What Does Medicaid Cover?
Having a Medicaid health plan means your visits to the doctor, hospital stays, and prescriptions are covered at little or no cost to you.
Here are some highlights of Medicaid covered benefits for Optima Family Care and Optima Health Community Care members. FAMIS members may have a low copay for some benefits. Medicaid and Medicare dual-eligible Optima Community Complete (HMO D-SNP) members: view plan details.
Check our member handbooks for a more detailed list of coverage. View our list of added benefits available just for being an Optima Health member.
Quality Professional Care
- 35,000 providers including doctors, urgent cares and hospitals
- access to quality specialists for allergies, diabetes, heart conditions, and more
- help scheduling doctor appointments and rides
- a dedicated advocate for coordinating your care and benefits
Exams
- preventive care
- regular medical care
- well-baby, well-child, and well-adolescent checkups
- dental benefits (PDF) (covered by Virginia Medicaid under a separate program)
- eye exams
- hearing exams Note: FAMIS members may have low copays
Note: FAMIS members may have low copays.
Emergency Care
- urgent care
- emergency care
- hospital stays
Prescription Drugs
- Optima Family Care (Medallion): no copays at in-network pharmacies for drugs on our drug list
- Optima Health Community Care (Commonwealth Coordinated Care Plus): no copays at in-network pharmacies for drugs on our drug list
- FAMIS: Low copay, typically $2 to $5
- Optima Community Complete (HMO D-SNP): view plan details for drug coverage if you are dual-eligible for both Medicare and Medicaid
Note: Does not cover Medicare Part D drugs, including the Medicare copayment
Free Therapy Services
- behavioral health services, counseling, and 24/7 crisis phone line
- addiction and recovery treatment services (ARTS)
- home health care and rehabilitation therapy
- physical, occupational, and speech therapies and audiology services
Free Services
- X-rays, labs, and imaging
- immunizations
- dental benefits (PDF) (covered by Virginia Medicaid under a separate program)
- 24/7 nurse advice line
- transportation to and from medical appointments
- interpreter and translation services
- maternity care and family planning
Home and Community-Based Services for Optima Health Community Care Members
- managed long term services and supports (some members may have patient pay)
- durable medical equipment and supplies
- personalized care plan
- coordination with family, caregivers, doctors, and community resources
- assistance with activities of daily living
Added Benefits Just For You
Optima Health members receive added benefits on top of the standard Medicaid coverage.
Become an Optima Health Member
Contact Cover Virginia and tell them you want Optima Health.
Call the Cover Virginia Call Center
1-855-242-8282 (TDD: 1-888-221-1590)
Monday through Friday from 8:00 a.m. to 7:00 p.m.
Saturday from 9:00 a.m. to noon.
Questions?
For questions about Optima Health benefits, please call us toll-free:
Optima Family Care: 1-888-512-3171 (TTY: 711)
Optima Health Community Care: 1-888-512-3171 (TTY: 711)