What Does Medicaid Cover?

Having a Medicaid health plan means your visits to the doctor, hospital stays, and prescriptions are covered.

There are no monthly premiums for adults between 19-64 years old within the income limits. Medicaid eligibility rules for noncitizens vary for different groups. Learn about the types of Medicaid programs.

Virginia offers several health coverage programs for children and qualifying pregnant and postpartum women. Learn about the FAMIS programs.

If you qualify for Medicaid and Medicare at the same time, make it easier when you choose Sentara Health Plans for both plans. You will gain more benefits than Medicaid and Medicare alone. Learn about our dual special needs plan.

Here are some of the covered benefits and services for Sentara Community Plan Medicaid members.

This is a brief description of benefits. All services must be received by participating providers unless pre-authorized by Sentara Health Plans.

Quality Expert Care

• Sentara Health Plans network of more than 35,000 providers including doctors, urgent cares and hospitals
• access to quality specialists for asthma, diabetes, and heart problems
• help scheduling doctor appointments and rides
• a dedicated advocate for coordinating your care and benefits

Exams

• preventive care
• routine medical care
• well-baby, well-child, and well-adolescent health exams
• dental benefits (covered by Virginia Medicaid under a separate program)
• eye exams
• hearing exams 

Emergency Care

• urgent care
• emergency care
• hospital stays

Prescription Drugs

• no copays at in-network pharmacies for covered drugs on our drug list
• some maintenance drugs are eligible for mail order through Express Scripts Pharmacy (requirements apply)

Questions?

For questions about Sentara Health Plans coverage and benefits, please call us at 1-800-881-2166 (TTY: 711), Monday through Friday from 8 a.m. to 8 p.m.