What is Exclusively Aligned Enrollment?
On January 1, 2025, the Centers for Medicaid and Medicare Services (CMS) and the Virginia Department of Medical Assistance Services (DMAS) will require exclusively aligned enrollment with the same health plan for your Medicare dual-eligible special needs plan (D-SNP) and Medicaid coverage.
Exclusively aligned enrollment is when you’re enrolled with one health plan for both your Medicare and Medicaid coverage. This aligns your coordination of care and benefits. When you are exclusively aligned, you will have one set of providers, one member ID card, and one health plan to call when you need assistance accessing services.
If you are not already aligned with the same health plan, you will be moved automatically to your D-SNP health plan’s Medicaid plan as of January 1, 2025.
You have a choice. The health plan you choose for your D-SNP determines the Medicaid plan you will have. The information below can help answer your questions if you want to make any changes and when you can do so.Frequently Asked Questions
I have Sentara Medicare Community Complete (HMO D-SNP) and have a different health plan for my Medicaid. What does this mean for me?
As of January 1, 2025, your Medicaid will change to Sentara Community Plan. You will keep Sentara Medicare Community Complete for your dual-eligible special needs plan. To learn about the Medicaid benefits and services you will get with Sentara Health Plans, visit sentaramedicaid.com or call 1-800-881-2166 (TTY: 711), Monday through Friday, 8 a.m. to 8 p.m.
I have Sentara Community Plan for my Medicaid and have a different health plan for my dual-eligible special needs plan (D-SNP). What does this mean for me?
As of January 1, 2025, your Medicaid plan will change to the same health plan where you have your D-SNP.
If you would like to keep Sentara Health Plans for your Medicaid benefits, you would need to enroll in Sentara Community Complete (HMO D-SNP) for your Medicare coverage before January 1, 2025. A Licensed Plan Advisor can help you switch your current D-SNP by calling 1-855-434-3267 (TTY: 711), April 1 through September 30, Monday through Friday, 8 a.m. to 8 p.m., and October 1 through March 31, 7 days a week, 8 a.m. to 8 p.m.
I have Sentara Medicare Community Complete (HMO D-SNP) and Sentara Community Plan for my Medicaid. What does this mean for me?
You will continue to have Sentara Health Plans for both your D-SNP and Medicaid. As of January 1, 2025, you must have the same health plan for both these plans. No further action is required.
I just received a new member ID card. Am I going to receive another one? What should I do with my old one?
You will have just one member ID card. Your member ID should have “Sentara Medicare Community Complete (HMO D-SNP)” at the top. This is the one card you will use for both your Medicare and Medicaid coverage with Sentara Health Plans.
If you have a Sentara Community Plan member ID card, you will no longer use it for accessing Medicaid services. You may discard it. You will use your Sentara Medicare Community Complete (HMO D-SNP) member ID card instead.
You do not need your red, white, and blue Medicare card, and can leave it at home in a safe place.
If you ever lose your Sentara Health Plans member ID card, you can request another online, through our app, or by contacting Member Services (see question 9).
Can I keep my primary care provider (PCP) and other doctors and specialists?
You can check if your providers are in-network for the Sentara Community Complete (HMO D-SNP) plan at sentarahealthplans.com/findadoc or call Member Services at the number below.
Will my prescription drug coverage change?
Changes to the covered prescription drugs happen at the beginning of each year. If we make a change to a drug you are taking at any other point in the year, we will send you a Notice of Change letter. We also update our online drug list monthly to provide the most up-to-date list of covered drugs. For more information on prescription drug coverage, check your Evidence of Coverage or visit the prescription drug webpage.
Beginning in 2025, there are three drug payment stages:
- Yearly Deductible Stage
- Initial Coverage Stage
- Catastrophic Coverage Stage
Will my care coordinator change?
If you have Sentara Community Plan for Medicaid and move to Sentara Community Complete for Medicare, you will receive a new care coordinator. The D-SNP care manager will call you within five days to schedule an assessment to determine your health goals and other preventive care you need. You will also receive welcome materials, which will give you more information about your plan.
Will my extra benefits change?
If you remain as a Sentara Health Plans member for both Medicaid and Medicare, your extra benefits will remain the same.
When the extra benefits are the same for both Medicare and Medicaid, you will use your Medicare benefit first. Some Medicaid benefits may be used after using Medicare benefits. Certain benefits do have restrictions and limitations.
If you switch your plan to a new MCO, some of your extra benefits may change. You should consult the MCO’s website to view complete lists of each plan’s extra benefits.
For a list of both your Medicare and Medicaid benefits that you will have access to as a Sentara Community Complete member, please visit our D-SNP Extra Benefits page.
How do I get in touch with Sentara Health Plans if I have questions?
Sentara Medicare D-SNP Member Services
1-866-650-1274 (TTY: 711)
April 1 through September 30, Monday through Friday, 8 a.m. to 8 p.m.
October 1 through March 31, 7 days a week, 8 a.m. to 8 p.m.
Additional Resources
Virginia Insurance Counseling and Assistance Program (VICAP)
A free, confidential service to help answer questions about Medicare and Medicare Advantage plans, including D-SNP.
1-800-552-3402 (TTY: 1-800-552-3402)
Monday through Friday, 8:30 a.m. to 5 p.m.
Virginia Managed Care Helpline
Provides free, unbiased information about Medicaid enrollment options.
1-800-643-2273 (TTY: 1-800-817-6608)
Monday through Friday, 8:30 a.m. to 6 p.m.