Optima Health Medicaid XP Eligibility

Who is Eligible?

As of January 1, 2019, thousands of Virginians between the ages of 19-64 are now able to get the health care they need at little to no cost.

You may be eligible if:
  • You are a Virginia resident, age 19 to 64
  • You are enrolled in a low cost individual health insurance plan on the federal exchange, or
  • You meet the income requirements
  • Income Requirements

    You may be eligible if you make less than:

    Family Size*1 Yearly*2 Monthly*2
    (1) $17,609 $1,469
    (2) $23,792 $1,983
    (3) $29,974 $2,499
    (4) $36,156 $3,014
    (5) $42,339 $3,529
    (6) $48,521 $4,044
    (7) $54,704 $4,560
    (8) $60,886 $5,074
    Additional persons $6,183 $516

    *1: Income requirements vary by household size. Up to 138% of the Federal Poverty Level, including 5% Federal Poverty Disregard.

    *2: 2020 Income Guidelines as of January 17, 2020.

  • Who Qualifies?

       Childless Adult    Parent (family of 3)    Person with Disability
    Before 2019: Not Eligible Eligible with annual income at or below $7,068 Eligible with annual income at or below $9,992
    In 2020: Eligible with annual income at or below $17,609 Eligible with annual income at or below $29,974 Eligible with annual income at or below $17,609

    Some adults may already be eligible for other Medicaid programs that offer limited benefits. Visit the Cover Virginia website to see if you qualify. Even if you qualify for a limited benefit program now, you may still be eligible for full health insurance benefits through Optima Health Medicaid XP beginning on January 1, 2019.

What plans are available?

Depending on your needs, you could be assigned to Optima Health under one of the following Medicaid plans:

  • Optima Family Care

    Optima Family Care is here for you and your family, with a variety of added benefits that can help keep you healthy and well.

    Make the most of your Medicaid benefits by taking advantage of our quality health care and extensive network of doctors and specialists as an Optima Health Medicaid XP eligible member.

    Explore Plan

  • Optima Health Community Care

    Optima Health Community Care is a Commonwealth Coordinated Care Plus (CCC Plus) Medicaid plan for many older people and those with disabilities.

    Members benefit from an individualized, fully-integrated program with a statewide network of providers. We provide a care team just for you with dependable community support.

    Explore Plan

  • How can I choose Optima Health?

    If you think you may qualify for healthcare coverage as Optima Health Medicaid XP eligible, please apply using one of the methods listed below and state that you wish to choose Optima Health as your plan provider.

    • Call the Cover Virginia Call Center at 1-855-242-8282 (TDD: 1-888-221-1590) to apply on the phone Monday through Friday 8 a.m. - 7 p.m. and Saturday: 9 a.m. - 12 p.m.
    • Apply online at www.commonhelp.virginia.gov
    • Complete an online application at the Health Insurance Marketplace: www.healthcare.gov
    • Mail or drop off an application to your local Department of Social Services. Find your nearest local Department of Social Services by visiting www.dss.virginia.gov/localagency
    • Call the Virginia Department of Social Services Enterprise Call Center at 1-855-635-4370

    When you receive your assignment letter from the Department of Medical Assistance Services (DMAS), you may not be assigned to an Optima Health plan. You have the right to choose us as your Medicaid plan provider within 90 days of being assigned.

Find out if you qualify

You can call Cover Virginia at 1-855-242-8282 (Toll-Free) or 1-888-221-1590 (TDD) or use the CoverVA.org online screening tool.

Check Your Eligibility

Optima Health Medicaid XP