Health Coverage Options After Medicaid

As COVID-19 becomes less of a threat, states will restart yearly Medicaid and Children’s Health Insurance Program (CHIP) eligibility reviews. Virginia Medicaid will continue to work to ensure that all eligible members maintain coverage while meeting all state and federal laws, rules, and regulations. When some individuals are found to be ineligible for Medicaid, Virginia will electronically transfer their information to the Federal Health Care Marketplace.

The Centers for Medicare & Medicaid Services (CMS) has announced a Marketplace Special Enrollment Period (SEP) — also referred to as “Unwinding SEP” — for qualified individuals and families who lose Medicaid or CHIP coverage. The SEP allows these individuals to enroll in Marketplace health insurance coverage outside of the annual open enrollment period which typically runs from November 1 to January 15 for Individual & Family health plans.

If You No Longer Qualify for Medicaid or CHIP

We can help!  If you no longer qualify for health coverage through Virginia Medicaid or CHIP, there are other affordable healthcare options. You may be able to get financial help to lower the cost of private health insurance through the Federal Marketplace. Optima Health offers Individual & Family health plans directly through us or through the Federal Marketplace.

Sign up for a Federal Marketplace health plan within 60 days of losing your Medicaid coverage or anytime during the annual open enrollment period from November 1 through January 15.

Talk to one of our OptimaFit® Personal Plan Advisors at 1-855-434-3253.

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Explore Marketplace Plans

OptimaFit Individual & Family health plans offer great health insurance coverage with a variety of deductible and copayment options.

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Plan Features

  • annual pediatric vision exams
  • annual preventive services
    • adult and childhood immunizations
    • colorectal cancer tests
    • colonoscopy
    • gynecological exams and Pap smears
    • mammograms
    • well baby and child exams
  • diabetes prevention
  • emergency services
  • health and wellness programs
  • hospitalization (surgery and overnight stays)
  • mental health and substance use disorder services
  • outpatient services/care
  • partners in pregnancy
  • retail and mail-order prescription drugs
  • value-added services
    • alternative medicine discount program – discounts for acupuncture, chiropractic, and massage therapy services
    • emergency travel assistance – global emergency health coverage and access to on-call providers
    • treatment cost calculator – provides out-of-pocket cost estimates for over 500 procedures and services
    • virtual consults – on demand care from anywhere

    If You Have Medicaid, but Didn't Renew in Time

    If you did not renew, you can return your information within 90 days of your renewal date for review.

    If Virginia Medicaid does not receive your form or your verifications, your benefits stop. You will receive a letter letting you know when your benefits will end. It is very important that you return your paperwork, even if you think you might not be eligible, for two reasons:

    • you may be eligible for coverage you may be unaware of or other programs that provide limited coverage
    • Virginia Medicaid cannot send your information to the Marketplace if they cannot review your case

    However, if you are closed for a “did not receive a completed renewal form" reason, you have three months after your closure to return the form or verifications for Virginia Medicaid to review your benefits – you don’t have to reapply! After the three months (90 days), if they don’t hear from you, then you will need to reapply if you would like to see if you might be eligible again.

    If you have questions about what you need to send Virginia Medicaid, talk with one of our Member Outreach representatives at 1-833-261-2367 (TTY: 711) Monday through Friday from 8:00 a.m. to 5:30 p.m. or Cover Virginia at 1-855-242-8282 (TDD: 1-888-221-1590).

    Renew Your Coverage

    Still Not Sure What To Do?

    Talk to one of our OptimaFit Personal Plan Advisors at 1-855-434-3253, or we can call you! Simply click on the link below and we will have an advisor help you.

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