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What’s
covered?

This is Medallion Medicaid coverage. As a member, you’ll enjoy benefits and services that can help you reach your health goals. Interested in choosing us as your Medicaid plan?

Ready to enroll?

The Aetna Better Health® difference

You deserve to be as healthy as you can be. That’s why we offer unique benefits that take care of the whole you. We have experience you can count on — with a range of services to help you on your health journey. You have some benefits that go beyond your standard health coverage.

 

Check this flyer for a complete list of benefits — English (PDF) | Spanish (PDF).

Healthy moms and kids

Are you pregnant or planning to start a family? Our Baby Matters program can help you stay healthy during your pregnancy. We’ll help you get the care and services you need. And you can earn rewards for making healthy choices.

More about pregnancy care

 

Kids also get extra perks, like free swimming lessons and sports physicals. Plus, up to a $25 gift card when they join the Ted E. Bear, M.D.® Wellness Club — English (PDF) | Spanish (PDF).

Wellness supplies and services

Do you have asthma or diabetes? Or need help with managing your weight? If so, we can help you get the supplies and services you need for healthier living. You can get inhalers, therapeutic shoes, access to a dietitian and more. Check the benefits flyer for more info. 

Rewards

Did you know that you can get rewards for taking care of your health? Complete a preventive care action, like a health screening, and you can earn a gift card. We’ll show you how it works. 

Extra help with rides

Need help with getting rides to local resources or services? You can enjoy free rides — up to 30 round trips or 60 one-way trips each year. This extra help goes beyond the standard rides benefit. 

Adult vision and hearing care

  • Vision care: One eye exam and $250 toward glasses (frames and lenses) or contact lenses each year for adults (ages 21 and older).
  • Hearing care: One hearing exam, $1,500 toward hearing aids, plus 60 batteries each year. Members also get unlimited visits for hearing aid fittings.

Even more benefits

  • Home meal delivery: Get home-delivered meals after hospital discharge for seven days (two meals per day).
  • General education development (GED): You can get help earning your GED. We’ll cover the cost of classes and provide you with a test voucher.
  • Over-The-Counter Health Solutions Period Stipend: A monthly stipend of $20 for members with periods to spend on their choice of period products through CVS Pharmacy®.  

More about period care products

 

  • Healthy Food Card: Eligible members can get money added to a special debit card. The card can be used to buy healthy groceries at nearby stores.

More about the Healthy Food Card

Benefits in your plan

Benefits in your plan

Learn about all your plan benefits, from vision and dental care to telehealth, maternity care and help stopping nicotine use. You can learn more about all these topics in your member handbook— English (PDF) | Spanish (PDF).

 

Medicaid coverage

 

Medicaid covers some services that we don't cover. For these services, you don't have to use a provider in our network. Check your member handbook for a list of these services.

 

Copays

 

Members don’t have any copays. You don’t pay anything to get services we cover. If a provider bills you, don’t pay the bill. Just call us at 1-800-279-1878 (TTY: 711).

 

Approval for services

 

Some services need approval, or prior authorization (PA), before you get them. We base all our decisions on whether the service is:

 

  • Needed for your health
  • Likely to help you
  • Covered

 

You can learn more about PA. Just visit our PA page.

We take care of the whole you. That means you’re covered if you need to see a specialist, have an emergency or plan to start a family. You have unlimited visits, so you can see your primary care provider (PCP) as many times as you need to — at no cost.

 

You can also get a wide range of preventive care and vaccines. Start by finding a provider today. If you need urgent care or emergency care, you can find a facility or hospital near you.

 

Find a provider

A healthy smile goes a long way. Dental care is part of your overall health. That’s why you should see your dentist every six months.

 

Check your member ID card from your dental plan. Then, call your plan for answers to questions about care and coverage.

 

Learn more about dental benefits

Keep your eyes healthy with routine eye exams. We work with Vision Service Plan (VSP) to provide you with vision care benefits, including glasses or contacts if needed.

 

Find a vision care provider

 

Or, call 1-800-877-7195.

We make it easy to get the medications you need to feel better. You may have a copay for those on our formulary. This is a list of medications we cover. If you don’t see yours on the list, ask your provider to find one that’s similar. And you can fill your prescription at any pharmacy in our network. 

 

More about pharmacy benefits

You deserve to be healthy in body and mind. Your plan covers health for you as a whole person. That includes help with your mental health or with substance use. You or your child can go to any behavioral health provider in our network. 

 

Help in a crisis

Call 911 or go to the nearest hospital if:  

 

  • You have thoughts of harming yourself or someone else  
  • You have an emergency and need help right now  
  •   

You can use any hospital for emergency care, even if it isn’t in our network. Just show your member ID card.  

You can also call: 

 

 

More about mental and behavioral health care

We can help you and your baby be as healthy as possible. When you take part in Baby Matters, here are some benefits you’ll enjoy:

 

  • Info about healthy pregnancies and baby care
  • Rewards you can earn
  • Help from a care manager
  • Local community programs and resources

 

More about pregnancy care

We’ll help you get birth control counseling and supplies. You can see any in-network or out-of-network provider. Any family planning care is private. You can call us at 1-800-279-1878 (TTY: 711) to choose a family planning provider. Or you can read more about family planning.

Through EPSDT, children under 21 can get full preventive health care services at no cost. This includes preventive health and wellness visits, like:

 

  • Annual checkups
  • Dentist appointments
  • Eye doctor appointments

Why do these visits matter? They can help doctors treat symptoms before they get worse. And in some cases, they can help prevent health issues before they start.

 

Have questions? Just call us at 1-800-279-1878 (TTY: 711).

 

More about EPSDT

Stopping nicotine use is hard, whether you smoke, chew, vape or use another method. Most people need help to quit, and we’re here for you. 

 

Quit Now Virginia 

 

This program provides free, 24/7 info and coaching — online or by phone. You can get:

 

  • One-on-one support from trained quit coaches
  • Stop smoking info and tools
  • Nicotine replacement therapy or medication
  • Special services for pregnant women
  • Counseling in English or Spanish, plus translation services for interpreting over 140 languages

Members ages 13 and older can take part in this program.

 

Questions on how to get started? You can call us at 1-800-279-1878 (TTY: 711).

 

Quit Now Virginia

Do you need help getting care? Our care management team is here for you. Care managers are nurses and social workers who understand your health conditions and help connect you to the right care. A care manager can help you learn more about your health, find a ride to your appointments and more.

 

More about care management

 

Chronic disease management

 

Some health issues need more care. Our care managers can help you manage chronic conditions, like:

 

  • Asthma
  • Diabetes
  • Coronary artery disease (CAD)
  • Congestive heart failure (CHF)
  • Chronic obstructive pulmonary disease (COPD)

 

More about chronic disease management

If it’s late at night or you can’t reach your PCP, you’re not alone. You can speak with a nurse about your health care questions 24 hours a day, 7 days a week. Not sure if you should find urgent care or go to the emergency room? The Nurse Line can help. It doesn’t take the place of your PCP, so be sure to follow up later.

 

Just call us at 1-800-279-1878 (TTY: 711). Then, choose the option for Nurse Line.

Through secure video on your computer, you can meet with a doctor for treatment of common health conditions. Cold or flu? Great reasons to use telehealth. You can also get help with allergies, sinus problems and more.

 

Telehealth

You can get a smartphone with an Android™ platform and Assurance Wireless Lifeline cell service at no extra cost to you. If you already have Lifeline, you can switch to Assurance Wireless. You’ll get:

 

  • A smartphone with an Android platform
  • Data each month
  • Unlimited texts
  • Voice minutes each month
  • Health tips and reminders by text
  • One-on-one texting with your health care team
  • Calls to Member Services that won’t count against your monthly minutes

 

Apply for your smartphone

If you have no way to get to the hospital during an emergency, call 911. We cover ambulance rides on the ground in a medical emergency. 

 

Nonemergency medical rides

 

If you don’t have a ride to your appointment, we’ll help you get one. These rides are for the medical services we cover, like:

 

  • Doctor visits
  • Dental or vision care
  • Behavioral health care
  • Pharmacy

To get a ride, just call ModivCare at 1-800-734-0430. Or you can go online.

 

More about rides

 

Health programs

 

These programs can help you live life as healthy as you can. We have special programs and services to help you get the care you need. And prevent health issues in the future.

 

More about health programs

Other language and format needs

 

Need language help? Just call us at 1-800-279-1878 (TTY: 711). We’re here for you ${member_services_hours}. You can get:

 

  • Interpreter services at no cost during any service or complaint process, including American Sign Language and real-time oral interpretation
  • Interpreter services for your medical visit (be sure to call 48 hours before your visit)
  • Info in another format, like audio CD-ROM, large print and braille
  • Materials in other languages if your primary language isn’t English

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