Frequently asked questions about health insurance
coverage options in Virginia
Virginia used to have a fully federally-run exchange, but as of the fall of 2020, Virginia transitioned to a state-run exchange that uses the federal platform. Consumers would not have noticed a change, however, as enrollment is still completed through HealthCare.gov, or through an approved enhanced direct enrollment entity.
But Virginia is actively working towards a transition to a fully state-run marketplace, under the terms of legislation that the state enacted in 2020. Virginia plans to have a fully state-run exchange by the fall of 2022. At that point, if all goes as planned, Virginia residents will no longer use HealthCare.gov or the federally-run call center.
Virginia’s health insurance marketplace offers individual and family health insurance plans. And although small group health insurance enrollments are conducted directly through the insurance companies (instead of through the exchange), Virginia is one of the states where there are still exchange-certified small business health plans available, for businesses with up to 50 employees.
People who are employed by a company that offers employer-sponsored health insurance benefits (and who are eligible for those benefits) do not use the marketplace, nor do people who are eligible for Medicare. Medicaid enrollment is available through the marketplace in some circumstances, although some low-income residents, including the elderly, enroll in Medicaid through the Virginia Department of Medical Assistance Services instead.
Open enrollment in Virginia for 2021 coverage ended on December 15, 2020. The open enrollment period for 2022 coverage will run from November 1 through December 15, 2021.
Outside of that open enrollment period, residents need a qualifying event in order to enroll in coverage or make a change to their plan.
For 2021, there are nine insurers participating in the exchange, but there were some changes: Virginia Premier left the market at the end of 2020, but Optimum Choice joined the market for 2021. Across the eight returning insurers, the average rate change amounted to a decrease of more than 7%.
For 2022, three additional insurers are joining the exchange: Aetna, Innovation Health Plan, and a third insurer that the state hadn’t yet named as of early August. The exchange will have a dozen insurers offering individual/family plans for 2022. And for the third year in a row, insurers have proposed an overall rate decrease.
As was the case in most states that use HealthCare.gov, exchange enrollment peaked in Virginia in 2016, when 421,897 people enrolled. Enrollment has dropped each year since then, with 261,943 people enrolling during the open enrollment period for 2021 coverage.
In most states, enrollment declined each year from 2017 through 2020, but increased a bit in 2021. That increase did not happen in Virginia during the open enrollment period, but more than 48,000 people signed up for coverage during the first several months of the COVID/American Rescue Plan special enrollment period in 2021, far outpacing the normal enrollment volume during the same time frame (when a qualifying event would normally be necessary in order to enroll; qualifying events are not necessary during the extended special enrollment window in 2021).
Virginia expanded Medicaid in 2019, so as expected, enrollment in private plans through Virginia’s exchange dropped substantially for 2020. People with income between 100% and 138% of the poverty level used to be eligible for premium subsidies to offset the cost of private plans in Virginia’s exchange. But now that Medicaid has been expanded, these people are eligible for Medicaid instead. As of August 2021, more than 571,000 people had gained access to Medicaid in Virginia as a result of the state’s expansion of eligibility rules.
Prior to ACA implementation, the uninsured rate in Virginia was 12.3%, according to U.S. Census data. It had fallen to 8.7% by 2016, and remained at 8.8% by 2018. But it dropped to 7.9% in 2019. Nationwide, there was an increase in the uninsured rate in 2019, but Virginia’s Medicaid expansion took effect in 2019, helping to reduce the uninsured rate in the state.
Now that Medicaid has been expanded, total enrollment in Medicaid and CHIP in Virginia is 79% higher than it was in late 2013, whereas it had only grown by about 8% as of 2018 (prior to expansion taking effect).
After the end of the open enrollment period for 2021 coverage, there were more than 218,000 people receiving premium subsidies in the Virginia health insurance marketplace, out of nearly 262,000 covered enrollees. The subsidies averaged $508/month, offsetting most of the average monthly premium costs and making medical insurance coverage affordable for people who would otherwise not be able to afford it. The American Rescue Plan has increased the size of premium subsidies and made them more widely available than they were during the open enrollment period.
Virginia lawmakers passed a budget in 2018 that called for Medicaid expansion, and Gov. Northam signed it into law in June 2018.
Roughly 400,000 Virginia residents initially became eligible for Medicaid coverage as of January 2019, and enrollment had exceeded 571,000 by August 2021. It had been at around 388,000 as of February 2020, but enrollment has increased significantly amid the job and income losses caused by the COVID pandemic.
The federal government will always pay the majority of the cost of covering the newly eligible population, but Virginia is responsible for paying 10% of the cost.
Read more about Medicaid expansion in Virginia.
Virginia enacted legislation in 2020 that took effect in mid-2021 and sharply limits short-term health plans in the state. Under Virginia’s new rules, short-term health plans are limited to inital terms of three months. Renewal is permitted, but total plan duration cannot exceed six months.
The new law also prohibits the sale of a short-term plan if it would result in a person having short-term coverage for more than six months in any 12-month period, and prohibits the sale of short-term health plans during the ACA’s annual open enrollment period (November 1 to a proposed end date of January 15; Washington and Maine have similar rules)
Lawmakers in Virginia passed legislation in 2018 aimed at expanding access to short-term medical plans, but Gov. Ralph Northam vetoed it in an effort to protect consumers and the ACA-compliant risk pool.
Read more about short-term health insurance in Virginia.
As of June 2021, there were 1,564,949 people enrolled in Medicare in Virginia, amounting to about 18% of the state’s population. Thirteen percent of Virginia’s Medicare beneficiaries are under 65 and eligible for Medicare due to a disability, while the other 86% are eligible due to their age.
- Cover Virginia (a state-run service that partners with the federal marketplace to provide Virginia residents with the information they need about enrolling in Medicaid or a private plan through the marketplace)
- Virginia’s Department of Medical Assistance Services (Medicaid)
- Virginia State Corporation Commission — Oversees and regulates health insurance companies, agents, and brokers; also tasked with creating Virginia’s new state-run health insurance exchange, which will be used for enrolling in health plans for 2023 and beyond.
- Virginia Insurance Counseling and Assistance Program (VICAP) — A resource for Medicare beneficiaries and their caregivers; VICAP can provide a variety of helpful information and assistance regarding Medicare coverage and enrollment.