Frequently Asked Questions about Using New Coverage

Below are answers to some frequently asked questions about using new Marketplace and Medicaid health insurance. If you need any help using your insurance to access care, contact a navigator.

Marketplace FAQs:

How do I check the status of my coverage? Do I still have a Marketplace plan?

You can find out if you still have Marketplace insurance by calling the Marketplace customer service number at 1-800-318-2596 or logging into your account at HealthCare.gov.

How do I show doctors that I have Marketplace health insurance?

You should receive a card in the mail from your health insurance company. You can present the card to your doctor to receive medical services.

Do all doctors accept my Marketplace plan?

NO. Not all doctors will accept your Marketplace plan. Before you make an appointment with a doctor, you need to call the doctor’s office and give them the information on your insurance card. Only schedule an appointment with the doctor if they accept your insurance. If they do not, you will have to pay 100% of the medical bill.

How do I find doctors that accept my insurance?

You can call the phone number that appears on the back of your health insurance card to find doctors who accept your Marketplace plan. All health plans also have online tools to help you find providers who accept your plan.

Do I need a referral to see a specialist?

That depends on the type of plan that you have. Some plans on the Marketplace require you to visit your Primary Care Physician (PCP) to get a referral to a specialist, and other plans do not. You can call the number on the back of your card to verify.

What if I moved or my income changed?

You need to inform the Marketplace if you’ve moved, had an income change, had a baby, or any other life change. You can report the change by calling the Marketplace at 1-800-318-2596 or in your online account at HealthCare.gov.

What if I get a job that offers me health insurance?

Most people whose employer offers them health insurance are not able to keep their Marketplace plans. The only exception is if the least expensive employer plan option to cover just the employee has a monthly premium that costs more than 9.61% of your gross household income.

How do I renew my Marketplace plan?

You can renew your plan every year, or choose a different plan, in three ways. You can call the Marketplace at 1-800-318-2596. You can go online and complete the renewal through HealthCare.gov. You can also contact a navigator or assister to help you.

How do I cancel my plan?

You can cancel your plan by calling the Marketplace at 1-800-318-2596 or in your online account at HealthCare.gov.

How do I submit documents?

Some people are asked to submit documents to the Marketplace to verify information on the application, like paystubs to show your income. When this happens, the person can enroll but must submit the requested documents in 90-95 days or may lose their coverage. You can submit documents by logging into your HealthCare.gov account. Click on your name in the top right corner. Select “My applications & coverage.” Select coverage for the current year. Click on “application details.” Upload your documents. If you do not have a HealthCare.gov account, you can mail the documents to the address in your eligibility notice. There will also be a barcode to include so the documents get connected to your application. Save your original documents and send copies!

Medicaid FAQs:

How do I check the status of my coverage? Do I still have Medicaid?

You can find out if you still have Medicaid insurance by calling Cover Virginia or by contacting your caseworker at your local Department of Social Services. The number for Cover Virginia is 1-855-242-8282.

How do I show doctors that I have Medicaid?

You will get two health insurance cards in the mail after your case is approved. One will be a Virginia Medicaid card that says “Commonwealth of Virginia, Department of Medical Assistance Services.” Virginia Medicaid also works with six different health plans, including Anthem and Aetna, to provide benefits. The second card will be from the health plan you are enrolled with. Give both cards to your doctor to receive medical services.

Do all doctors accept Medicaid?

NO. Not all doctors accept Medicaid insurance, and those who do may not accept all 6 Medicaid health plans. Before you make an appointment with a doctor, call the doctor’s office and give them the information on your Medicaid card and health plan card. Only schedule an appointment with a doctor if they accept your Medicaid health plan. If the doctor does not, you will have to pay 100% of the medical bill.

How do I find doctors that accept Medicaid?

You can call the phone number that appears on the back of your health plan card to find doctors who accept your Medicaid plan. The health plan should have also sent you a member handbook which will tell you how to find the list of covered doctors online.

How do I change my Medicaid health insurance company?

You will be automatically enrolled into one of the six health plans when you are approved for Medicaid. All plans must offer the same medical benefits — but each plan also offers some different extra benefits. You can change your plan within 90 days of your Medicaid approval or once per year during a time called Open Enrollment. You will get a notice before your Open Enrollment begins that will tell you how to change plans.

How do I order a replacement card? What if my card never arrived?

You can order a replacement Medicaid card by calling Cover Virginia at 1-855-242-8282. Request a new health plan card by calling the company directly.

What if I have a problem? How do I find my caseworker?

The name and phone number of your caseworker should appear on your Medicaid approval letter. You can get this information by calling Cover Virginia at 1-855-242-8282. Call your health plan if you need help getting medical care.

What if I start making more money? What if I need to add a family member?

If your income changes or you need to add or remove a family member, you should notify your caseworker. You can find your caseworker’s name, phone number, and email address by calling Cover Virginia at 1-855-242-8282.

Can I request an interpreter?

YES. You can request an interpreter to speak with your doctor, your caseworker, and customer service representatives at Cover Virginia and your insurance company.

How do I renew my coverage?

Medicaid must be renewed each year. You will be contacted through the mail before your renewal is due. You might get a renewal packet in the mail — if you do, it is important to respond by the deadline so you do not lose your Medicaid. You can fill the forms out and mail them, call Cover Virginia to complete them over the phone, or log in to your CommonHelp account (if you have one) and complete them there. Some people’s Medicaid can be automatically renewed without them having to do anything. If this happens, you will get a letter telling you that your coverage has been renewed. It is important that you keep your address updated with your caseworker so you don’t miss any important mail.

How do I submit documents?

If the state is unable to verify information on your application or when it is time to renew, they will ask you to send additional documents (for example, pay stubs to show your income). You can email documents to verify_docs@coverva.org. You can also fax or mail them to the address in the document request letter. Include your case number or telephone number in the email or on the documents. Always save the original documents for your records and document the date you sent them.

Does Medicaid include dental and vision services?

Medicaid offers dental benefits to both adults and children through DentaQuest. You can find DentaQuest contact information here. Children enrolled in Medicaid also get vision care. Most Medicaid health plans offer some vision care for adults, but coverage differs between plans. To find the best plan for you, compare here.

How do I show a pharmacist that I have Medicaid?

You can present your Commonwealth of Virginia Medicaid card to the pharmacist in order to cover your prescriptions.

Can I transfer my case between states?

No, every state has a separate Medicaid program. If you move from Virginia, you must end your Virginia Medicaid and apply in the state you now reside in. If you are moving to Virginia, you must end your Medicaid coverage in the previous state and apply for coverage here.

What if I lose my Medicaid coverage?

If you think that your loss of Medicaid coverage is an error, you can appeal the decision. If you miss the appeal window, you can reapply at any time. If you lost Medicaid because you were no longer eligible, you may be able to enroll in a Marketplace health plan, but only have 60 days to do so. If you miss the 60 day window, you will have to wait until Marketplace Open Enrollment.

Thank you to the Enroll Virginia navigators at the Central Virginia Legal Aid Society for compiling this guide.