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 2023. At that point, Virginia residents will no longer use HealthCare.gov or the federally-run call center. Instead, residents will use the new state-run platform, which is being created by Get Insured.
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.
The open enrollment period for individual/family health plans runs from November 1 to January 15. Outside of open enrollment, a qualifying event is necessary to enroll or make changes to your coverage.
In Virginia, consumers may be able to buy affordable individual and family health insurance by enrolling through the ACA marketplace (HealthCare.gov; transitioning to a state-run platform in the fall of 2023). During the open enrollment period for 2023 coverage, 88% of the people who enrolled in private plans through Virginia’s marketplace were eligible for subsidies.
Virginians may also find affordable coverage through Medicaid if they’re eligible. See Medicaid eligibility guidelines in Virginia.
For the very small minority of Virginia residents who aren’t eligible for Medicaid, Medicare, an employer’s plan, or a subsidy in the marketplace, short-term health insurance can be a lower-cost coverage option, albeit with fewer regulations that apply to the plans. Learn more about short-term health insurance in Virginia.
There are 12 insurers that offer health plans in Virginia’s exchange in 2023, with coverage areas that vary by insurer:
- Aetna Health (HMO plans; new for 2023)
- 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
346,140 Virginia residents enrolled in private qualified health plans (QHPs) through the Virginia exchange/marketplace during the open enrollment period for 2023 coverage. This was the highest enrollment in Virginia’s exchange since 2018.
Virginia expanded Medicaid in 2019, so as expected, enrollment in private plans through Virginia’s exchange dropped substantially as of 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 2023, more than 735,000 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 113% higher than it was in late 2013, whereas it had only grown by about 8% as of 2018 (prior to expansion taking effect). Nationwide, Medicaid/CHIP enrollment is up about 61% from where it was in 2013.
After the end of the open enrollment period for 2023 coverage, there were more than 304,000 people receiving premium subsidies in the Virginia health insurance marketplace, out of about 346,000 total enrollees. The subsidies offset a significant portion of the average monthly premium costs, 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; that continues through 2025, thanks to the Inflation Reduction Act.
Virginia lawmakers passed a budget in 2018 that called for Medicaid expansion, and Gov. Northam signed it into law in June 2018. 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.
Roughly 400,000 Virginia residents were initially expected to enroll in Medicaid under the expanded eligibility guidelines, and enrollment had stood at about 388,000 as of February 2020. But the initial projections were pre-COVID, and the pandemic changed everything. By early 2023, Medicaid expansion enrollment in Virginia had exceeded 735,000. The pause on Medicaid disenrollments during the pandemic (March 2020 through March 2023) drove Medicaid enrollment sharply higher nationwide, but that rule ended in March 2023 and states are rechecking eligibility for everyone enrolled in Medicaid over a year-long period that will continue into 2024. As a result, Medicaid enrollment is expected to decline by millions of people nationwide.
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 initial 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 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 then-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 late 2022, there were 1,615,622 people enrolled in Medicare in Virginia, amounting to about 18% of the state’s population. Nearly 12% of Virginia’s Medicare beneficiaries are under 65 and eligible for Medicare due to a disability, while the rest are eligible due to their age (ie, being at least 65).
Read more about Medicare in Virginia, including details about Medicare Advantage, Medicare Cost plans, Medicare Part D, and state rules for Medigap plans.
- 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.