Understanding your health care choices with Virginia Medicaid insurance.
You want your family to have the best health care possible, but it’s hard to know where to start when you’re looking for insurance. Many Virginians with Medicaid or FAMIS (the children’s health insurance program) may not realize they can choose a health insurance plan for their benefits. Your plan choice can make a big difference in your care.
Things to look for when you’re choosing a plan
1. Extra benefits
Every health plan offers the same standard Medicaid benefits, like doctor visits, but some of them have extra benefits at no cost, too. You might like extra benefits one plan has to offer more than another. And don’t forget — it’s not all about how many benefits are listed. Think about which ones you or your family would really use. For example, Anthem HealthKeepers Plus members get extras for kids, like sports physicals and for adults to make every day easier, like free rides to the grocery store or farmer’s market.
2. Doctors who work with the plan
Find out if your doctors work with the plan. Before you choose a plan, you should look at the doctors who work with them. If you have a primary care provider (PCP) you want to keep seeing, it’s important to be sure he or she is in your plan. You can look also at hospitals, specialists and other providers in the plan near you. It’s easy to search or browse through Anthem HealthKeepers Plus plan doctors online with our Find a Doctor tool.
3. Drug list and medicines
Make sure your plan pays for your medicines. Most Medicaid and FAMIS health insurance plans have a drug list (sometimes called a formulary) showing the medicines they pay for. Check the plan’s drug list to make sure the medicines you take are covered by the plan. In some cases, you might need to take a generic version, or you might need to ask the plan for approval before they’ll cover it.
4. Customer service and experience
Get to know the Member Services or care coordination teams. You want to know you can reach someone when you really need them, so pick a plan with reliable customer service. You can see which ones have experience in Medicaid or managed care programs, or even if they have experience in Virginia or your area. If you need a care coordinator, you might want someone who is close by and can meet with you or your loved one face-to-face. Health plans with a local presence may have more connections to other community organizations or support groups who can help you, too.
Are you ready to switch?
You can only change plans a few times a year, but Medallion 4.0, Virginia’s new Medicaid program, is coming soon, and you can choose a different plan when it starts in your area:
Go to www.virginiamanagedcare.com or call the Managed Care HelpLine at 1-800-643-2273 (TTY 1-800-817-6608) to switch. Or if you’re happy with the plan you have, you don’t have to do anything to keep it.