Navigating state-sponsored healthcare plans can feel confusing, especially when you're trying to figure out what services are covered without hitting unexpected out-of-pocket costs. Anthem HealthKeepers Plus is a managed care plan serving eligible members under Virginia's Medicaid programs, including Cardinal Care and FAMIS. This plan provides comprehensive medical, dental, vision, and behavioral health care services alongside value-added extras at no cost to qualifying individuals and families.
Understanding your coverage requires looking past basic medical appointments to examine preventive care, prescription drug rules, emergency services, and value-added programs. Knowing how to maximize these benefits helps you avoid coverage gaps and get the full value of your plan.
Core Medical Benefits and Primary Care
At the heart of the Anthem HealthKeepers Plus plan is a broad network of doctors, hospitals, and medical specialists across Virginia. Your primary care provider (PCP) acts as your main healthcare contact, coordinating routine checkups, managing chronic conditions, and issuing referrals for specialized care when necessary.
- Preventive Care: Routine annual physicals, immunizations, and standard health screenings for adults and children carry zero copays when you use in-network providers.
- Urgent and Emergency Care: Emergency room visits and urgent care clinic visits are fully covered if you face a sudden, serious medical issue. You don't need prior authorization for true emergency care.
- Condition Care Management: Dedicated care managers assist members dealing with complex chronic conditions like asthma, diabetes, or heart disease by scheduling appointments and coordinating specialized treatments.
Routine preventive visits help catch health issues early. Make sure you select a local PCP shortly after enrollment to streamline your care coordination.
Dental and Vision Coverage Details
Many state-sponsored health plans separate dental and vision benefits or limit them strictly to minors, but Anthem HealthKeepers Plus offers structured coverage across different age groups.
Adult dental benefits—administered via DentaQuest under Virginia's Department of Medical Assistance Services—include routine exams, cleanings, X-rays, and basic fillings. Children and teens enjoy expanded dental coverage designed to support growing teeth and preventive habits.
Vision care follows a similar age-tiered structure:
- Members 21 and Older: You receive one routine eye exam every 12 months, plus an extra yearly allowance of up to two hundred fifty dollars for prescription eyeglasses, frames, or contact lenses.
- Members Under 21: Children and young adults receive routine eye exams every 24 months, along with medically necessary glasses, contact lenses, and replacements if items are lost, broken, or stolen.
Behavioral Health and Pharmacy Services
Mental health and substance use treatment form a critical part of the plan's medical framework. Anthem HealthKeepers Plus covers outpatient mental health counseling, intensive outpatient programs, partial hospitalization, opioid treatment services, and residential recovery programs for pregnant and postpartum individuals.
Pharmacy benefits operate through CarelonRx, covering a wide range of prescription medications and approved over-the-counter drugs with zero co-pays for eligible members.
- Generic and Brand Drugs: Most standard prescriptions are filled instantly at participating local pharmacies.
- Specialty Pharmacy: Complex conditions requiring specialized medications include dedicated delivery and pharmacist consultation support.
- Over-the-Counter Allowance: Eligible members can obtain approved everyday health items like allergy medications and first-aid supplies at no cost.
Always check the preferred drug list (formulary) before filling a new prescription. If your medication requires prior authorization, your prescribing doctor must submit clinical documentation to prevent pharmacy delays.
Value-Added Extra Benefits
Beyond mandatory state medical coverage, Anthem HealthKeepers Plus includes several non-medical perks designed to improve everyday health and community well-being:
- Healthy Rewards: You can earn cash rewards on a prepaid card for completing healthy habits, such as annual well-child visits, flu shots, prenatal checkups, and diabetes screenings.
- Transportation Assistance: If you lack reliable transportation to medical appointments, the plan provides non-emergency medical transportation (NEMT) rides. You must schedule these trips in advance through member services.
- 24/7 NurseLine: Registered nurses are available day or night to answer medical questions, help you evaluate symptoms, and guide you toward the right care setting.
- LiveHealth Online: You can consult a doctor or mental health professional 24/7 using a smartphone or computer without waiting for an office appointment.
To check your specific eligibility for these perks, log into the secure Anthem Virginia Medicaid Portal or review your digital member handbook.
Common Mistakes to Avoid
Managing your health coverage successfully means avoiding several common operational pitfalls:
- Failing to Renew on Time: Medicaid eligibility requires annual renewal during your designated regional enrollment window. Missing this deadline causes a lapse in active coverage.
- Skipping PCP Designation: Not picking a primary care provider leaves your medical file unmanaged, which can complicate specialist referrals and preventive tracking.
- Ignoring Prior Authorization Rules: Certain advanced imaging scans, specialized treatments, and non-emergency hospital admissions require prior approval. Always verify with your doctor whether an authorization request is pending before receiving elective procedures.
- Out-of-Network Visits: Seeing doctors outside the approved provider network can leave you responsible for unexpected medical bills. Always verify provider participation using the online directory before your appointment.
Frequently Asked Questions
How do I change my primary care provider?
You can switch your PCP at any time by logging into your online member account, using the mobile app, or calling member services directly. Changes usually take effect at the start of the following month.
Are transportation services free for all medical appointments?
Non-emergency medical transportation is available at no cost for covered health services, dental visits, and pharmacy pickups. You must book your ride at least 48 hours in advance through the designated transportation coordinator.
What should I do if my prescription is denied at the pharmacy?
If your pharmacist tells you a drug isn't covered or needs prior authorization, contact your prescribing doctor immediately. Your doctor must submit additional clinical notes to explain why that specific medication is medically necessary for your treatment.
How do I claim my Healthy Rewards earnings?
Once you complete an eligible health activity—such as a yearly checkup or vaccination—the activity is recorded in your member profile. You can view, track, and redeem your earned dollars through the online Benefit Reward Hub.
Where can I find a complete list of participating doctors?
You can search the live provider directory on the official Virginia Medicaid Website or use Anthem's provider lookup tool to filter doctors, clinics, and hospitals by specialty and location.
