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  1. Optima Health Home
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  3. Medicaid
  4. What Does Medicaid Cover?

What Does Medicaid Cover?

Having a Medicaid health plan means your visits to the doctor, hospital stays, and prescriptions are covered at little or no cost to you.

Here are some highlights of Medicaid covered benefits for Optima Health Medicaid members.

Medicaid and Medicare dual-eligible Optima Community Complete (HMO D-SNP) members: view plan details.

Check our member handbooks for a more detailed list of coverage. View our list of added benefits available just for being an Optima Health member.

Quality Expert Care

  • 35,000 providers including doctors, urgent cares and hospitals
  • access to quality specialists for allergies, diabetes, heart problems, and more
  • help scheduling doctor appointments and rides
  • a dedicated advocate for coordinating your care and benefits

Exams

  • preventive care
  • routine medical care
  • well-baby, well-child, and well-adolescent health exams
  • dental benefits (covered by Virginia Medicaid under a separate program)
  • eye exams
  • hearing exams

Note: FAMIS Children members may have low copays.

Emergency Care

  • urgent care
  • emergency care
  • hospital stays

Prescription Drugs

  • no copays at in-network pharmacies for drugs on our drug list
  • FAMIS Children: Low copay, typically $2 to $5
  • Optima Community Complete (HMO D-SNP): view plan details for drug coverage if you are dual-eligible for both Medicare and Medicaid

    Note: Does not cover Medicare Part D drugs, including the Medicare copayment.

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© Optima Health 2023, PO Box 66189, Virginia Beach, Virginia 23466

Sentara Health Plans and Optima Health are trade names of Sentara Health Plans, Sentara Health Insurance Company, Sentara Health Administration, Inc., and Sentara Behavioral Health Services, Inc. Optima Health Insurance Company is an additional trade name for Sentara Health Insurance Company. Virginia Premier Health Plan is an additional trade name for Sentara Health Plans. Optima Behavioral Health is an additional trade name for Sentara Behavioral Health Services, Inc. Optima Health Maintenance Organization (HMO) products, and Point-of-Service (POS) products, are issued and underwritten by Sentara Health Plans. Optima 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 Optima Health 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.)