Health Coverage Options for 2025

While Virginia’s Insurance Marketplace Open Enrollment Period has ended for 2025, there are lots of life circumstances and events that allow people to enroll in Marketplace coverage outside of Open Enrollment. These include marriage or divorce, loss of other health coverage, or a move. A full list of these “Special Enrollment Periods,” which typically last for 60 days after the change in circumstances or life event, can be found here. Extra financial help is still available throughout 2025, meaning many people qualify for free or very low-cost coverage through the Marketplace.  

There is also an extra-Special Enrollment Period still in effect for Virginians who lose their Medicaid/FAMIS coverage due to no longer being eligible (e.g., their income increased above the Medicaid/FAMIS limits). They can shop on the Marketplace anytime through June 30, 2025. Starting July 1, 2025, Virginians losing Medicaid/FAMIS coverage can qualify for coverage on the Marketplace for up to 90 days after their coverage loss.

And don’t forget: Virginians can apply for/enroll in Medicaid/FAMIS 365 days a year! They are not required to enroll within a specific time window. Check out the updated 2025 income limits for the Medicaid and FAMIS programs under the “Learn” menu here and find the updated outreach materials here.
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Celebrating 60 Years of Medicaid!

This year, the Medicaid program turns 60 years old! We’ll be highlighting key components of the Medicaid and FAMIS programs all year long to celebrate. 

Did you know that the largest population served by Virginia’s Medicaid and FAMIS programs is children? The Medicaid and FAMIS programs provide comprehensive coverage for nearly 770,000 children and youth throughout Virginia. Medicaid enrollment during childhood is associated with better health in adulthood and leads to lower high school dropout rates.  

Medicaid also helps pay for health-related services that Virginia public schools provide to their students, reimbursing school divisions across the state for over $56 million in state fiscal year 2023 for key services and administrative activities, including physical and occupational therapy, nursing services, health-related administrative activities, and many more. This provides a critical funding source for schools, particularly for special education services.

Recent Medicaid Eligibility Updates

As of December 1, 2024, Plan First is now an opt-in program.

  • Plan First is Virginia’s limited benefit program that covers family planning services such as birth control and cervical cancer screenings, for adults with incomes between 138% and 205% of the federal poverty level.
  • Previously, everyone who met the requirements was evaluated for this program if they did not qualify for full benefit Medicaid or FAMIS coverage. Now, applicants will not be evaluated for Plan First if they do not request it.
  • If you are working with someone who may need to access family planning services, be sure to counsel them on opting in to this program when completing the Medicaid/FAMIS application! 

Additionally, Reasonable Opportunity Periods are no longer limited!

  • A Reasonable Opportunity Period (ROP) is a 90-day period of coverage provided to applicants while their citizenship or immigration status is being verified and/or while they are awaiting receipt of immigration documents.
  • Now, an individual can receive multiple concurrent 90-day ROPs with good cause, such as if the individual is still waiting for a third party to provide their immigration documents. Additionally, if their coverage is closed for not providing documents and they reapply for coverage, they can be given another ROP. 

Virginia has also made permanent the returned mail procedures that were required during the pandemic.

  • If mail is returned, the eligibility worker must attempt to contact the applicant/member by at least two methods, such as phone, text, or email, in addition to sending a letter to the last known address, informing the applicant of the agency's attempt to locate them and asking that they contact the office. The case narrative must include documentation of all methods used for attempting contact. 

Ask About Aspirin Campaign for Maternal Heart Health

The state Department of Medical Assistance Services (DMAS) has launched its Ask About Aspirin campaign for maternal heart health! The campaign encourages pregnant Medicaid/FAMIS members to talk to their providers about aspirin as an effective primary prevention tool against maternal heart disease, if they have certain risk factors such as a history of high blood pressure, diabetes, or kidney disease; if they are pregnant with more than one baby; if they are under 18 or over age 35; or if they have a BMI >30. To learn more, visit the DMAS website. We also encourage you to watch Jasmine’s story on the importance of maternal heart health! 

NEW! Medicare Prescription Drug Savings

Great news! People with Part D plans through traditional Medicare or Medicare Advantage plans with prescription drug coverage will not pay more than $2,000 on covered out-of-pocket prescription drug costs. The cap only applies to drugs that are covered by the Medicare plan. Medicare members can review their plan or use Plan Finder to input prescriptions to see coverage and preferred pharmacy options.


Secondly, Medicare and Medicare Advantage members can voluntarily enroll into the Medicare Prescription Payment Plan to pay for their prescriptions in monthly installments spread across the calendar year. Those interested can opt-in through their health/drug plan. While the costs are not reduced, it may be easier for some members to afford their medications with the payment plan. Members will be billed by their health/drug plan instead of paying for their prescription at the pharmacy.  

Keep in mind the Extra Help program is an existing federal program that helps people with income less than 150% of the federal poverty level and limited assets pay for the monthly premiums, annual deductibles, and copays related to their prescriptions. People with Medicare who are enrolled in Medicaid coverage or the Medicare Savings Programs are automatically enrolled in the Extra Help program!

Find a Dentist in the Cardinal Care Smiles Network

Brought to you by Cardinal Care Smiles


Everyone deserves a great oral health future, and Virginia’s Medicaid program provides dental coverage, managed by DentaQuest. DentaQuest makes it easy to find a dentist close to home. There are four simple ways you can find a dentist in the Cardinal Care Smiles network:
  • Using the Cardinal Care Smiles Member Services Call Center. Member Services can help find a dentist. Members can reach Member Services at 1-888-912-3456, Monday through Friday, 8am – 6pm. The TTY/TDD number (for those with speech or hearing challenges) is 1-800-466-7566. Your phone must be TTY/TDD-equipped to use this line.
  • Using the Member Email Form. Members can visit www.dentaquest.com/virginia. Click on the “Member Page,” and then click “Member Email Form” on the left side of the screen. Fill out the form and click Submit.
  • Using the DentaQuest Website. Members should only visit dentists enrolled in the Cardinal Care Smiles program. A list of these dentists is available online at www.dentaquest.com/virginia. 
  • Click on “Find a Dentist.”
  • Click on the “Find a Dentist” button.
  • Click “Choose a location and plan.”
  • Enter your address, city, or zip code. Click “Yes, this is correct.”
  • Select your Virginia Cardinal Care Smiles plan.
  • You can search for a dental provider in four ways:
  • Find a Dentist by Name – you can search for a dentist by their last name.
  • Find a Dentist by Specialty – use this to search for a specialty dental provider.
  • Find Services by Location – use this to search for a dentist near your location.
  • Places by Type – use this to look for health care clinics and Federally Qualified Health Centers.
  • Using the myDentaQuest Free Mobile App. Members can download the mobile app by visiting Mobile App | DentaQuest. Once registered, members can search for a dentist.
  • You can search for a provider using the “Find a Dentist” button, using the same categories as the website. 

Upcoming SignUpNow Workshops

The Virginia Health Care Foundation has announced Winter and Spring 2025 SignUpNow workshops. Participants learn how to assist individuals and families with applying for and renewing their Medicaid/FAMIS coverage. SignUpNow offers 2 types of training. (Please Note: Workshops cover different material, please read carefully to ensure you are registering for the workshop you would like to attend.):


  • SignUpNow – Medicaid/FAMIS workshops cover the “ins and outs” of the eligibility requirements, application procedures, and post-enrollment information for Virginia’s Medicaid/FAMIS programs for children and families (Medicaid, Medicaid Expansion, and the FAMIS programs). 


  • SignUpNow – ABD workshops cover information for Virginia’s Aged, Blind, or Disabled (ABD) Medicaid covered groups, including ABD with Income ≤80% FPL; programs for Virginians who receive Supplemental Security Income (SSI), an Auxiliary Grant, or Long-Term Services and Supports (LTSS); and the Medicare Savings Programs. 


Learn more at vhcf.org/workshops/!

Medicaid/FAMIS Enrollment

As of January 15, 2025, there were nearly 2 million Virginians enrolled in Medicaid/FAMIS. This includes:

  • 747,314 adults enrolled in Medicaid Expansion (“New Adult Coverage”) and low-income parents/caretaker adults;
  • 38,558 pregnant/postpartum enrollees in Medicaid for Pregnant Women (MPW), FAMIS MOMS, or FAMIS Prenatal Coverage;
  • 767,574 children enrolled in FAMIS or FAMIS Plus;
  • 227,710 individuals enrolled due to being Aged, Blind, or Disabled (ABD)

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