans, like the UnitedHealthcare Community Plan, offer extra benefits such as the One Pass™ program, which provides free access to select fitness locations and virtual workout options.
Provider Networks:
Review the provider networks associated with each health plan. A provider network is a group of healthcare professionals, such as doctors, specialists, and hospitals, that have contracted with the insurance company to provide services to its members. Choosing a plan with a robust provider network ensures that you have access to a wide range of healthcare options.
Eligibility and Enrollment:
Each health plan has specific eligibility requirements. For example, some plans cater to specific demographics, such as pregnant women, adults under 65, or children. Additionally, pay attention to the enrollment periods. Some plans have specific dates when you can sign up, and these may vary by area.
Cost:
Consider the cost implications of each health plan. Virginia Medicaid offers health coverage at no-cost or low-cost, depending on your financial situation. Compare the premiums, deductibles, and co-pays associated with each plan to make an informed decision.
Transition Options:
If you are currently enrolled in a health plan and wish to switch, understand the transition process. You have the right to choose a different health plan for your Medicaid coverage. Some plans, like Sentara Health Plans, may offer easy transition options. Additionally, if your circumstances change and you are no longer eligible for Medicaid, you can explore other coverage options, such as an employer's plan, Medicare, or a plan through the Virginia Insurance Marketplace.
Remember, it is important to carefully review the details of each health plan, considering your unique needs and circumstances. The official Virginia Medicaid website and the enrollment website are valuable resources for more detailed information on the available plans and how to change your health plan.
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Transitioning to other coverage
If you are no longer eligible for Medicaid, you can transition to other coverage. This could be an employer's plan, Medicare, or a plan purchased through the Virginia Insurance Marketplace. During the unwinding process, 34,110 Virginia residents transitioned from Medicaid to a Marketplace plan.
You can apply for a Marketplace plan online at www.commonhelp.virginia.gov or over the phone by calling the Cover Virginia Call Center at 1-855-242-8282. Help is available Monday to Friday, 8:00 am to 7:00 pm, and Saturday, 9:00 am to 12:00 pm. You can also complete a paper application and mail it in or drop it off at your local Department of Social Services Office.
If you are transitioning to an employer's plan or Medicare, you should contact your employer or Medicare directly to understand the steps you need to take.
It is important to note that health coverage from Virginia Medicaid needs to be renewed each year. This is called an annual renewal. If your local Department of Social Services has all the information needed to complete your renewal, this process will be done automatically. You will receive a notice in the mail informing you if your coverage will continue for another year. If your renewal cannot be completed automatically, you will receive a paper renewal form in the mail, and you must take action to renew your health coverage.
Additionally, you have the right to choose the health plan you want for your Medicaid coverage in Virginia. You can join or change your UnitedHealthcare Community plan of Virginia - Cardinal Care every year.
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Medicaid Dual Special Needs Plans
In Virginia, you can change your Medicaid health plan by visiting the enrollment website. The state's Medicaid program is managed care, which means you will be enrolled in a health plan with a group of doctors and other providers working together to give you health services. Virginia Medicaid currently has five Managed Care Organizations (MCOs):
- Aetna Better Health
- Anthem HealthKeepers Plus
- Molina Healthcare
- Sentara Community Plan
- UnitedHealthCare Community Plan
You have the right to choose the health plan you want for your Medicaid coverage. You can compare the added benefits each plan offers and enroll in a health plan online, by mobile app, or by phone during open enrollment.
For example, UHC Dual Complete Special Needs Plans (SNP) provide benefits such as transportation to medical appointments and routine vision exams. Similarly, Aetna Medicare Advantage Dual Eligible Special Needs Plans (HMO D-SNP) offer additional benefits and services not covered under Medicare, such as dental, hearing aids, and eyewear. They may also help coordinate your Medicare and Medicaid covered services.
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Frequently asked questions
You can change your health plan by visiting the enrollment website or calling the Managed Care HelpLine. You can also find your MCO's contact information.
Medicaid is available to low-income elderly residents, disabled people, pregnant women with a household income of up to 148% of poverty, and adults under 65 with an income below 138% of the poverty level. Children are eligible if their household income is up to 148% of poverty.
You can fill out the online application, apply over the phone, or complete a paper application.
