Virginia health insurance marketplace guide 2023

For the 2023 plan year, Virginia has a state-run exchange that uses the federally-run enrollment platform. This means the state oversees the exchange, but applicants enroll via HealthCare.gov (prior to the 2021 plan year, Virginia relied fully on the federally-run exchange).

From a consumer’s standpoint, nothing has changed (yet) about Virginia’s exchange. Enrollments are still conducted through HealthCare.gov, just as they have been since the fall of 2013. But Virginia as described above, Virginia will have its own fully state-run exchange platform in place by late 2023, for enrollment in 2024 health plans. This is a result of 2020 state legislation (HB1428 and SB732), which directed the state to create its own health insurance exchange.

Virginia’s exchange will be funded with an assessment on insurers that won’t exceed 3% of premiums (for plans sold both on- and off-exchange). The fee for HealthCare.gov in 2023 is 2.75% of premiums, although it’s only 2.25% for state-run exchanges that use the federal enrollment platform. Since Virginia has transitioned to this model, the cost to use HealthCare.gov is lower than it would otherwise have been.

The open enrollment period for individual/family coverage runs from November 1 through January 15. Outside of that window, a special enrollment period is necessary in order to enroll or make a change to your coverage.

Special enrollment periods are generally linked to a qualifying life event, although some special enrollment periods (such as the enrollment opportunity for Native Americans, or for people earning under 150% of the poverty level) do not require a specific life event.

Learn more about enrollment opportunities in our comprehensive guide to open enrollment and to special enrollment periods.

As of 2023, there are 12 insurers that offer health plans in Virginia’s exchange, including one newcomer (Aetna Health, which is an HMO affliate) and one exit (Bright Health stopped offering individual/family plans in any state at the end of 2022).

2023 health plans are available in Virginia’s exchange from the following insurers, with coverage areas that vary by insurer:

• Aetna Health (new for 2023, HMO plans)
• Aetna Life (EPO plans)
• CareFirst
• Cigna
• Group Hospitalization and Medical Services, Inc.
• Health Keepers/Anthem
• Innovation Health Plan 
• Kaiser Foundation Health Plan of the Mid-Atlantic
• Optima
• Piedmont Community Healthcare (and Piedmont HMO)
• Oscar Health
• Optimum Choice

For the fourth year in a row, average pre-subsidy premiums in Virginia’s individual market decreased for 2023. And the 2023 decrease was substantial, due to the state’s new reinsurance program.

Bright Health left Virginia’s individual/family market after the end of 2022, but Aetna is offering HMO plans for 2023 (Aetna Health), in addition to EPO plans (Aetna Life), so there are still 12 insurers offering plans through Virginia’s exchange for 2023.

The insurers that offer individual market coverage through Virginia’s exchange made the following average rate changes for 2023:

• CareFirst: 15% decrease 
• Cigna: 19.6% decrease
• Group Hospitalization & Medical Services, Inc: 24.3% decrease
• Health Keepers (Anthem): 10.5% decrease 
• Kaiser Foundation Health Plan of the Mid-Atlantic: 12.3% decrease 
• Optima: 21.4% decrease
• Piedmont Community Healthcare (and Piedmont HMO): 16.6% decrease 
• Oscar Health: 13.3% decrease
• Optimum Choice: 7.8% decrease
• Aetna Life (EPO): 19.7% decrease
• Aetna Health (HMO): New for 2023
• Innovation Health Plan: 24.8% decrease

So all of the returning insurers have implemented rate decreases for 2023, and most are double-digit decreases.

But overall average rate changes don’t tell the whole story:

• They only apply to full-price premiums, and most exchange enrollees receive premium subsidies. For enrollees whose costs are offset by subsidies, net rate changes also depend on how the subsidy amount changes from one year to the next. And when a state implements a reinsurance program (as Virginia has done for 2023), one of the known effects is that premium subsidies get smaller, since they are offsetting smaller overall premiums. Depending on the plan that a person buys, this can sometimes result in an increase in the after-subsidy premium. So it’s important to shop carefully during open enrollment.
• They don’t account for the fact that rates increase with age. Even if your insurer’s rates remain flat from one year to the next, your price will still go up just because you’re a year older (if you receive subsidies, the subsidies will increase to keep up with the age-related premium increases; subsidies for older enrollees are significantly larger than subsidies for younger enrollees).
• They lump all insurers and plans together. Coverage areas and plan availability vary from one insurer to another, which means rates in one area can change more or less than rates in another area of the same state.

Although average premiums decreased in Virginia for 2020, 2021, and 2022, that had certainly not been the case in previous years. Here’s a summary of how rates have changed over the years in Virginia’s individual market (note that all rate changes apply to full-price premiums; after subsidies are applied, the rate changes can be much different).

2015: Average rate increase of 10.2%

For all 14 carriers in the individual market in Virginia (including off-exchange plans), PricewaterhouseCooper data indicated a weighted average finalized premium increase of 10.2% for 2015.

But for people who had the benchmark Silver plan, price increases were more muted, mostly averaging 3% to 6% in much of the state, especially for enrollees willing to shop around in order to make sure they still had the second-lowest-cost Silver plan in 2015. The Virginia Association of Health Plans called the price increases “relatively modest” for people who were enrolled in an exchange plan in 2014 and then renewed their coverage or switched to another exchange plan for 2015.

2016: Average rate increase of 8.5%

Regulators in Virginia announced approved rate changes for 2016 in early October 2015. For carriers that offered individual plans in the Virginia exchange, rate changes for 2016 ranged from a 3.34% decrease (Innovation Health Insurance Co.) to a 19.1% increase (Group Hospitalization and Medical Services). For the entire individual market—which includes five carriers that only offer plans off-exchange (two of which had increases in excess of 14 percent)—the overall weighted average rate increase in Virginia was 8.5% for 2016.

2017: Average rate increase of 18.4%

There were ten insurers offering plans in the Virginia exchange for 2017. The weighted average rate increase across all of them was just over 18%. The average benchmark plan (second-lowest-cost silver plan) premium in Virginia was 10% more expensive in 2017 than it was in 2016 (that’s less than half the 22% nationwide average increase in benchmark plans that year).

Aetna offered all new plans for 2017, replacing Coventry’s 2016 plans. But Aetna subsequently exited the Virginia market altogether at the end of 2017. As noted above, Aetna has returned to Virginia’s marketplace for 2022.

CareFirst Blue Choice and GHMSI terminated all of their bronze plans at the end of 2016, and mapped bronze enrollees to silver plans instead.

For an analysis of the rate review process that took place in Virginia during the summer of 2016, ACAsignups has a comprehensive review of the initial rate filings in Virginia for 2017, an updated version that provides additional clarity, and a revised version with revisions as of August 2016.

2018: Average rate increase of 57.7%

When rates for 2018 were being set in the spring of 2017, insurers in Virginia initially assumed, for the most part, that funding for cost-sharing reductions (CSR) would continue in 2018. But they revised the rate filings later in the summer to reflect the new assumption that CSR funding would not continue, adding the cost of CSR to silver plan rates. Ultimately, the Trump administration announced in mid-October that CSR funding would end immediately, so it was wise planning on the part of insurers to have added the cost of CSR to their premiums for 2018 (insurers are still required to provide CSR benefits to all eligible enrollees, regardless of whether the insurer is being reimbursed for the costs).

The seven insurers that offered coverage in the Virginia exchange in 2018 increased their average premiums between 34% and 81% for 2018, with an average increase of 57.7%. Silver plans generally had the most significant rate increases, since the cost of CSR was added to their premiums.

Optima had the largest percentage increase of any of the insurers in Virginia for 2018, and in areas where they offered coverage along with one or more other insurers for 2017, Optima’s rates tended to be on the higher end of the spectrum in 2017 as well. It’s noteworthy that that Optima’s rates were so high that their medical loss ratio dropped to just 49 percent for 2018, resulting in huge refunds for consumers in 2019.

For people who get premium subsidies, the subsidies were much larger for 2018 than they were in 2017, to offset the enormous rate increase (the unsubsidized cost of the lowest-priced silver plan for a 40-year-old went from $303/month to $1012/month in the Charlottesville area), keeping the after-subsidy cost of the benchmark plan roughly equivalent to what it was in 2017 (slightly lower, actually, but roughly equivalent). But for people who don’t get premium subsidies, the rate increase in the Charlottesville area was the most substantial in the country.

2019: Average rate increase of 9.6%

The Virginia Bureau of Insurance posted a summary of average rate increases for 2019, with data as of August 22, 2018. The BOI also put together a very informative overview of the projected 2019 market and how it compared with previous years.

At ACA Signups, Charles Gaba calculated a weighted average rate increase of just under 10% in Virginia’s individual market for 2019. Premium changes for 2019 varied considerably from one insurer to another: There were some decreases, but GHMSI increased average premiums by 45 percent.

The insurers attributed a significant portion of the proposed 2019 rate increases to continued federal uncertainty and regulations that will destabilize the individual markets, including the expansion of short-term plans and association health plans, and the elimination of the individual mandate penalty after the end of 2018.

As was the case for 2018, Optima’s rate filing ended up being newsworthy for 2019. Optima’s initial rate filing, submitted in May 2018, called for an average rate decrease of 1.9%. They filed revised rates on August 9 (SERFF filing number OPHL-131486283) that called for an average rate decrease of 7.2% (this is what was ultimately approved by regulators and implemented). The deadline to revise rate filings was August 10, and Anthem’s revised filing on that date included plans to expand back into some of the areas where they had exited the year before, ending Optima’s monopoly in some areas. In response, Optima filed yet another set of revised rates on August 16, proposing an average rate decrease of 16.6% (see the revised filings under the same SERFF tracking number that applied to the first revised filings).

But the Virginia BOI rejected this additional filing, as it came after the August 10 deadline. Optima submitted a petition to the State Corporation Commission, asking that their post-deadline rate revision be considered. But a few days later, BOI responded, clarifying that Optima’s latest filing (submitted after the August 10 deadline) was not a response to any objections BOI had to their earlier filings, but was instead a revised filing based on a smaller projected profit margin for 2019, and filed only after Optima realized that they would no longer have a monopoly in 2019 (due to Anthem’s last-minute coverage area expansion). BOI’s response makes it clear that they had offered Optima an opportunity to lower their projected profit margin earlier in August, but the insurer chose not to do so when they believed that they would still have a monopoly in the Charlottesville area. Optima’s petition indicated that they were aware that without a monopoly, their proposed rates (a 7.2% average decrease, as opposed to the 16.6% decrease) would result in a significant reduction in enrollment and a loss of revenue. But BOI’s response essentially indicated that Optima must lie in the bed they made. In mid-September, the State Corporation Commission agreed with BOI, stating that “the decision not to submit its most competitive rates by the August 10th filing date was Optima’s, and Optima’s alone. Only after seeing a more competitive (and timely submitted) rate filing did Optima attempt to submit lower or more competitive rates after the filing date.”

Virginia Premier joined the exchange in the Richmond area (rating area 7) for 2019. Virginia Premier’s filing indicated that they expected about 4,000 people to purchase their plans for 2019, almost entirely via the exchange (Virginia Premier offered plans in the exchange in 2020 as well, but left at the end of that year).

2020: Average rate decrease of 5%

Oscar Health entered the markets in six states for 2020, including Virginia (Oscar also expanded its existing coverage area in nine other states). Oscar’s plans became available in the Richmond area for 2020 — the same area where Virginia Premier entered the market in 2019. Five of the nine insurers in Virginia’s marketplace decreased their average premiums for 2020, and the overall average rate change across all the insurers amounted to a decrease of 5%.

Health Keepers and Cigna were projected to have roughly two-thirds of the state’s total market share in 2020. Optima Health Plan and Kaiser had another quarter. The other insurers together made up the remaining 7.5 percent of the market. So of the four insurers that hold nearly all of the market share, three reduced their premiums for 2020 (in Optima’s case, the reduction was more than 20 percent), and one implemented a very slight increase.

Benchmark plan premiums dropped by an average of 6 percent in Virginia for 2020, so premium subsidies (which are based on the cost of the benchmark plan) were also smaller than they were in 2019.

Optima Health Insurance Company is a separate entity that only offers plans (PPOs) outside the exchange in Virginia. The rates for those plans decreased by an average of 19.6% for 2020.

2021: Average rate decrease of 3.7%.

Virginia continued to have nine insurers offering individual market coverage in the exchange in 2021, but the specifics changed a bit: Optimum Choice entered Virginia’s marketplace for 2021, with plans available in the Washington, Arlington, Alexandria, and Winchester areas. And Virginia Premier, which offered plans in Virginia’s exchange in 2020, no longer offers any individual market plans (Virginia Premier has continued to offer Medicare and Medicaid plans).

In August 2020, the Virginia Bureau of Insurance published a summary of the rate changes that insurers had filed for 2021. Additional details are available in SERFF and on the federal government’s rate review page, which indicates that the rate filings the BOI published in August were ultimately approved by state and federal regulators.

Overall, the average rate change for 2021 amounted to a decrease of 3.7%.

2022: Average rate decrease of 3%

For the third year in a row, average pre-subsidy premiums in Virginia’s individual market decreased for 2022. The overall average rate decrease for 2022 was nearly 3%.

Virginia’s exchange also had three additional insurers offering plans for 2022. Aetna, Bright Health, and Innovation Health Plan joined the exchange, bringing the total number of exchange insurers to 12 — the highest it had ever been.

During the open enrollment period for 2022 coverage, 346,140 Virginia residents enrolled in private qualified health plans (QHPs) through the Virginia exchange/marketplace. This was the highest enrollment the state had seen since 2018.

Like most states that use HealthCare.gov, enrollment in Virginia’s exchange initially peaked in 2016 and began to decline after that. The decline was particularly significant in 2019, when Medicaid expansion took effect in Virginia. Prior to 2019, people with income between 100% and 138% of the poverty level were eligible for premium subsidies to purchase private plans in the exchange, whereas they became eligible for Medicaid instead as of 2019.

And although nationwide enrollment increased slightly in 2021, it declined again in Virginia, by more than 3%. That could be attributed to the still fairly new expansion of Medicaid, combined with the effects of the COVID pandemic and people transitioning onto Medicaid due to job/income losses. Enrollment in Virginia’s fairly new Medicaid expansion coverage has increased sharply during the pandemic, with more than 735,000 people enrolled as of April 2023.

But enrollment in Virginia’s exchange rebounded for 2022, due in large part to the enhanced subsidies available under the American Rescue Plan, the longer open enrollment period, and the additional federal funding for outreach and enrollment assistance. And it grew again, by nearly 40,000 people, during the open enrollment period for 2023 coverage.

Here’s a summary of enrollment in private individual market plans in Virginia’s exchange each year (these numbers represent the number of people who bought plans during open enrollment; the number fluctuates throughout the year as people drop their coverage and others enroll via special enrollment periods).

• 2014: 216,356 people enrolled
• 2015: 385,154 people enrolled
• 2016: 421,897 people enrolled
• 2017: 410,726 people enrolled
• 2018: 400,015 people enrolled
• 2019: 328,020 people enrolled
• 2020: 269,474 people enrolled
• 2021: 261,943 people enrolled
• 2022: 307,946 people enrolled
• 2023: 346,140 people enrolled