Health insurance in Virginia is now easy to buy. Virginia residents can access healthcare through their employers, insurance agents, brokers, or Medicare if they are disabled or over 65. This guide will outline the choices available to Virginians, the associated average costs, and instructions on how to sign up for a health plan for yourself or your family.
What should Virginians know about Cheap Health Insurance in Virginia?
Market strategies: You can purchase an Affordable Care Act (ACA) plan through the Healthcare.gov website in Virginia if the health insurance you receive from your employer does not offer enough coverage for you and your family. Suppose you work for a small business that does not provide insurance, you are unemployed, or if you are under 30 and no longer qualify for your parent’s insurance, you can also buy ACA.
Open enrollment: This specific period runs from November 1st through January 31st. You can only enroll outside this window if you meet the requirements for a Special Enrollment Period.
A qualifying life event (QLE) results in the loss of insurance coverage. If you need to change your existing plan as a result of changes in your circumstances, such as getting married, having a kid, divorcing, etc., or if your Medicare or Medicaid eligibility has changed, you might also be qualified for a special enrollment period. You have 60 days following the occurrence to enroll in a new plan or modify your existing one.
Health Insurance Marketplace: In 2021, Virginia will offer its residents insurance through the Healthcare.gov website. Virginians will be able to buy ACA-compliant plans on the state’s online exchange beginning in 2023.
Types of coverage: In 2021, 54.1% of Virginians received healthcare through their employer. Medicare (14.8%) and Medicaid (13.5%) were the two next-highest groups. 5.9% of insurance was nongroup, which includes short-term insurance policies and comprehensive health plans not offered through the ACA Marketplace. 4.4% of Virginians receive medical care from the military. 2020’s Medicaid expansion helped Virginia’s uninsured rate drop to 8%.
How can I sign up for the health insurance exchange in Virginia?
Virginia residents can currently acquire an ACA-compliant health insurance plan on Healthcare.gov. However, Virginia will run its exchange beginning in 2023.
You must register on Healthcare.gov to view the plans that are offered. Your Social Security number, family income, address, and phone number will all be required of you. In addition, if you want to include any family members in your plan, you will also be required to give some of this information to them.
After registering, you can compare prices by viewing up to three plans. Eight businesses will offer plans on Healthcare.gov’s Virginia page in 2022. While some of these plans are accessible throughout the state, others are only in select regions. In Virginia, the following insurance companies provide ACA-compliant plans.
- HealthKeepers Anthem
- Consider CareFirst BlueCross BlueShield.
- Insurance company Cigna Health and Life Inc.
- The Kaiser Permanente
- Plan Optima Health
- Oscar Insurance Company
- Incorporated is Piedmont Community HealthCare.
- UnitedHealthcare
How can I sign up for individual and family health insurance in Virginia?
You can still acquire health insurance policies through private businesses, brokers, or insurance agents if you don’t want to use healthcare.gov.
There are a few mandatory factors to consider when looking for individual coverage, whether for oneself or several individuals. These factors consist of:
- Medical requirements
- Preferred type of plan
- Premium accessibility
- Deductibles for individuals versus families
- Virginia health insurance for individuals
If you’re in good health and don’t take many prescription medications, you probably want a plan with a large deductible and cheap monthly premium. On the other hand, if you have a chronic illness, you should probably select a plan with a high monthly premium but a minor deductible.
You will be able to select from the following sorts of plans:
- HMO Plan: A healthy person who visits their doctor seldom and doesn’t require many prescriptions is a suitable candidate for an HMO plan. However, there are more limitations with this plan in terms of how you can get medical treatment. It would help if you used the in-network medical professionals covered by the plan, got referrals for specialty visits, and designated a primary care physician.
- PPO Plan: A Preferred Provider Organization (also called PPO) plan offers more flexibility. Although it can cost a little more, you can see providers who are not in your network. A PPO plan is a fantastic option for people with chronic health conditions who frequently consult specialists. It won’t mandate you to designate a primary care physician or acquire a referral to see a particular doctor specialist.
- POS Plan: A Point of Service Plan (POS) is a choice resembling a PPO and an HMO plan. You still need to get a referral if you want to see a specialist, even if you see an out-of-network provider. Also, check out EPO medical insurance plan.
Best family health insurance in Virginia
A family’s health care plan selection can be a little more challenging. Consider how each person might implement the strategy even if you and your spouse are in good health; if your children have recurrent medical problems, you may have to pay a lot out of pocket. In this situation, choosing a plan with a more significant monthly premium but a lower deductible might be the wiser choice. Make sure the plan covers the required services by carefully reviewing the details. You should confirm that the specialist is a part of the plan’s network if someone in your family receives specialty care.
The fact that many plans offer both an individual and a family deductible is another factor to consider for family plans. Each person covered by the plan is subject to an individual deductible, but the family deductible applies to the entire family. It’s possible to reach the family deductible before everyone on the plan has reached their deductibles if one of your family members requires hospitalization or pricey surgery.
What is the average cost of health insurance in Virginia?
The Healthcare.gov website’s Virginia section classifies health insurance plans into 4 metal tiers:
- Bronze
- Silver
- Gold
- Platinum
The type of coverage remains the same regardless of price. A high deductible and coinsurance make bronze plans different from others. The monthly premiums for a Gold plan are more significant, but the coinsurance costs are lower.
Bronze plans are a fantastic option if you’re healthy and visit the doctor infrequently. Bronze plans feature large deductibles but modest monthly rates. Every time you see a doctor, you’ll also be required to pay a 40% coinsurance. In Virginia, the cheapest Bronze plan is $343 per month.
The monthly price for silver plans is greater, but they have lower deductibles and coinsurance payments (30%). These schemes provide most tax breaks and advantages. Considering all benefits, a Silver plan may be less expensive than a Bronze one. Virginia’s least expensive Silver health insurance plan has an average monthly cost of $445.
Gold and Platinum plans are your best option if you have ongoing medical conditions. Your out-of-pocket expenses will be minimal because they offer the lowest coinsurance fee and deductible (20% for a Gold and 10% for a premium plan). These policies, however, have high monthly premiums. The cheapest Gold package is $435 per month.
Is health insurance in Virginia affordable?
Medicaid may be available to Virginians who meet the federal poverty level yet have no income or a modest income. 2019 saw the state’s Medicaid program expanded to cover all low-income people aged 19 to 64.
Virginia Medicaid
Medicaid is beneficial for those looking for the cheapest health insurance in VA. Residents with low incomes who meet at least one of the following requirements are eligible for Medicaid:
- Age of at least 65
- Pregnant
- In charge of a little child
- Be handicapped
- Live with a person who is disabled
Residents who have the ages somewhere between 19 and 64 and reside in families that make less than 130% of the federal poverty threshold are eligible for Medicaid. It is the best and most affordable family health insurance plan for people in Virginia. In 2022, this amounts to $17,131 for an individual and $29,207 for a family of three. Visit Cover Virginia to learn more about the coverage options and to determine your Medicaid eligibility.
Virginia’s Family Access to Medical Insurance Safety (FAMIS)
Your children can be eligible for FAMIS or FAMIS Plus even if you are not eligible for Medicaid. The amount of money a family makes each month affects their eligibility, and a family of four can qualify if they make up to 205% of the federal poverty level. All covered are doctor visits, prescription drugs, mental health services, hospital care, eyeglasses, routine checks, dental work, and vaccinations.
What are Medicare choices available to seniors and individuals with disabilities in Virginia?
The federal government’s Medicare program covers medical expenses for people 65 and older and those with specific disabilities.
The most fundamental type of Medicare is Original Medicare. Part A (inpatient care) and Part B make up two sections (preventive care and outpatient medical services). Under Original Medicare, there are no out-of-pocket expense caps and no prescription medication benefits. You must obtain Medicare Part D coverage if you need prescription medication regularly. Inpatient hospital stays’ Medicare Part A Premium and Deductible will increase to $1,556 in 2022 from $1,484 in 2021. Medicare Part B participants will pay an average monthly premium of $170.10 in 2022 for health insurance in va, up from $148.50 in the previous year.
Although Medicare has been approved, private insurance companies still provide and sell Medicare Advantage plans. The Original Medicare benefits are included in all of these plans, also known as Medicare Part C, as required by law. Still, many of them also provide prescription drug coverage and gym memberships. They also provide coverage for hearing, dentistry, and vision.
The four different forms of Medicare Advantage Plans are
- Private fee-for-service plans
- HMOs
- PPOs
- Special Needs Plans
By 2022, there will be 132 Medicare Advantage Plans in the state, but you can only select the one available in your county.
A Medicare Supplement Insurance Plan, often known as Medigap, should be purchased if you need assistance paying out-of-pocket expenses associated with Original Medicare. A Medicare Supplement Insurance Plan will cover coinsurance, deductibles, and other out-of-pocket costs. These plans don’t cover long-term care, dental, vision, or hearing care. However, a Medicare Supplement Insurance Plan might offer medical insurance for your trip if you go abroad. Any Medicare Advantage Plan will not be compatible with a Medicare Supplement Insurance Plan.
Eligibility
Only those people are eligible for Medicare who are:
- A citizen or permanent resident of the United States who has lived here for the last five years
- Disabled or at least 65 years old
- Have End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS, sometimes referred to as Lou Gehrig’s disease).
Enrollment
Beginning your Social Security or Railroad Retirement Board benefits four months before your 65th birthday will immediately enroll you in Medicare. If nothing of those options works for you, the next best thing is to visit or call your local Social Security office. Medicare enrollment is available during the following times:
Initial enrollment: You have a three-month window before turning 65 and a three-month window following that age to enroll. During this time, you can register if you have never had Medicare. You could alter your plan even if you enrolled in Medicare when you were younger.
General enrollment: Select this enrollment window if you missed the first one. January 1st-March 31st is the general enrollment period for Medicare. You can select Part D, Medigap, Medicare Advantage, or Original Medicare.
Medicare Advantage Open Enrollment: From January 1st to March 31st, you can make changes to your Medicare Part C, generally known as Medicare Advantage. During open enrollment, which runs from October 15th to December 7th, you can enroll, change plans, or cancel your coverage.
Special enrollment periods: You can qualify for a special enrollment period if you lose coverage or your eligibility changes outside the general enrollment periods.
Resources for Medicare
Medicare beneficiaries and their caregivers can receive free, impartial, and private counseling from the Virginia Insurance Counseling and Assistance Program (VICAP). The program’s trained volunteers may provide details on Medicare coverage, how to sign up, and support. No volunteer counselor will ever try to sell you insurance; instead, they offer unbiased advice.
Do Virginians have access to short-term health insurance plans?
Short-term healthcare insurance plans are offered in Virginia, but they can only last for three months and a maximum of six months. If purchasing a short-term plan would result in you having short-term coverage for longer than six months in any calendar year, you are not permitted to do so. Additionally, from November 1st to December 15th, during the ACA’s Open Enrollment period, you won’t be allowed to purchase any short-term insurance.
Pre-existing ailments, pregnancy, or treatment for mental illnesses are not covered under short-term insurance. Short-term insurance is often only accessible to healthy adults between the ages of 18 and 64.
FAQs on Health Insurance in Virginia
Is health insurance required in Virginia?
Currently, Virginia upholds the ACA requirement that all citizens carry health insurance. If you don’t, there isn’t a tax penalty, though.
Do I have to utilize Virginia’s Health Insurance Marketplace?
No, a broker, agent, or private health care provider can help you purchase full health insurance plans or short-term insurance outside of the exchange in Virginia. The distinction is that none of the tax credits offered on the ACA marketplace apply to off-exchange plans.
What non-traditional health insurance plans, such as cost-sharing arrangements, are offered in Virginia?
Faith-based cost-sharing programs are the most widely used type. Members of a faith-based plan split the expense of medical care with other participants. You do not have to be religious or a member of a specific religion to take part in a plan. Most faith-based health insurance plans in Virginia do not cover pre-existing diseases, mental health treatment, or pregnancy, even though they can be affordable. These plans are unregulated because neither Virginia nor the federal government views them as health care plans. Ask many questions before enrolling if you want to join a faith-based plan.
Do I still need health insurance if I have an HSA/FSA?
It’s typically not viable to use an HSA or an FSA plan to save enough funds to cover a significant medical emergency. Nevertheless, HSA/FSA plans can be utilized to reduce out-of-pocket expenses, including deductibles, copays, and coinsurance.
If I have health insurance, do I still need short-term disability coverage in Virginia?
It depends on the type of work you do. Disability insurance is intended to assist with daily expenses like the mortgage, utilities, and groceries. These expenses will not be covered by health insurance. Investing in a disability plan is smart if your line of work has a high risk of an accident.
If I have health insurance, do I still need long-term disability coverage in Virginia?
It depends on your line of work. What a disability plan covers in terms of household expenses is not covered by health insurance. Having long-term disability insurance is a smart idea if your job is dangerous and there is a chance of getting hurt.
What is covered by FAMIS?
FAMIS is a program that offers low-income families with children medical insurance in Virginia. All covered are doctor visits, hospital care, prescription drugs, mental health services, dental work, eyeglasses, routine checks, and vaccinations.
Visit our website NewHealthInsurance.com to learn more.
