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Medicaid Expansion and the Marketplace Exchange

Frequently Asked Questions

We want everyone to have access to high quality, low cost care by getting coverage through a government-assisted program that best fits his or her needs. Three major open enrollment events for government-assisted programs are scheduled in fall 2018:

  • Medicaid Expansion: Enrollment begins November 1. Coverage is effective January 1
  • Medicare Advantage: October 15 – December 7
  • Affordable Care Act Federal Exchange: November 1 – December 15

What is Medicaid expansion?

The rules have changed. There is new health care coverage for adults beginning January 1, 2019. If you applied for Medicaid in the past and were denied, you may soon be eligible. Eligibility is based on income, with a single adult making up to $16,754 per year, or a family of three making up to $28,677 per year eligible for coverage.

If you are not eligible for Medicaid, you may still be eligible for health insurance coverage through the Healthcare Exchange.

When can I sign up for Medicaid?

Enrollment for newly eligible Medicaid beneficiaries will begin on November 1, 2018. Coverage will begin on January 1, 2019.

How can I sign up for Medicaid?

There are several ways to sign up for Medicaid. You can apply by phone by calling the Cover Virginia Call Center at 1-855-242-8282 or the Virginia Department of Social Services Enterprise Call Center at 1-855-635-4370. You can apply in person by visiting your local Department of Social Services. You can also apply online by visiting commonhelp.virginia.gov.

Visit the Community Health Education Center (CHEC) on December 19 from 10 a.m. to 3 p.m. to learn about and apply for new health coverage for adults. You may want to bring a pay stub so you can more quickly see if you are eligible, but it is not required. CHEC is located on the ground floor of the Gateway building. Patients and community members are welcome.

Additionally, Financial Counseling will staff a kiosk every Tuesday, Wednesday and Thursday from 9:00 am to 3:00 pm through January 31, 2019. The kiosk is located inside the Main Hospital diagonal to the Subway entrance to the cafeteria. You may also contact VCU Health Financial Counseling at 804-828-0966 for assistance by telephone.

What if I’m still not eligible for Medicaid?

You still have options. You can sign up for insurance through the Healthcare Exchange, also called the Health Insurance Marketplace. You may be eligible for financial assistance to help you afford your Healthcare Exchange plan. You may also still be eligible for VCU’s Indigent Care Program.

When can I sign up for a Healthcare Exchange plan?

You can sign up for a Healthcare Exchange plan between November 1 and December 15, 2018. You cannot sign up for a Healthcare Exchange plan for 2019 after December 15, 2018, unless you have a life-changing event, like getting married or having a baby. You should visit www.healthcare.gov on November 1 so you can learn more information and review your Healthcare Exchange plan options.

How can I sign up for a Healthcare Exchange plan?

You can sign up for a Healthcare Exchange plan online by visiting www.healthcare.gov. You can also apply by phone by calling the Healthcare Exchange Call Center at 1-800-318-2596 (TTY: 1-855-889-4325). You can also apply through an agent or broker in your community.

Can I stay in the VCC program if I sign up for Medicaid?

No. October 31, 2018 was the last day for new patients to apply for VCC. If you already have VCC and it is going to expire soon, you may re-apply to stay in the program until March 31, 2019. However, we will ask you to complete a Medicaid application when you renew because VCC is not insurance, and we want you to have Medicaid in place when your enrollment in VCC ends to avoid a gap between enrollment in VCC and Medicaid. Medicaid offers more health benefits than VCC at low or no cost. You should apply for Medicaid as soon as possible so you can gain these benefits.

Can I stay in the VCC program if I sign up for a Healthcare Exchange plan?

No. October 31, 2018 was the last day for new patients to apply for VCC. If you already have VCC and it is going to expire soon, you may re-apply to stay in the program until March 31, 2019. However, we will ask you to complete a Medicaid application first because VCC is not insurance, and we want you to avoid a gap between enrollment in VCC and Medicaid.

If you are not eligible for Medicaid, you may be eligible for financial assistance to help you afford a health insurance plan through the Healthcare Exchange. You can sign up for a Healthcare Exchange plan between November 1 and December 15, 2018. You cannot sign up for a Healthcare Exchange plan for 2019 after December 15, 2018, unless you have a life-changing event, like getting married or having a baby. You should visit www.healthcare.gov on November 1 so you can learn more information and review your Healthcare Exchange plan options.

Can I stay in the VCC program instead of signing up for Medicaid or a Healthcare Exchange plan?

No. October 31, 2018 was the last day for new patients to apply for VCC. If you already have VCC and it is going to expire soon, you may re-apply to stay in the program until March 31, 2019. However, we will ask you to complete a Medicaid application first because VCC is not insurance, and we want you to avoid a gap between enrollment in VCC and Medicaid.

Will I be able to have a Medicaid or a Healthcare Exchange plan and participate in the Indigent Care Program?

Yes, if you have insurance through Medicaid or the Healthcare Exchange, you may still be eligible for the Indigent Care Program to cover out of pocket costs when you visit VCU Health providers.

Can I keep seeing my primary care provider after I sign up for Medicaid?

When you sign up for insurance through Medicaid, you will be randomly assigned to a health insurance plan and a primary care provider so you can use your coverage as quickly as possible. You will also receive information on how to change your health insurance plan and a side-by-side comparison of six choices. You will have 90 days to change your plan. If you want to keep seeing your primary care provider, ask him or her which of the six health insurance plans he or she accepts. You will need to choose one of the plans your primary care provider accepts if you want to keep seeing that provider. Make sure you also tell the plan you choose the name of your current primary care provider and that you would like to keep seeing him or her. All the health plans except Aetna will make that change effective the same day. Aetna will make the change effective the first day of the next month. 

Can I keep coming to VCU Health to see specialists?

Your primary care provider will refer you to the appropriate specialist based on your needs. These specialists may include VCU Health providers.