Even Better Together
Virginia Premier Medicaid is becoming a part of Optima Health on July 1, 2023. We are still committed to you and continuing to service all your healthcare needs.
Medicaid members, don’t lose your healthcare coverage. The renewal process is back.
Empowering Your Family's Healthcare
Make Virginia Premier your health plan.
or call toll-free: 1-800-643-2273 (TTY: 711)
For over 20 years, Virginia Premier has provided high-quality Medicaid coverage to individuals and families in Virginia.
The Virginia Premier Elite Individual (Medallion) plan makes healthy living easy with affordable care. Medicaid coverage includes doctor visits, emergency care and prescriptions. There are no referrals to see a specialist and you get extra benefits like our 24/7 Nurse Advice Line and a free cell phone. En español.
Are you eligible?
To qualify for Virginia Medicaid, you must:
- Be a resident of Virginia
- Be a U.S. citizen, permanent resident, or legal alien
- Meet Virginia’s income requirements
It is easy to check if you may qualify. Just answer five quick questions in the Cover Virginia Eligibility Screening Tool. The tool will not ask you for your name or contact info.
You may apply for Medicaid in Virginia anytime of the year. Use the option best for you.
- Online: Visit commonhelp.virginia.gov
- Phone: Call Cover Virginia at 1-855-242-8282
- In Person: Visit your local Department of Social Services (DSS). View office locations.
How to Choose Virginia Premier
When your application goes through, the Department of Medical Assistance Services (DMAS) will send you a letter.
The letter will automatically assign you to a health plan. If it already says Virginia Premier, great! Your member ID card is on the way. If it is a different plan, it is simple to switch to Virginia Premier. Here’s how:
- Call the Managed Care Help Line at 1-800-643-2273 (TTY/TDD: 1-800-817-6608).
- Have your Medicaid ID number on hand.
- Tell them you want to switch your health plan to Virginia Premier.
You have up to 90 days to switch. After that, you may switch to Virginia Premier when it is open enrollment where you live. View regions.
Virginia Medicaid Coverage
Plus Virginia Premier Extra Benefits
When you become a Virginia Premier member, you get more than basic Medicaid alone. Our extra benefits are a special mix to help address your health and your social needs. Here are just some of the benefits offered to you when you choose Virginia Premier as your Medicaid plan.
- Members get access to quality doctors and medical facilities through the Virginia Premier provider network. To see if your doctor, specialists or hospital is included in our network, check our Provider Directory search tool.
- Urgent Care: Urgent care visits for serious medical conditions that are not life threatening are covered.
- Emergency Care: Hospital visits for emergencies and anything life threatening are covered, including transportation.
- Chronic Disease Management: Members with chronic conditions like diabetes, heart disease and asthma get personal coaching from a registered nurse. Your nurse will work with you to create an Action Plan to manage your symptoms, know when to call the doctor, avoid problems and help you feel better.
- Behavioral health services: Services and treatment options for people with mental health conditions such as depression, anxiety or other mental health issues.
Members under 21 years old can get one oral exam and one cleaning per year, as well as one set of bite wing X-rays.
Dental services for adults age 21 and up are included with Virginia Medicaid coverage as of July 1, 2021. Coverage includes:
- Cleanings, exams and X-rays
- Root canals
- Dentures and partials
- Tooth extractions and other oral surgeries
- Gum related treatment
- Other general services
Not covered: braces and bridges.
- Eye exam and lenses every 24 months. Up to $100 credit for frames or contacts every 24 months.
- Diabetic Members: Eye exam, lenses and frames covered in full every 12 months.
- Medical Transportation (Standard Benefit): Virginia Premier schedules free transportation to and from medical visits.
- Non-Medical Transportation (Added Benefit): On a case-by-case basis, social workers may schedule rides related to social services. If approved, the member added benefit is three non-medical round trips every quarter. The rides are limited to 50 miles one way and may include an out-of-state destination. Unused trips do not carry forward to the next quarter. Social services that may qualify are:
- Obtaining food at a grocery store or food bank
- Applying for work or going to a job interview
- Applying for benefits or completing paperwork
- Court date
- Necessary medical, durable medical equipment (DME) and dental services not covered by benefits.
- Trips need to be set up at least five business days beforehand. Weekends and holidays do not count toward these days.
- Call us at 1-855-800-3480 (TTY: 711), Monday through Friday, 6:00 am to 6:00 pm to set up a ride.
Virginia Premier covers medications prescribed by your doctor, including some over-the-counter drugs with a prescription. Learn more about pharmacy benefits.
- Virginia Premier’s Nurse Advice Line is ready to help at any time when you have medical questions.
- A registered nurse will always answer your call.
- Call 1-800-256-1982 (TTY: 711) 24-hours a day, seven days a week.
- Free Smartphone: One free smartphone per member household with 4.5 GB of data, unlimited texts and 350 voice minutes each month. Calls to Virginia Premier are also free. SafeLink Wireless®
- Health and Wellness Programs: Premier Wellness is our free program for members covering nutrition, exercise, wellness and living smoke-free.
- Healthy Eating Program: Learn about food labels, portion control and meals that help lower cholesterol and blood pressure. Includes online tools, food trackers and classes.
- Fitness Program: A Health Educator will recommend physical activity unique to your needs. Includes a pedometer to track steps, exercise bands and online tools.
- Access to CVS MinuteClinic®: Services include vaccines, screenings, physicals and monitoring chronic conditions. Diagnosis and treatment of minor illnesses, injuries or skin conditions also offered.
- Chronic Care Management: Registered nurse and text message programs to manage chronic conditions such as diabetes and asthma.
- Chronic Disease Management Education: Virginia Premier covers the cost of disease self-management classes. Eligible conditions include heart disease or heart failure, diabetes and asthma.
- Healthy Footsteps℠: Virginia Premier’s program supporting the healthy growth of children from birth to age 12. Includes milestone messages and reminders for check-ups, shots and dental visits.
- Healthy Self℠: Virginia Premier’s screening, diagnosis and treatment program for teens and young adults. It includes check-up reminders and educational messages.
- Sports Physicals: Members under age 21 can get screened once a year before taking part in sports. Also for members currently or formerly in foster care, up to age 26.
- GED Testing Assistance: Up to $275 in GED study materials and testing costs.
- Meals After Hospital Stays: Up to 56 home-delivered meals over 28 days after hospital stays.
Potentially up to $25 in gift cards per health and wellness goal up to the yearly max, pending eligibility confirmation. *
- Adult flu vaccinations
- Well-child visit and immunizations
- Well-adolescent visit and immunizations
- Breast cancer screening (women age 40 and up)
- Cervical cancer screening (Pap test)
- Colorectal cancer screening (age 45 and up)
- Joining our Healthy Heartbeats Program for pregnancy care
- First prenatal visit
- Postpartum checkup
*List of health and wellness goals are subject to change.
- Healthy Heartbeats Program: Our team works closely with you to help you have a healthy pregnancy and baby.
- Gift Card Rewards: Earned for joining Healthy Heartbeats, having prenatal visits and a postpartum visit 7-60 days after giving birth.
- Baby Showers: Have fun and learn about healthy pregnancy tips and resources. Includes a diaper bag raffle. All attendees get a care package.
- Ovia: Free app with pregnancy health articles and trackers.
- Text4Baby: Free text messages with health tips helping you through pregnancy, birth, and your baby’s first year.
- Supplies and services: Members have access to a free breast pump, lactation consultant, prenatal classes, parenting classes and family planning.
- Safe sleep education program.
- Check benefit information
- Complete your new member screening
- Take a Health Risk Assessment
- Use the Health Tracker Tools
- Communicate with a Health Educator
- Reference a health library
- Search health topics
For a full list of the plan details and benefits, see our Medallion/FAMIS Member Handbook (PDF).
You may also contact Member Services at 1-800-727-7536 (TTY: 711) with any questions, Monday through Friday, 8:00 am to 8:00 pm.
Already a Member?
Take advantage of the resources available to you. Visit our member’s page.
Keep your info updated. The state needs to know when your address, phone number, income, or the number of people in your household changes. First, contact your local Department of Social Services office and let them know about the changes. Then, tell Virginia Premier by calling Member Services at 1-800-727-7536 (TTY: 711) Monday through Friday, 8:00 am to 8:00 pm.
Time to renew? Look for a letter in the mail from the state when it is time to renew your Medicaid coverage for the year. The letter will let you know the steps you need to take, if any. The state may process many renewals automatically (During the COVID-19 public health emergency, Medallion members will not lose coverage for failing to submit renewal paperwork).
Free and Reduced-Cost Services Near You
There’s more to staying healthy than just seeing the doctor. That’s why we’re partnering with Aunt Bertha, the nation’s largest free online directory of community organizations.
Virginia Premier members can use Aunt Bertha’s online search tool to get help with housing, employment, transportation, food and more. Just enter your ZIP code to find local resources and programs that are ready to lend a hand.
Helping People is What We Do Best
Questions? We have a friendly team of experts just a phone call away. Call 1-800-727-7536 (TTY: 711) Monday through Friday 8:00 am to 8:00 pm. We also offer free translator services.
¿Tiene preguntas? Contamos con un equipo amable de expertos a solo una llamada de distancia. Llame al 1-800-727-7536 (TTY: 711) de lunes a viernes, de 8:00 a. m. a 8:00 p. m. También ofrecemos servicios gratuitos de traducción.