Frequently Asked Questions

Medicaid is a 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. Sentara Community Plan is the Medicaid plan offered by Sentara Health Plans.

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.

The Virginia 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 Virginia Insurance Marketplace marketplace.virginia.gov.

You pay no enrollment costs, no monthly premiums, and no co-payments.

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 Sentara Health Plans open enrollment website to find out the dates for your area and plan type.

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

Yes. Visit How to Switch to learn more.

Yes, health insurance is available to you if you have a pre-existing condition as long as you meet the eligibility requirements.

Please see the list of doctors in the Sentara Health Plans network.

If you are enrolled in a Sentara Health Plans 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 Sentara Health Plans mobile app.

A care coordinator is a Sentara Health Plans clinical staff member dedicated to helping 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 who qualify will receive a letter from their care coordinator with more information, including office hours and contact information.

D-SNP is a special type of Medicare Advantage plan for people eligible with both Medicare and Medicaid called a Dual Special Needs Plan. Medicaid 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.

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.

Visit the DMAS website at dmas.virginia.gov