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Virginia Health Insurance Consumer Guide
This guide was developed to help you choose the right health insurance plan for you and your family. The coverage options found in Virginia’s ACA Marketplace may be a good choice for many consumers, and we’re here to help explain the choices available.
Virginia currently has a state-run exchange that uses the federally run health enrollment platform, known as HealthCare.gov for residents to purchase its ACA Marketplace plans. Virginia is in the process of building a fully state-run exchange, and it will debut in the fall of 2023, for coverage effective in 2024.1
The federal government helps consumers pay for insurance through an advance premium tax credit if you buy coverage from the exchange. Depending on your income and other circumstances, you may also get help to lower your monthly insurance premium (the amount you pay to enroll in the coverage) and possibly your out-of-pocket expenses.
Dental coverage in Virginia
Looking to improve your smile? Dental insurance may be a smart addition to your health coverage. Our guide explores dental coverage options in Virginia.
Virginia’s Medicaid program
Medicaid expansion in Virginia took effect in January 2019. Since then, Virginia’s Medicaid enrollment has grown to more than 3 million people.2
Medicare coverage and enrollment in Virginia
As of May 2023, the number of Medicare beneficiaries in Virginia was 1,631,641.3 Our Virginia Medicare guide explains what you need to know about Medicare’s coverage options, as well as Virginia’s Medigap (Medicare Supplement) regulations.
Short-term coverage in Virginia
In Virginia, short-term health insurance plans are available for purchase but state regulations ban the sale of the plans during the ACA open enrollment window.4
Frequently asked questions about health insurance in Virginia
Who can buy Marketplace health insurance?
To qualify for health coverage through the Virginia Marketplace, you must: 5
- Live in Virginia
- Be lawfully present in the United States
- Not be incarcerated
- Not be enrolled in Medicare
Eligibility for financial assistance (premium subsidies and cost-sharing reductions) depends on your income and how it compares with the cost of the second-lowest-cost Silver plan in your area – which depends on your age and location. In addition, to qualify for financial assistance with your Marketplace plan you must:
- Not have access to affordable health coverage through your employer. If your employer offers coverage but you feel it’s too expensive, you can use our Employer Health Plan Affordability Calculator to see if you might qualify for premium subsidies in the Marketplace.
- Not be eligible for Medicaid or CHIP.
When can I enroll in an ACA-compliant plan in Virginia?
The open enrollment period for individual/family health coverage runs from November 1 to January 15 in Virginia.6
If you need your coverage to start on January 1, you must apply by December 15. If you apply between December 16 and January 15, your coverage will begin on February 1. 5
Outside of open enrollment, a qualifying event is necessary to enroll or make changes to your coverage.If you have questions about open enrollment, you can learn more in our comprehensive guide to open enrollment. We also have a comprehensive guide to special enrollment periods
How do I enroll in a Marketplace plan in Virginia?
To enroll in an ACA Marketplace plan in Virginia, you can:
- Visit HealthCare.gov to access Virginia’s health insurance marketplace. Here you will find an online platform to shop, compare, and choose the best health plans.
- Purchase individual and family health coverage with the help of an insurance agent or broker, a Navigator or certified application counselor, or an approved enhanced direct enrollment entity.7
You can also call HealthCare.gov’s contact center by dialing 1-800-318-2596 (TTY: 1-855-889-4325). The call center is available 24 hours a day, seven days a week, but it’s closed on holidays.
How can I find affordable health insurance in Virginia?
You may find affordable health insurance options in Virginia by signing up through HealthCare.gov.
As of early 2023, nearly nine out of ten eligible enrollees in Virginia saved money on premium payments that amounted to an average savings of $407/month – reducing the average net premium of subsidy-eligible enrollees to $86/month after subsidies. 8
The Affordable Care Act provides income-based advance premium tax credits (subsidies) that offset your premium payments to help keep your expenses down. People with household incomes below 250% of the federal poverty level also qualify for cost-sharing reductions (CSR) that may reduce your deductibles and out-of-pocket expenses when you buy a Silver plan. Between the premium subsidies and cost-sharing reductions, you may find that an ACA plan is the cheapest health insurance option for you.
Source: CMS.gov 8
How many insurers offer Marketplace coverage in Virginia?
There are 12 insurers that offer health plans in Virginia’s exchange for 2023, including one newcomer (Aetna Health).9
The following carriers offer health plans on the Virginia exchange for 2023:
- Aetna Health (HMO plans)
- Aetna Life (EPO plans)
- Group Hospitalization and Medical Services, Inc.
- Health Keepers/Anthem
- Innovation Health Plan
- Kaiser Foundation Health Plan of the Mid-Atlantic
- Piedmont Community Healthcare (and Piedmont HMO)
- Oscar Health
- Optimum Choice
Are Marketplace health insurance premiums increasing in Virginia?
The insurers that offer individual market coverage through Virginia’s exchange requested the following average rate changes for 2024: 10
Virginia’s ACA Marketplace Plan 2024 Proposed Rate Increases by Insurance Company
|Aetna Health (HMO)||16.4%|
|Aetna Life (EPO)||-18.9%|
|Group Hospitalization and Medical Services Inc.||99.94%|
|Innovation Health Plan||26.40%|
|Kaiser Foundation Health Plan of the Mid-Atlantic||16.31%|
|Piedmont Community HealthCare (and Piedmont HMO)||26.77%|
How many people are insured through Virginia’s Marketplace?
During the open enrollment period for 2023 coverage, 346,140 Virginia residents enrolled in private qualified health plans (QHPs) through the Virginia ACA marketplace.11
This was the highest enrollment the state had seen since 2018, and likely was connected to the American Rescue Plan (ARP). Under the ARP – now extended by the Inflation Reduction Act – subsidies are more significant and accessible through the end of 2025. 12
What health insurance resources are available to Virginia residents?
Virginia Consumer Assistance Program
Assists people insured by private health plans, Medicaid, or other plans in resolving problems pertaining to their health coverage; assists uninsured residents with access to care.
(877) 310-6560 / [email protected]
State Exchange Profile: Virginia
The Henry J. Kaiser Family Foundation overview of Virginia’s progress toward creating a state health insurance exchange.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.Footnotes
- “Health Benefit Exchange” SCC.Virginia.gov
- “Enrollment Reports” Department of Medical Assistance Services, Commonwealth of Virginia Accessed September 2023
- “Medicare Monthly Enrollment ” CMS.gov, May 2023.
- “Availability of short-term health insurance in Virginia” healthinsurance.org, Jan. 12, 2023
- “A quick guide to the Health Insurance Marketplace“HealthCare.gov
- “When can you get health insurance?” HealthCare.gov, 2023
- “Entities Approved to Use Enhanced Direct Enrollment” CMS.gov, April 28, 2023
- “2023 Marketplace Open Enrollment Period Public Use Files”CMS.gov, 2023
- “Health Carrier list PY 2023” SCC Virginia.gov, September 2022
- “ACA Rate & Form Filing Information – 2024 Presentations”, State Corporation Commission, Virginia.gov, Accessed August 2023
- “Marketplace 2023 Open Enrollment Period Report: Final National Snapshot” CMS.gov, Jan. 25, 2023
- “Health Insurance Marketplaces 2023 Open Enrollment Report” CMS.gov, Accessed August 2023
- “ASPE Issue Brief (2014)” ASPE, 2015
- “Health Insurance Marketplaces 2015 Open Enrollment Period: March Enrollment Report”, HHS.gov, 2015
- “HEALTH INSURANCE MARKETPLACES 2016 OPEN ENROLLMENT PERIOD: FINAL ENROLLMENT REPORT” HHS.gov, 2016
- “2017 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2017
- “2018 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2018
- “2019 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2019
- “2020 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2020
- “2021 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2021
- “2022 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2022