Virginia Medicaid has resumed the normal eligibility review process. Medicaid and Family Access to Medical Insurance Security Plan (FAMIS 1 ) coverage won't continue automatically like it did during the pandemic.
We can help! Losing Medicaid or FAMIS coverage qualifies you for a Marketplace Special Enrollment Period (SEP) — also referred to as an “Unwinding SEP.” The SEP is your chance to enroll in a Marketplace health insurance outside of the annual Open Enrollment Period (OEP) which typically runs from November 1 to January 15 for Individual & Family health plans. For some individuals, Virginia will electronically transfer their information to the Marketplace.
There are other healthcare options that may be more affordable than you think. Sentara Health Plans, formerly Optima Health offers Individual & Family health plans that can help lower the cost of your health insurance with a Marketplace plan. Talk to one of our Personal Plan Advisors at 1-855-434-3253 to see if you qualify for a subsidy
Sign up for a Marketplace health plan within 90 days of losing your Medicaid coverage during your SEP or anytime during the annual OEP from November 1 through January 15.
Our Individual & Family Health Plans offer great coverage with a variety of deductible and copay options. All plans are classified by metallic tiers to make it easier for you to compare plans based on prices and coverage. Our plans include essential health benefits 2 to help control and manage our health. All plans also include value-added benefits like health and wellness programs and gym membership discounts. And with our broad provider network, in most cases, you can keep your current doctor 3 .
| Gold | Silver | Bronze | |
| Monthly premium | Gold $$$ | Silver $$ | Bronze $ |
| Percent of Healthcare cost covered | Gold 80% | Silver 70% | Bronze 60% |
| Good for members who. | Gold want to pay more premium costs upfront to reduce out-of-pocket expenses at time of care. | Silver need to balance monthly premium costs with out-of-pocket costs. | Bronze don't plan to use a lot of healthcare services. |
See if you qualify for financial help.
If Virginia Medicaid does not receive your form or your verifications, your benefits stop for "failure to renew." However, you can return your information late –within 90 days of missing your renewal date. After 90 days has passed, you need to reapply for Medicaid coverage if you think you are still eligible.
1 FAMIS is federally known as Children's Health Insurance Program (CHIP).
2 Essential Health Benefits are a set of 10 categories of services covered under the Affordable Care Act. These include inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, mental health services and more.
to make sure your doctor is in network prior to using services.
4 Office visit copay or coinsurance may apply.
5 Cost share may apply for Health Savings Account (HSA) plans and other health situations.
Sentara Health Plans is the trade name for Sentara Health Plans, Sentara Health Insurance Company, Sentara Health Administration, Inc., and Sentara Behavioral Health Services, Inc. Health Maintenance Organization (HMO) products, and Point-of-Service (POS) products are issued and underwritten by Sentara Health Plans. Preferred Provider Organization (PPO) products are issued and underwritten by Sentara Health Insurance Company. Sentara Health Administration, Inc. provides administrative services to group and individual health plans but does not underwrite benefits. All plans have benefit exclusions and limitations and terms under which the policy may be continued in force or discontinued. Medicare products are administered under an agreement with Sentara Health Plans and the Centers for Medicare and Medicaid Services (CMS). Medicaid and FAMIS products are administered under an agreement with Sentara Health Plans and the Virginia Department of Medical Assistance Services (DMAS).