Frequently Asked Questions
What is Medicaid?
Medicaid is benefit program that provides health coverage to people with low incomes, and people with disabilities. It covers adults and children who meet certain requirements. The state and federal governments fund the program.
What is the difference between Medicare and Medicaid?
Medicare and Medicaid are two separate, government-run programs. Medicare is a federal program for people age 65 and over, and people under age 65 who have been disabled at least two years, no matter their income. It provides hospital and medical coverage. Medicaid provides healthcare coverage to eligible children and adults with low incomes, and people with disabilities.
What is the difference between the Health Insurance Marketplace and Medicaid?
The Health Insurance Marketplace (“Exchange”) is an online service that allows people to shop for health insurance for themselves or their families. When you fill out an application at the Marketplace, you are automatically evaluated for Medicaid. It also determines if someone qualifies for subsidies that may help lower the cost of health insurance. Medicaid is a government healthcare benefit for eligible people with low incomes, and people with disabilities. The state and federal governments fund Medicaid. You can apply through the Health Insurance Marketplace or directly with the state.
What does Medicaid cost?
You pay no enrollment costs, no monthly premiums, and no co-payments. With FAMIS, most co-payments are just $2 to $5 and some services like preventive care are free. A medical provider cannot refuse to treat you if you are unable to pay the co-payment, but you are still responsible for the co-payment. During the COVID-19 pandemic, there are no co-pays for any Medicaid or FAMIS covered services.
What is Medicaid open enrollment?
Open enrollment is the time of year when current Medicaid members can switch health plans. The time period for making a change depends on where you live, and the type of Medicaid coverage you receive. Visit the Optima Health open enrollment website to find out the dates for your area and plan type.
What is the Virginia Medicaid expansion?
In 2018, Virginia approved offering Medicaid to more low-income adults. This allowed thousands of residents to become newly eligible for quality health coverage as of January 1, 2019. Childless adults, parents, or a person with a disability may be eligible if:
- they are a Virginia resident, aged 19-64
- they are not already in or eligible for Medicare
- they meet income requirements
What are the differences between Optima Family Care, Optima Health Community Care, and Optima Health Medicaid XP?
Optima Family Care is our Medallion 4.0 plan. It primarily serves pregnant women and children.
Optima Health Community Care is our Commonwealth Coordinated Care Plus (CCC Plus) plan. It serves people with complex health cases (adults or children with disabilities, people who live in a nursing facility, people age 65 and older and qualify for Medicaid through income requirements).
Optima Health Medicaid XP is the name used to identify our members who are eligible under the expansion of Virginia Medicaid. More information can be found at the Cover Virginia website.
Can I switch to Optima Health from another Medicaid plan?
Yes. Visit How to Switch to learn more.
How do I enroll in Optima Health Medicaid
Will I be able to enroll if I have a pre-existing condition?
Yes, health insurance is available to you if you have a pre-existing condition as long as you meet the eligibility requirements.
Will I be able to keep my current doctor?
How will my doctor know that I have Optima Health insurance?
If you are enrolled in an Optima Health Medicaid plan, you will be mailed a healthcare card to use when you visit your doctor. You may also view your ID card from the Optima Health mobile app.
What is a Care Coordinator?
A Care Coordinator is an Optima Health clinical staff member dedicated to help members understand how their plan works, the benefits covered, and how to access services such as scheduling appointments and transportation. Care Coordinators help members work with their doctor(s), and develop a health risk assessment and a personalized care plan specific to their healthcare needs. Members will receive a letter from their Care Coordinator with more information, including office hours and contact information.
What is D-SNP?
D-SNP is a special type of Medicare Advantage plan for people eligible for both Medicare and Medicaid called a Dual Special Needs Plan. CCC Plus members who are eligible for D-SNP can choose the same health plan for both their Medicare and Medicaid coverage to gain more added benefits and seamless care coordination. To keep it simple, most people choose the same plan provider for both Medicare and Medicaid coverage.
What is ARTS?
Addiction and Recovery Treatment Services (ARTS) is the DMAS program for addiction and recovery treatment. View more information about the ARTS program, including requirements and covered services at dmas.virginia.gov.
How can I find more information about DMAS programs?
Visit the DMAS website at dmas.virginia.gov.