TABLE OF CONTENTS
Virginians can get healthcare through an employer, insurance brokers and agents, or through Medicare if you’re disabled or 65 or older. This guide will show you the options available to Virginians, the cost of many of these options, and how you or your family can enroll in a health plan.
Currently, Virginians interested in purchasing an ACA-compliant health care plan can purchase one through Healthcare.gov. However, starting in 2023, Virginia will operate its own exchange.
On Healthcare.gov, you’ll need to register to see available plans. You will be asked to provide your Social Security number, your household income, your address, and your phone number. You’ll also be asked to provide some of this information for any member of your family you wish to include in your plan as well.
Once you’ve registered, you’ll be able to see up to three plans simultaneously to compare costs. In 2022, eight companies offer plans on the Virginia section of Healthcare.gov. Some of these plans are available statewide, while others are only available in certain areas. The following providers offer ACA-compliant plans in Virginia.
If you don’t wish to use healthcare.gov, you can still purchase health care plans through private companies, brokers, or insurance agents.
There are some important considerations when shopping for individual coverage, whether for yourself or for multiple people. These considerations include:
If you’re healthy with few or no prescriptions, you probably want a plan with a low monthly payment and a high deductible. On the other hand, if you have a chronic health condition, you’ll probably want to select a plan that offers a lower deductible but comes with a higher monthly premium.
The following are the types of plans you’ll have to choose from:
Choosing the right health care plan for a family can be a little more complicated. You need to think about how each person might use the plan. While you and your spouse may be healthy, if you have children with chronic health problems, you could end up paying a lot of out-of-pocket costs. In this case, you might be better off selecting a plan with a higher monthly premium but a lower deductible. Review the plan details carefully to make sure the services you need are covered. If someone in your family receives specialty care, you should also check to make sure the specialist participates in the plan’s network.
Another consideration for family plans is that many plans have an individual deductible and a family deductible. An individual deductible applies to each person covered by the plan, while the family deductible applies to the entire family. If one of your family members is hospitalized or undergoes an expensive surgery, it’s possible to meet the family deductible before every person on the plan has met their individual deductible.
The Virginia section of the Healthcare.gov website uses the familiar metal tier structure to organize health care plans: Bronze, Silver, Gold, and Platinum. There is no difference in the kind of coverage you receive, only the cost. With a Bronze plan, you’ll pay more in coinsurance and you have a higher deductible. With a Gold plan, you’ll pay a lower coinsurance cost but have larger monthly premiums.
|Average premium in Virginia||2019||2020||2021||2022|
|Most affordable Bronze plan||$410||$380||$358||$343|
|Most affordable Silver plan||$525||$506||$470||$445|
|Most affordable Gold plan||$531||$510||$464||$435|
Virginians who have no or low income according to the Federal Poverty Level may be eligible for Medicaid. In 2019, the state expanded Medicaid to include all low-income individuals between the ages of 19 and 64.
Medicaid is available to low-income residents who meet at least one of the following criteria:
Medicaid is available to residents aged 19 to 64 who live in households that earn less than 130% of the federal poverty level. In 2022, this is $17,131 for an individual, while for a family of three, it’s $29,207. You can find out more about what coverage is available and if you are eligible for Medicaid assistance at Cover Virginia.
Even if you don’t qualify for Medicaid, your children may be eligible for FAMIS or FAMIS Plus. A family’s monthly income determines eligibility, and a family of four can earn up to 205% of the Federal Poverty Level and qualify. Coverage includes doctor visits, hospital care, prescription medicines, mental health services, dental care, eyeglasses, regular checkups, and immunizations.
Medicare is the federal government program to provide health care for seniors aged 65 and older and those with qualifying disabilities.
If you want some help paying for out-of-pocket costs with Original Medicare, you should purchase a Medicare Supplement Insurance Plan, also known as Medigap. A Medicare Supplement Insurance Plan will pay for out-of-pocket costs such as coinsurance, deductibles, and copays. These plans do not pay for vision, dental, or hearing, nor coverage for long-term care. If you travel out of the country, however, a Medicare Supplement Insurance Plan can provide health insurance for your trip. A Medicare Supplement Insurance Plan will not work with any Medicare Advantage Plan.
To qualify for Medicare, you must be:
If you start receiving your Social Security or Railroad Retirement Board benefits at least four months before you turn 65, you’ll be automatically enrolled in Medicare. Otherwise, you must fill out an application online or contact your local Social Security office. You can enroll in Medicare during the following periods:
The Virginia Insurance Counseling and Assistance Program (VICAP) provides free, unbiased, and confidential counseling for Medicare beneficiaries and their caregivers. The program’s trained volunteers can provide information and assistance concerning Medicare coverage and how to enroll. Each volunteer provides unbiased advice and no counselor will ever try to sell you insurance.
In Virginia, there are short-term healthcare insurance plans available, but plans are limited to a minimum of three months with a maximum duration of six months. You cannot purchase a short-term plan if it would result in you having short-term coverage for more than six months in any 12-month period. You will also not be able to buy any short-term insurance during the ACA’s Open Enrollment period from November 1 to December 15.
Short-term insurance does not cover pre-existing conditions, pregnancy, or mental health care. In most cases, short-term insurance is only available to people who are in good health and aged between 18 and 64.
Virginia currently follows the ACA mandate that everyone must have health insurance. However, there is no tax penalty if you don’t.
No, you can buy off-exchange full health care plans or short-term insurance from a broker, agent, or private health care company. The difference is off-exchange plans are not eligible for any of the tax credits that are available on the ACA marketplace.
The most popular form of cost-sharing plans are faith-based plans. In a faith-based plan, members share health care costs with other members. You don’t need to be a member of a particular denomination (or even religious) to participate in a plan. While these plans can be relatively low-cost, most faith-based plans don’t cover pre-existing conditions, mental health care, or pregnancy. Since the federal government and Virginia don’t consider them health care plans, these plans are unregulated. If you would like to join a faith-based plan, make sure you ask lots of questions before enrolling.
In most cases, it’s impossible to use an HSA or an FSA plan to save enough money to deal with a serious medical emergency. HSA/FSA plans can be used, however, to lower out-of-pocket costs such as deductibles, copays, and coinsurance.
It depends upon the nature of your job. Disability coverage is designed to help with household costs like mortgage, utilities, or groceries. Health insurance will not pay for these costs. If you work in a job where an injury is a possibility, purchasing a disability plan is a good idea.
It depends on the nature of your job. Health insurance does not cover the kind of household costs which a disability plan covers. If your job is a dangerous one and injury is a possibility, having long-term disability coverage is a good idea.
FAMIS is a program that provides health coverage for children from low-income families. Coverage includes doctor visits, hospital care, prescription medicines, mental health services, dental care, eyeglasses, regular checkups, and immunizations.