Virginia Medicaid has resumed the normal eligibility review process. Medicaid and Family Access to Medical Insurance Security Plan (FAMIS1) coverage won't continue automatically like it did during the pandemic.
You No Longer Qualify for Medicaid or FAMIS
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. 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 2023 Marketplace health plan within 60 days of losing your Medicaid coverage during your SEP or anytime during the annual OEP from November 1 through January 15.
Explore Marketplace Plans
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 benefits2 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 doctor3.
| Gold | Silver | Bronze | |
| Monthly Premium | Gold$$$ | Silver$$ | Bronze$ |
| Percent of healthcare cost covered | Gold80% | Silver70% | Bronze60% |
| Good for members who... | Goldwant to save on premium costs while still reducing out-of-pocket costs. | Silverneed to balance monthly premium costs with out-of-pocket costs. | Bronzedon't plan to use a lot of healthcare services. |
Here are some plan features:
- $0 preventive care4
- on-demand virtual consults5
- 24/7 Nurse Advice Line
- mental health benefits
- 24/7 Behavioral Health Crisis Line
- affordable prescription drugs from a pharmacy or mail-order
- diabetes, asthma, and healthy eating programs
- maternity care
- annual pediatric vision exams
You Have Medicaid, but Didn't Renew in Time
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 would need to reapply for Medicaid coverage if you think you are still eligible.
Still Not Sure What To Do?
Listen to KISS_FM Richmond's Community Conversations Replay: Medicaid Renewals and Options if You No Longer Qualify.
Talk to one of our Personal Plan Advisors at 1-855-434-3253, or we can call you!