Jeffrey Wade
Virginia has a number of health insurance options for low-income residents. These include Virginia's Medicaid and FAMIS programs, which provide free coverage for children, pregnant women, and adults, including those with disabilities. Virginia's Insurance Marketplace also offers free or low-cost coverage, and the federal government helps consumers pay for insurance through an advance premium tax credit if they buy coverage from the exchange. In addition, Virginia's Health Safety Net Organization provides free or reduced-cost medical care and prescription medicines at local clinics and community health centers.
| Characteristics | Values |
|---|---|
| Eligibility | Adults under 65 earning up to 138% of the federal poverty level ($20,782 for a single person, and about $35,631 for an adult in a household of three people) |
| Pregnant people with household incomes up to 148% of poverty | |
| Adults over 65, disabled, or blind with income and resources within certain limits | |
| Enrollment period | November 1 – January 15 each year |
| Enrollment cost | No enrollment costs and no monthly premiums for adults between 19-64 years old who qualify |
| Application process | Apply online at marketplace.virginia.gov or mail/drop off a paper application to the local Department of Social Services |
| Contact Enroll Virginia navigators for free assistance with the application process and understanding health coverage options | |
| Other options | Free or low-cost coverage through Virginia's Insurance Marketplace |
| Free or reduced-cost medical care and prescription medicines at local free clinics or community health centers |
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What You'll Learn
Medicaid eligibility and enrollment
Virginia's Medicaid program provides health coverage for children, pregnant women, and adults, including those with disabilities. Medicaid is available to Virginia adults under the age of 65 who earn up to 138% of the federal poverty level. For example, in 2024, this was $20,782 for a single person and around $35,631 for an adult in a household of three people.
Pregnant people with household incomes up to 148% of poverty are also covered (this coverage also continues for 12 months postpartum). Virginia also offers FAMIS (Family Access to Medical Insurance Security), which provides health coverage for uninsured pregnant women who are not eligible for Medicaid but have household incomes up to 205% of poverty. Adults aged 65 or older, disabled, or blind may qualify for full Medicaid, provided their income and resources are within certain limits.
Those with income over the Medicaid limit who need long-term care or have high medical costs may still qualify for Medicaid through a Medically Needy spenddown. This works like an insurance policy deductible, where the amount of the deductible is called the "spenddown liability." Once medical bills are equal to or greater than the spenddown liability, the application will be reassessed for Medicaid eligibility.
Virginia's Medicaid program also includes the Commonwealth Coordinated Care Plus Waiver (CCC+), a managed care program through which residents receive their Medicaid benefits. The Program of All-Inclusive Care for the Elderly (PACE) combines the benefits of Medicaid and Medicare into one program.
There are several ways to enroll in Medicaid in Virginia:
- Fill out the online application at www.commonhelp.virginia.gov.
- Apply over the phone by calling the Cover Virginia Call Center at 1-855-242-8282 (TDD: 1-888-221-1590).
- Mail a paper application to your local Department of Social Services office or apply in person.
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FAMIS health coverage
Virginia has several free or low-cost health insurance programs for those who qualify. One of these programs is FAMIS, or Family Access to Medical Insurance Security Plan, which is Virginia's health insurance program for children. FAMIS provides free or low-cost health coverage to children in families that earn too much money to qualify for Medicaid but may struggle to purchase private insurance.
Eligibility for FAMIS health coverage is based on income, as well as other factors such as age or disability. Adults under the age of 65 are eligible for FAMIS if their income doesn't exceed 138% of the poverty level. Pregnant women who are not eligible for Medicaid but have household incomes up to 205% of the poverty level may also qualify for FAMIS. Children are eligible for Medicaid if their household incomes are up to 148% of poverty; above this level, they are eligible for the FAMIS program if the household income doesn't exceed 205% of the poverty level.
To find out if your children qualify for FAMIS, you can use the Eligibility Screening Tool. If you think your children are eligible, you can apply for a full review. Project Connect Outreach Workers can also provide free one-on-one help with applying for FAMIS, gathering the necessary information, and understanding your options.
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Health insurance options through Virginia's Insurance Marketplace
Virginia's Insurance Marketplace offers health insurance options for those who qualify. The state-run platform offers free or low-cost coverage to eligible Virginians, with financial help available for monthly premiums and medical expenses. The open enrollment period for the Virginia ACA Marketplace is from November 1 to January 15 each year.
The Virginia ACA Marketplace saw its highest enrollment in 2024, with 400,058 residents signing up for private qualified health plans. This surge in enrollment was due to the subsidy enhancements under the American Rescue Plan and the Inflation Reduction Act, as well as the end of pandemic-era Medicaid continuous coverage.
Virginia's Insurance Marketplace is not the only option for low-income residents. The state also offers Medicaid, which provides free health coverage for those who qualify. Medicaid is available to adults under 65 with an income of up to 138% of the federal poverty level. For example, in 2024, a single person with an income of $20,782 or an adult in a household of three with an income of about $35,631 would be eligible. Additionally, Medicaid has specific programs for adults over 65, disabled individuals, and blind people, with higher income and resource limits.
For those who are pregnant, Virginia offers FAMIS (Family Access to Medical Insurance Security), which provides health coverage for uninsured pregnant women who don't qualify for Medicaid but have a household income of up to 205% of the poverty level. Pregnant individuals with a household income of up to 148% of poverty are covered by Medicaid. This coverage extends for 12 months postpartum, a benefit that Virginia was one of the first states to offer.
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Medicare Insurance Counseling
Virginia expanded Medicaid in 2019, and as of early 2025, 595,000 people were enrolled in the program. Medicaid is available to Virginia adults under the age of 65 who earn up to 138% of the federal poverty level. This includes low-income elderly residents, disabled people, and blind people. Pregnant women with household incomes up to 148% of poverty are also covered, and this coverage continues for 12 months postpartum.
For those who are not eligible for Medicaid, there are other options for medical insurance. These include employer-sponsored plans, Medicare, or a plan purchased through the Virginia Insurance Marketplace. Virginia's Insurance Marketplace offers open enrollment from November 1 to January 15 each year, during which Virginians can receive financial help with the cost of their monthly premiums.
To help individuals understand their options and navigate the complexities of health insurance, free Medicare insurance counseling is available through the Virginia Insurance Counseling and Assistance Program (VICAP). VICAP is a part of a nationwide network of health insurance assistance programs and is offered at various locations throughout the state. Trained and certified VICAP counselors assist older adults, persons with disabilities, and their caregivers in understanding and comparing Medicare and other health insurance benefits. They can also help with filing for medical benefits, low-income subsidies, and health care appeals and grievances.
To access VICAP counseling services, individuals can contact their local Area Agency on Aging (AAA) or find a VICAP counselor in their area. Additionally, Medicare 101 Workshops are led by VICAP for individuals who will soon be eligible for Medicare or those who want to learn more about it.
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Applying for health insurance
Virginia has several options for health insurance, including free state-sponsored programs, free or low-cost coverage through the Virginia Insurance Marketplace, and free or reduced-cost care from a health safety net organization. Here is a step-by-step guide to applying for health insurance in Virginia:
Step 1: Understand the Options
Virginia offers various health insurance options, including:
- Medicaid: This is a free state-sponsored health insurance program for eligible individuals. In Virginia, Medicaid is available to adults under 65 with incomes up to 138% of the federal poverty level. Certain groups, such as pregnant women, adults over 65, disabled individuals, and children, may have different eligibility criteria.
- FAMIS (Virginia's CHIP): FAMIS provides health coverage for uninsured pregnant women and children who do not qualify for Medicaid but have household incomes within certain limits.
- Virginia Insurance Marketplace: This is an online marketplace where Virginians can shop for affordable and low-cost health insurance plans. Financial assistance may be available to help with monthly premiums and medical costs.
- Health Safety Net Organizations: These organizations offer free or reduced-cost medical care and prescription medicines at local clinics or community health centers.
Step 2: Determine Eligibility
Each health insurance program in Virginia has specific eligibility criteria, primarily based on age, income, and health status. It is essential to review the eligibility requirements for each program to determine which one best suits your needs.
Step 3: Gather Required Information and Documents
When applying for health insurance, you will typically need to provide personal information such as your name, date of birth, Social Security number, and address. You may also need to provide proof of income, employment, and citizenship or immigration status.
Step 4: Apply for Health Insurance
You can apply for health insurance in Virginia through the following channels:
- Online: Apply through Virginia's Insurance Marketplace website (marketplace.virginia.gov) or CoverVA.org.
- Mail or In-Person: Submit a paper application to your local Department of Social Services (DSS). You can find your local DSS office by visiting dss.virginia.gov/localagency.
- Assisted Application: If you need help with the application process, you can contact a Project Connect Outreach Worker, Navigator, or Certified Application Counselor. These trained professionals can provide free assistance with understanding your options and completing the application.
Step 5: Provide Additional Information if Needed
In some cases, you may be asked to provide additional information or documentation after submitting your application. Respond promptly to any requests from the health insurance provider to ensure a smooth application process.
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Frequently asked questions
Poor people in Virginia can get medical insurance through Virginia's free state-sponsored health insurance programs, Medicaid or FAMIS, or free or low-cost coverage through Virginia's Insurance Marketplace.
Medicaid is available to Virginia adults under 65 who earn up to 138% of the federal poverty level. There are no enrollment costs and no monthly premiums for adults between 19-64 years old who qualify.
FAMIS (Virginia's CHIP) provides health coverage for uninsured pregnant women who are not eligible for Medicaid but have household incomes up to 205% of poverty.
