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.
As a result of the COVID pandemic, there’s a one-time enrollment window, from February 15 to August 15, 2021, during which any Virginia residents who are eligible to use the marketplace can enroll in a new plan. Learn more about enrollment in Virginia.
During this window in 2021, Virginia residents can newly enroll or switch from one plan to another, and a qualifying event is not necessary (normally, a qualifying event would be necessary in order to enroll or make a plan change outside of the fall enrollment period).
The enrollment window in 2021 is a good opportunity for Virginia residents to enroll or reassess their coverage in order to take advantage of the enhanced premium subsidies provided by the American Rescue 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%.
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 nearly 15,000 people had enrolled through Virginia’s exchange during the first several weeks of the COVID/American Rescue Plan enrollment window in 2021. This was about 2.5 times the enrollment pace of the same time period the year before (when a qualifying event would have been 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 April 2021, more than 542,000 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 71% 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 542,000 by April 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.
Despite relaxed federal rules regarding short-term health insurance, the duration of short-term plans in Virginia is limited to six months with no renewals.
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.
And the state enacted legislation in 2020 that will sharply restrict short-term health insurance plans as of July 2021. At that point, short-term plans in Virginia will be capped at three months, and only one renewal will be allowed, for a maximum duration of six months. The new law will also prohibit 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 prohibit the sale of short-term health plans during the ACA’s annual open enrollment period (November 1 to December 15; Washington and Maine have similar rules)
Read more about short-term health insurance in Virginia.
As of February 2021, there were 1,555,827 people enrolled in Medicare in Virginia, amounting to about 18% of the state’s population. Fourteen 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.