Frequently asked questions

Eligibility depends on your income, household size, age, health needs, and the state you live in. You can check your Medicaid eligibility on HealthCare.gov.

To apply for Medicaid in Virginia:

• Apply online at Virginia’s Insurance Marketplace
• Call the Cover Virginia call center Monday through Friday, 8 a.m. to 7 p.m., and Saturday, 9 a.m. to 12 p.m. at 1-833-5CALLVA (TTY: 1-888-221-1590)
• Or, mail or drop off a paper application to your local Department of Social Services (DSS). To find your local DSS, go to dss.virginia.gov/localagency. Application forms are available at coverva.dmas.virginia.gov/apply/applications.

D-SNPs cover everything Original Medicare does—and more. This may include:

• Prescription drug coverage (Part D)
• Help coordinating your care
• Routine dental, vision, and hearing
• Rides to medical appointments
• Over-the-counter products (OTC)
• Grocery support or meal delivery
• Fitness programs

Full Medicaid: You may qualify for more services and lower costs through your D-SNP.

Partial Medicaid: You may still qualify for a D-SNP, but could have slightly different benefits or costs.

A Licensed Plan Advisor or health plan representative can help you sign up.

If you have full Medicaid in Virginia:

Because your Medicaid is through a Managed Care Organization (MCO), you can switch once a month into a Dual Eligible Special Needs Plan (D-SNP) that works with your Medicaid plan. These are called fully integrated D-SNPs, and they’re designed to coordinate both your Medicare and Medicaid benefits.

Dual-eligibles and those who get the Extra Help Low-Income Subsidy (LIS) can make one plan change per month. Their options include:

• Switching from a Medicare Advantage Plan with drug coverage into Original Medicare plus a standalone Part D drug plan (PDP)
• Or switching between different Part D drug plans
• However, you can’t join or change DSNPs or other Medicare Advantage plans during this monthly change period

If you have partial Medicaid in Virginia:

You may qualify for Extra Help with prescription drug costs or for the Qualified Medicare Beneficiary (QMB) program. Each month, you can switch between Medicare drug plans (Part D) or return to Original Medicare with a drug plan. 

If you are already a Medicare beneficiary, there are certain times when you are able to switch to a Medicare Advantage plan.

The annual enrollment period is from October 15 through December 7. You can make changes to your Medicare coverage that starts on January 1.

The Medicare Advantage open enrollment period allows you to make a change outside of the annual enrollment period. From January 1 through March 31, you can switch from your Medicare Advantage plan back to Original Medicare or to another Medicare Advantage plan.

Enrollment periods

When you first sign up for Medicare, you will have Original Medicare unless you enroll in a plan like a Medicare Advantage plan. Original Medicare generally pays 80% of covered inpatient and outpatient medical costs leaving the insured responsible for the deductibles and 20%.

A Medicare supplement policy generally covers the deductibles and the 20% not covered by Original Medicare for covered services, depending on the supplement.

A Medicare Advantage plan is another way to get your Medicare coverage. Sentara Medicare offers Medicare Advantage plans.

Most Medicare Advantage plans offered through Sentara Medicare also include Part D prescription drug coverage. Unlike Original Medicare or Original Medicare combined with a Medicare supplement policy, no separate Part D prescription plan is necessary. Medicare Advantage plans often offer services not covered by Original Medicare and supplement policies such as dental, vision, hearing, transportation, and wellness benefits.

• Annual wellness visit
• Immunizations
• Mammogram
• Colonoscopy screening exam

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Sentara Medicare D-SNPs include:

• Preventive and comprehensive dental allowances
• Vision services:
  • Annual eye exam
  • Allowance for glasses and/or contact lenses

• Hearing aid allowance
  • Annual hearing exam
  • One set of hearing aids
  • Hearing aid batteries 

There are copays and limitations for some of the dental, vision, and hearing allowances described above.

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Sentara Medicare D-SNPs include coverage for emergency services when you are outside of the service area. Emergency services are covered within the United States and its territories as well as worldwide. If you have an unexpected illness or injury when outside of the service area, you should call the 24/7 Nurse Advice Line at the number on your Member ID card. In any life-threatening emergency, always go to the closest emergency department or call 911.

Remember, Sentara Medicare may review all emergency department care after the fact, to determine if a medical emergency did exist. If an emergency did not exist, you may be responsible for payment for all services.

Yes. You must continue to pay your monthly Medicare Part B premium when you are enrolled in a Medicare Advantage plan.