Sentara Health Plans, formerly Optima Health, is the insurance arm of Sentara Health, the not-for-profit health system based in Norfolk, Virginia. It covers nearly 1 million people in Virginia and, through AvMed, in South Florida (company figures).
Sentara has narrowed its focus. It left standard Medicare Advantage for 2026, keeping only plans for people with both Medicare and Medicaid, and it is now in a network standoff with Anthem that affects Hampton Roads patients.
Updated November 2026. This profile draws on company materials, regulatory filings, federal data and Health Plan News analysis. It is independent of Sentara Health Plans; for questions about your coverage, call the number on your member ID card.
Sentara Health Plans at a Glance
| Item | Details |
|---|---|
| Parent | Sentara Health (not-for-profit) |
| Headquarters | Virginia Beach and Norfolk, Virginia |
| Health plan president | Michael Cole (since June 15, 2026) |
| Parent CEO | Dennis Matheis |
| Service area | Virginia; South Florida through AvMed |
| Brands | Sentara Health Plans, Sentara Community Plan (Medicaid), AvMed |
| Members | Nearly 1 million |
| Medicare Advantage | Dual-eligible special needs plans only, since 2026 |
| Medicaid | One of five Virginia Cardinal Care plans |
Individual and Employer Plans
Sentara sells ACA plans in Virginia, where its 2027 filing covered about 158,000 individual-market members and requested an average increase of 22.9% (source). AvMed is on Florida’s 2027 individual market carrier list for Miami-Dade, Broward, Palm Beach and several north Florida counties. Employer plans include Vantage HMO and POS, Plus PPO and BusinessEDGE small-group plans.
Medicaid and Medicare
Sentara Community Plan is one of five managed care plans in Virginia’s Cardinal Care Medicaid program. In Medicare, Sentara exited standard Medicare Advantage, prescription drug and chronic-condition plans in Virginia, North Carolina and Florida starting in 2026, and AvMed left Florida Medicare Advantage entirely (source). Our Medigap vs Medicare Advantage guide can help former members compare options.
The Anthem Network Dispute
Sentara ended contract talks with Anthem Blue Cross and Blue Shield of Virginia for Medicare Advantage, Medicaid and ACA plans on October 5, 2026, affecting about 215,000 Hampton Roads members, after the two sides disagreed on payment rates (source). Sentara says Anthem owes more than $105 million in overdue claims. Anthem members who use Sentara hospitals should check their network status for 2027; see our Anthem profile.
Sentara Health Plans by the Numbers
- Market position: Sentara is the second-largest ACA exchange insurer in Virginia, with 21%, behind Anthem’s 33%, according to 2024 AMA data. See our market share by state page.
- Claim denials: AvMed’s HealthCare.gov plans in Florida denied 27.3% of in-network claims in 2024, above the 18.7% national rate (federal data compiled by KFF).
Recent Sentara Health Plans News
- Leadership: Michael Cole, formerly president of Regence BlueCross BlueShield, became president of Sentara Health Plans in June 2026. (source)
- Medicare pullback: Sentara cut more than 200 jobs with its 2026 Medicare Advantage exit. (source)
- 2027 rates: Sentara requested an average 22.9% increase for 2027 Virginia individual plans. (source)
How To Contact Sentara Health Plans
| Purpose | Contact |
|---|---|
| Employer plans | 1-800-275-3755 (TTY 711) |
| Individual and family | 1-866-514-5916 |
| Medicare | 1-800-927-6048 |
| Medicaid (Sentara Community Plan) | 1-800-881-2166, Monday to Friday, 8 a.m. to 8 p.m. |
| AvMed | 1-800-477-8768; avmed.org |
| Website | sentara.com/health-plans |
For other carriers, see our profiles of the largest health insurance companies and follow our Health Insurance Companies hub.
Sources
ACASignups.net; ACASignups.net (from VA SCC filings); AMA Competition in Health Insurance (2025); AvMed facts at a glance; Sentara facts and figures; Becker’s Payer Issues; Becker’s Payer Issues; DMAS; Becker’s Payer Issues; LiveInsuranceNews; Becker’s Payer Issues; Sentara broker update; Florida DFS 2027 carrier list; Florida DFS 2027 carrier list; AvMed; American Medical Association, Competition in Health Insurance (2025 update); CMS Transparency in Coverage public use file (2024, via KFF).