Frequently Asked Questions about Optima Health Medicaid XP

Optima Health Medicaid XP is not a health plan. It is our way of identifying those that are newly eligible under the Virginia Medicaid expansion and assigned to us for managing their health care.

If you qualify for coverage under the Medicaid expansion, and are assigned to Optima Health as your Managed Care Organization (MCO), you will be enrolled in either Optima Family Care or Optima Health Community Care as an eligible member.

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  • What is the Virginia Medicaid expansion?

    In late May 2018, the Virginia General Assembly approved Medicaid expansion to over 400,000 low income residents. Effective January 1, 2019, more adults (aged 19-64) in Virginia will have access to quality, low-cost health insurance through Medicaid. Thousands of Virginians, who were not able to before, will soon be newly eligible to access the health care they need.

    Eligibility requirements:

    Childless adults, parents, or a person with disability may be eligible for the Medicaid expansion when they meet the following categories:

    • They are a Virginia Resident, aged 19-64.
    • They are not already in or eligible for Medicare
    • They meet the income requirements
  • What is Optima Health Medicaid XP?

    Optima Health Medicaid XP is the name that we are using to identify our newly eligible members through Medicaid Expansion.

    Each newly eligible member that is joining an Optima Health Medicaid plan, will either be assigned to Optima Family Care or Optima Health Community Care to serve their healthcare needs.

  • When will coverage be available?

    Pre-enrollment for Optima Family Care and Optima Health Community Care under Optima Health Medicaid XP begins November 1st, 2018, and you can start using your health insurance benefits on January 1, 2019.

  • How much does coverage cost?

    For 2019, there is no cost to members. But during phase 2 (2020), copays and work requirements may apply to certain members. More information is to come in the next year.

  • What are the differences between Optima Health Medicaid XP, Optima Family Care, and Optima Health Community Care?

    Optima Family Care primarily serves pregnant mothers and children.

    Optima Health Community Care serves people with complex health cases; i.e. adults or children with disabilities, reside in a nursing facility, or are 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 newly eligible under Virginia Medicaid through the Medicaid Expansion. More information can be found at the Cover Virginia website.

  • How do I enroll, or switch to Optima Health Medicaid coverage from another plan?

    To enroll in an Optima Health Medicaid plan, or to see if you qualify, call Cover Virginia at 1-855-242-8282 (Toll Free) or 1-888-221-1590 (TDD)

  • 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?

    Although there may be some limited exceptions, in most cases you will be able to keep your current doctor. Please see the lists of doctors in the Optima Family Care and Optima Health Community Care networks.

  • How will my doctor know that I have Optima Health health insurance?

    Once the program begins in January 2019, if you are enrolled in an Optima Health Medicaid plan under Optima Health Medicaid XP, you will be mailed a healthcare card to use when you visit your doctor.


To enroll in a health insurance plan, or to see if you qualify, visit the Cover Virginia website, or call 1-855-242-8282 (Toll Free), or 1-888-221-1590 (TDD).