Virginia health insurance

This page is dedicated to helping consumers quickly find health insurance resources in the state of Virginia. Here, you’ll find information about the many types of health insurance coverage available. You can find the basics of the Virginia health insurance marketplace and upcoming open enrollment period; a brief overview of Medicaid expansion in Virginia; a quick look at short-term health insurance availability and rules; statistics about state-specific Medicare rules; as well as a collection of health insurance resources for Virginia residents.

Virginia’s health insurance marketplace

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 to 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.

Virginia uses the federally run exchange, so applicants enroll through HealthCare.gov. (Virginia is one of seven federally run exchange states that conducts its own plan management, so the state takes an active role in overseeing plans sold in the exchange.)

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 will have a state-run exchange that uses the federal enrollment platform as of the fall of 2020, and a fully state-run exchange by the fall of 2022. Residents may not notice a difference in the fall of 2020, since enrollment and call center help will still be done via HealthCare.gov.

Virginia open enrollment period and dates

Open enrollment for 2021 health plans ran from November 1 through December 15, 2020. This window is an opportunity for an individual or family in Virginia to change their coverage if they wish to do so, and for new enrollees to purchase coverage for 2021. Enrollment and plan changes outside of that window are only available (on-exchange or outside the exchange) if a person has a qualifying event.

Nine insurers are offering 2020 coverage through the Virginia health insurance marketplace, and five of them decreased their average premiums for 2020. Although the exchange has robust total insurer participation, plan availability varies from one part of the state to another, depending on each insurer’s service area. In the western part of the state, Anthem is the only insurer that offers medical coverage in Virginia’s exchange.

For 2021, there are nine insurers participating in the exchange, but there will be some changes: Virginia Premier is leaving the market at the end of 2020, but Optimum Choice is joining the market for 2021. Across the eight returning insurers, the average proposed rate change is a decrease of nearly 7 percent.

Read more about Virginia’s health insurance marketplace.

Virginia enrollment in qualified health plans

As was the case in most states that use HealthCare.gov, exchange enrollment peaked in Virginia in 2016, when 421,897 people enrolled. Enrollment dropped to 410,726 people enrolled for 2017, and to 400,015 people for 2018. A similar enrollment decline occurred in most of the other states that use the federally run exchange, due in part to the Trump administration’s funding cuts for exchange marketing, outreach, and enrollment assistance. In addition, confusion about the status of the ACA’s individual mandate may have played a role.

Virginia expanded Medicaid in 2019, so as expected, enrollment in private plans through Virginia’s exchange dropped substantially for 2020. By the end of open enrollment, 269,474 people had signed up for private plans for 2020 coverage. People with income between 100 and 138 percent 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.

Read more about Virginia’s health insurance exchange.

Medicaid expansion in Virginia

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 became eligible for Medicaid coverage as of January 2019, and enrollment had exceeded 462,000 by September 2020. 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 percent of the cost.

Read more about Medicaid expansion in Virginia.

Short-term health insurance 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.

How has Obamacare helped Virginia residents?

Prior to ACA implementation, the uninsured rate in Virginia was 12.3 percent, according to U.S. Census data. It had fallen to 8.7 percent by 2016, and remained at 8.8 percent by 2018 – and has likely fallen quite a bit more since then, as Medicaid expansion took effect in 2019.

Now that Medicaid has been expanded, total enrollment in Medicaid and CHIP in Virginia is 58 percent higher than it was in late 2013, whereas it had only grown by about 8 percent as of 2018 (prior to expansion taking effect).

As of 2020, there were more than 215,000 people receiving premium subsidies in the Virginia health insurance marketplace, out of more than 245,000 covered enrollees. The subsidies averaged nearly $554/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.

Medicare coverage and enrollment in Virginia

Medicare, a health benefits program run by the federal government, covers most Americans who are at least 65 years old. Medicare benefits are also available to disabled Americans. As of August 2020, there were 1,543,740 people enrolled in Medicare in Virginia, amounting to about 18 percent 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 percent are eligible due to their age.

Read more about Medicare in Virginia, including details about Medicare Advantage, Medicare Cost plans, Medicare Part D, and state rules for Medigap plans.

Read more about the differences between Medicare Advantage and Medigap, including how the costs stack up against each other (in terms of premiums as well as out-of-pocket costs like deductibles and coinsurance) as well as things to consider in addition to the costs.

Virginia health insurance resources

• 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.

State-based health reform legislation

Scroll to the bottom of the page for information on recent state-level bills related to health reform.

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.