Health Coverage Rights And Options
We will notify individuals who may have a change in their Medicaid eligibility status or benefits. If they no longer qualify for Medicaid, their letter will include the date their coverage ends. They will have an opportunity to appeal if they believe they are still eligible for Medicaid coverage. We also will share information on other health coverage options, including health insurance and financial help available through the Federal Marketplace.
We are working closely with Enroll Virginia and its network of assisters to make sure affected individuals visit HealthCare.gov within 60 days of losing their Medicaid coverage. To learn more, visit EnrollVa.org or call 1-888-392-5132.
Everything You Need To Know About Medicare
MEDICARE SAVINGS PROGRAMS
These programs provide assistance paying for Medicare co-insurance, deductible, and Part B premiums. Eligibility is based on income and assets. Contact the Prince William Area Agency on Aging at 703-792-4156 to determine eligibility and apply.
REPORT MEDICARE FRAUD
The Senior Medicare Patrol Program helps Medicare and Medicaid beneficiaries identify, prevent, and report health care fraud. Visit virginiasmp.org or call 1-800-938-8885 to learn more.
Which Medicaid Plan Is Best In Virginia
The best Medicaid plan will be different from person to person based on their specific needs. There are a variety of plans to choose from. Not all of them are available in all areas, so check to see which ones are available to you before choosing one. You might also want to check with your doctors to see which plans they accept if you dont want to have to change doctors.
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Virginia Medicaid Enrollment Numbers
By June 2016, total enrollment in Virginias Medicaid program was 968,666, which was 4% higher than it had been in late 2013. Enrollment growth hovered in the single digits until Medicaid was expanded, and then it grew substantially. By July 2020, total Medicaid and CHIP enrollment had grown to over 1.5 million, which was an increase of more than 50% increase since late 2013. Medicaid enrollment in Virginia, and in much of the nation, had a sharp increase in 2020 driven by the coronavirus pandemic.
As of November 2021, 1,926,548 Virginians are covered by Medicaid/CHIP programs.
Unitedhealthcare Senior Care Options Plan
UnitedHealthcare SCO is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our SCO program.
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When Is Open Enrollment
Your open enrollment period depends on the program that you are enrolled in and where you live. Different regions may have different open enrollment periods. To learn when open enrollment happens where you live, . You will receive a letter informing you of your open enrollment period before open enrollment begins.
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After The Covid Public Health Emergency: What Comes Next
Under the current federal public health emergency, Medicaid members can keep their health coverage even if their eligibility status changed during the COVID-19 pandemic. Once the emergency ends, the Virginia Medicaid agency will have one year to review eligibility for our members and renew coverage for those who qualify.
Although we do not yet know when the public health emergency will end, we are preparing now to ensure that all eligible Medicaid members have the information they need to stay covered.
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Learn More About Your Coverage What You Need To File Your 2020 Taxes And If Youre Eligible For A Special Enrollment Period
If you enrolled or renewed your coverage for 2021, now is a great time to learn how to get the most value from your health care coverage. Explore the resources available to help you maximize your 2020 health care coverage.
If you were covered by a Marketplace plan in 2020, you will need two important forms to complete and file your 2020 tax return. If you were uninsured in 2020, the fee is $695 per adult and $347.50 per child up to a maximum of $2,085 or 2.5% of your annual household income above the tax filing threshold, whichever is more. You may qualify for an exemption from the fee if you meet certain requirements.
The 2021 Open Enrollment period ended on December 15, 2020. As a result, you cannot sign up for health care coverage until the 2022 Open Enrollment period UNLESS you become eligible for a Special Enrollment Period. You must experience a qualifying life event like getting married, having or adopting a baby, losing your current health coverage in order to be eligible. If you have a qualifying event, you may be eligible to enroll during the 2021 Special Enrollment Period .
As always, one-on-one help is still available! You will have someone who will help you every step of the way. Located throughout the state, application assisters are highly trained and know all about how to enroll in and renew health care coverage. Use the locator to find help in your area. Their services are at no-cost: you do not have to pay for their help!
Virginia Medicaid Mailing Address
Virginia Medicaid Street: 600 E Broad StCity: RichmondState: VirginiaZip Code: 23219
Apply-for-Medicaid-Online.com is a leading hub that provides the best and most updated information for Virginia Medicaid and Virginia state health insurance.
Our users may find new information for Virginia Medicaid and Virginia state health insurance, and usually share it with us, helping us help other users. If you find new data for Virginia Medicaid, we would appreciate if you dropped us a quick message via the contact us page form or the comments form below.
We always make sure to confirm any new information as soon as it is released and publish it for free for the benefits of you and all users who wish to apply to Virginia Medicaid and Virginia state health insurance.
This Apply-for-Medicaid-Online.com website was created as a completely independent website that is not affiliated with Virginia Medicaid, Virginia state health insurance or any state or federal office, department, agency, board, or commission.
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How To Complete Forms For Medicaid Application By Phone
If you cannot file an online Medicaid application, do not have the means of visiting your local office or are unable to retrieve a VA Medicaid application for mailing, you have one more option to consider. The Department of Social Services accepts applications for Medicaid over the phone in certain instances.You can apply for medical coverage by calling 855-242-8282. Note that times may vary by branch, but caseworkers are available Monday through Friday from 8 a.m. to 7 p.m. You may also call on Saturdays between the hours of 9 a.m. and noon for phone assistance with your Virginia Medicaid application if you so choose.
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How You Can Help
We are asking members to make sure we have their current mailing address and phone number. We will use this contact information to send members important paperwork that we need to check eligibility and renew their coverage. Please help us spread the word and provide support to members who need assistance. Medicaid members can update their information in one of three ways:
- Visit commonhelp.virginia.gov. To create an account, go to the website and click Check my Benefits. You can link a case to a CommonHelp account by using the member case number and client ID, log in and select Manage My Account.
- Call the local Department of Social Services by visiting dss.virginia.gov/localagency/index.cgi to search for the local agencys number.
The Department of Medical Assistance Services also offers a toolkit to guide stakeholders and advocates as you assist Medicaid members with the end of the public health emergency. The toolkit includes materials in English, Spanish and other languages such as fact sheets, FAQs, posters, fliers and more. Help us get the message out by distributing these materials or sharing them on your social media accounts.
Some Medicaid members may receive multiple reminders to update their contact information with Virginia Medicaid. Please let members know that they only need to update their information once and can ignore subsequent messages if they have completed their update.
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Canceling Magi Medicaid Coverage
Getting Health Care Coverage During The Special Enrollment Period
During the year, situations occur that could make you eligible to enroll in a health care plan through the Marketplace after Open Enrollment ends. These are called qualifying life events. Examples include, but are not limited to:
- Getting married or loss of coverage due to a divorce
- Losing your employer-sponsored health care coverage, or coverage under FAMIS or Medicaid
- Turning 26 so you are no longer eligible for coverage under a parents health care plan
- Having or adopting a baby
If you have experienced a qualifying life event and are determined eligible to participate in a Special Enrollment Period, you will be able to choose from all the health care plans available in your area. You may qualify for financial assistance too! Known as advance premium tax credits , these credits lower the amount of money you pay for your health care coverage each month.
You can use healthcare.gov to determine if you are eligible to enroll during this Special Enrollment Period. If you are, you can create an account on healthcare.gov and enroll in a Marketplace plan. You may be asked to provide proof of your qualifying life event, so make sure to save any notices about loss of coverage and other important documents.
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Medicaid Expansion Beginning January 1 2019
The rules have changed. More people qualify. Beginning January 1, 2019, more adults living in Virginia will have access to quality, low-cost health insurance. Eligibility is based on income. For example, an adult without children whose annual income is at or below $16,754, or a family of three with annual income at or below $28,677, or a person living with a disability with an annual income at or below $16,754, qualifies for coverage. For more information, please visit .
How Do I Transfer My Prescriptions
To speak with a pharmacy representative who can help you transfer your prescription, call Member Services at 1-855-249-5025, or 711 , Monday through Friday, from 7:30 a.m. to 9 p.m. .
When you call, please have your prescription number and the name and phone number of the pharmacy where you wish to transfer them from ready. Well handle the rest.
You can also visit New Member Prescription Transfer for information on how to transfer your prescriptions.
If you want to transfer a prescription from another pharmacy to a Kaiser Permanente medical center pharmacy, call the Kaiser Permanente pharmacy location of your choice and provide the following information:
- Your name and Kaiser Permanente member ID
- Name and telephone number of the other pharmacy
- Name of the prescribed medication
- Prescription number of the prescribed medication
- Name and phone number of the doctor who prescribed the medication
If you want to transfer a prescription from a Kaiser Permanente medical center or mail order pharmacy to another participating pharmacy, you must contact that participating pharmacy.
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Income Requirements For Virginia Medicaid
If you would like to be able to qualify for one of the Medicaid programs in Virginia, you will have to fall into the income bracket for the program you think you should be in. Pregnant women who might be in the FAMIS Plus program or Medicaid can make no more than 143% of the FPL as determined by the MAGI . For the childrens FAMIS program, MOMS, or Plan First, you cant earn more than 200% of the FPL. Children who are not yet 19 have to be in households that earn less than 143% of the FPL.
You can click here to find out more about the income limits for each household size.
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The Impact Of Medicaid Expansion In Virginia
An estimated 400,000 people were expected to become eligible for coverage under the expanded guidelines, but that number is higher now as a result of the COVID pandemic .
By early 2020, about 375,000 people had gained coverage under the expanded eligibility guidelines. By mid-2022, however, that number had grown to more than 671,000 people. When the COVID public health emergency ends and Medicaid eligibility redeterminations resume, some of those individuals will transition away from Medicaid.
About 138,000 people were previously in the coverage gap, not eligible for Medicaid in Virginia, and also not eligible for premium subsidies because their income was too low . The expansion of Medicaid made coverage realistically available to this group. And people with income between 100% and 138% of the poverty level, who were previously eligible for significant premium subsidies and cost-sharing reductions in the exchange, became eligible for Medicaid instead as of 2019, with far lower out-of-pocket costs.
According to Medicaid expansion advocates, Virginia had been missing out on $142 million in federal funding every month since the start of 2014, as a result of not expanding Medicaid. But that changed in 2019, when federal Medicaid expansion funding started to flow into the state. States pay 10% of the cost of Medicaid expansion, and the federal government pays 90%. This is a much more generous split than regular Medicaid funding.
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Virginia Medicaid Expansion History
Gov. Terry McAuliffe took office in January 2014, and had long said that Medicaid expansion was one of his top priorities. It was a contentious issue between the Governor and the state legislature, with a government shut-down that loomed in the summer of 2014 because of budget disagreements pertaining to Medicaid expansion.
Various proposals to partially expand Medicaid, or expand coverage with modifications, were considered by lawmakers in 2014, 2015, and 2016, but none of them passed. In September 2016, Governor McAuliffe reiterated his point that Medicaid expansion would help to close the budget gap that Virginia was facing. McAuliffe left office in January 2018, with Medicaid expansion still on his wish list. But his successor, Governor Ralph Northam, had campaigned on the promise of expansion, and Virginia Democrats gained significant ground in the House of Delegates. But a tie-breaker win went to the Republicans, who held a 51-49 majority in 2018.
Legislation was introduced in the Virginia Senate in January 2018 to expand Medicaid , but a party-line vote in the Education and Health Committee killed it before the end of January. The following week, a House committee voted 14-3 in favor of HB 338, which would have imposed work requirements on some existing Medicaid enrollees in Virginia. HB338 passed in the house in February, with a 64 to 36 vote, but it did not advance in the Senate.
Which Drugs Are Covered
If you are eligible for Medicaid and choose to receive your care from Virginia Premier with Kaiser Permanente, you are covered for drugs included in our approved list. To check if your medication is covered, click the link above or contact Member Services at1-855-249-5025, or 711 , Monday through Friday, from 7:30 a.m. to 9 p.m. .
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What Is Virginia Medicaid Number
Virginia Medicaid number where you can call and speak to Virginia state health care agent regarding Virginia Medicaid Application is .
Virginia Medicaid hours of operation regarding Virginia Medicaid Application are Monday through Friday, from 9:00 am to 5:30pm, but the best calling hours for Virginia Medicaid to call regarding Virginia Medicaid Application are 10:00 am to 3:00 pm.
Comparing Medicare And Medicaid
Medicare is a federal health insurance program open to Americans aged 65 and older and disabled persons under 65. Medicaid is a state-specific insurance program for low income individuals with limited financial assets regardless of their age.
Medicare, generally speaking, offers the same benefits to all eligible participants. However, coverage is divided into Medicare Part A for inpatient care, Part B for outpatient care and Part D for prescription coverage. Medicaid is more comprehensive in its coverage but the benefits are specific to the age group. Children have different eligibility requirements and receive different benefits from low income adults and from the elderly or disabled persons.
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