Orlando Harmon
If you live in Virginia and want to apply for Obamacare, you can do so during the annual Open Enrollment Period (OEP). This typically lasts for six weeks every fall, with Virginia's OEP for 2025 lasting from November 1, 2024, to January 15, 2025. During this time, you can purchase, change, or renew your healthcare coverage. If you miss the OEP, you may still be able to apply through a Special Enrollment Period (SEP) if you experience a qualifying life event, such as getting married, having a baby, losing other health coverage, or moving to a new area. You can apply for Obamacare through HealthSherpa, HealthCare.gov, or your state-based exchange.
| Characteristics | Values |
|---|---|
| Name of the program | Patient Protection and Affordable Care Act (also known as Affordable Care Act or Obamacare) |
| Who is it for? | Virginians eligible for Medicaid or the Family Access to Medical Insurance Security (FAMIS) programs |
| How to apply? | 1. Online through CommonHelp 2. Phone the Cover Virginia Call Center at 1-855-242-8282 3. Through your local department of social services |
| Documents required | Social Security numbers, military discharge papers, military service history information, insurance card information |
| Additional information | Assisters in your community can help with the application and enrollment process |
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What You'll Learn
Open Enrollment Period (OEP)
The Open Enrollment Period (OEP) is the annual period during which individuals can enroll in or change their health insurance plans through the Marketplace. The OEP for 2025 in Virginia begins on November 1, 2025, and ends on January 15, 2025. This period applies to all Virginians in every county, city, and town, providing access to the healthcare exchange and Obamacare.
During the OEP, individuals can enroll in any Obamacare plan offered in their state. It is important to note that not all insurers cover all areas of the state, but multiple insurers offer plans across Virginia. The costs of these plans can vary based on location, age, the type of plan chosen, the number of people covered, and any additional benefits selected beyond basic coverage. To help with these costs, Obamacare in Virginia offers subsidies, such as tax credits, which can significantly reduce monthly premiums.
If an individual misses the OEP, they may still have options through a Special Enrollment Period (SEP). An SEP allows enrollment or changes to a health plan outside the typical OEP window if an individual experiences a qualifying life event, such as getting married, having a baby, losing health coverage, or moving to an area with different health plan options. To utilize an SEP, individuals typically must apply within 60 days of the qualifying event.
For those who do not qualify for an SEP and miss the OEP, short-term health insurance may be an option in some states. Short-term health insurance can be purchased outside of the OEP for up to four months in a 12-month period. However, these plans do not cover pre-existing conditions and may be subject to medical underwriting.
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Special Enrollment Period (SEP)
The Patient Protection and Affordable Care Act (also known as the Affordable Care Act or Obamacare) provides Virginians with access to the Federal Health Insurance Marketplace to purchase health insurance. Outside of the annual Open Enrollment Period (November 1 – January 15), Virginians can purchase a health plan on Virginia's Insurance Marketplace or make changes to their existing plan if they qualify for a Special Enrollment Period (SEP).
You qualify for a Special Enrollment Period if you have experienced certain changes in your circumstances known as Qualifying Life Events. Some Qualifying Life Events must be verified by Virginia's Insurance Marketplace to open up a Special Enrollment Period. You may qualify for a Special Enrollment Period if, in the past 60 days, you or anyone in your household:
- Got married. Pick a plan by the last day of the month, and your coverage can start the first day of the next month.
- Had a baby, adopted a child, or placed a child for foster care. Your coverage can start on the day of the event, even if you enroll in the plan up to 60 days afterward.
- Got divorced or legally separated and lost health insurance. Divorce or legal separation without losing coverage doesn't qualify you for a Special Enrollment Period.
- Died. You'll qualify for a Special Enrollment Period if someone on your Marketplace plan dies, causing you to lose your current health plan.
- Moved to the U.S. from a foreign country or United States territory. Moving only for medical treatment or staying somewhere for vacation doesn't qualify you for a Special Enrollment Period.
You may also qualify for a Special Enrollment Period if you lose qualifying health coverage you had through a parent, spouse, or other family member. This might happen if:
- You lose health coverage because you turn 26 (or the maximum dependent age allowed in your state) and can no longer be on a parent's plan.
- A family member loses health coverage or coverage for their dependents.
- You are no longer a dependent.
- You won't qualify for a Special Enrollment Period if you chose to drop the coverage you have as a dependent, unless you also had a decrease in household income or a change in your previous coverage that makes you qualify for savings on a Marketplace plan.
You may qualify for a Special Enrollment Period to enrol in Marketplace coverage if you or anyone in your household lost qualifying health coverage in the past 60 days or expects to lose coverage in the next 60 days. Individuals have 60 days from the loss of coverage to enrol in a new health plan. Depending on your Special Enrollment Period type, you usually have 60 days before or 60 days following the event to enrol in a plan. You can enrol in Medicaid or the Children's Health Insurance Program (CHIP) at any time. Job-based plans must provide a Special Enrollment Period of at least 30 days.
If you need assistance enrolling in a health plan, updating your personal information, or have any questions, contact the Marketplace's customer service representatives. A Virginia Licensed Insurance Agent can provide you with free personalized plan recommendations and enrolment support.
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Qualifying for a subsidy or tax credit
The Patient Protection and Affordable Care Act, also known as Obamacare, offers Virginians access to the Federal Health Insurance Marketplace to purchase health insurance. To qualify for a subsidy or tax credit, your income must be at least 100% of the federal poverty level (or above 138% of the federal poverty level in states that have expanded Medicaid). Although there is usually an income cap of 400% of the poverty level, this does not apply from 2021 through 2025.
The subsidies are tax credits that help middle-income and low-income people afford health insurance when they do not have access to affordable employer-sponsored coverage or government-sponsored coverage (usually Medicaid/CHIP or Medicare). Most eligible enrollees take these tax credits in advance, paid directly to their health insurance carrier each month to offset the amount paid in premiums. However, you can also pay the full price for a plan throughout the year and then claim your subsidy as a lump sum when filing your taxes.
If you are a member of a federally recognized tribe or an Alaska Native Claims Settlement Act corporation shareholder, you may qualify for additional CSRs. Consumers eligible to receive Advance Premium Tax Credits are required by federal law to file a federal income tax return for the year of coverage. If your income changes during the year, make sure to update your insurance application within 30 days of the change.
Open enrollment for marketplace plans runs from November 1 to January 15 in most states. Outside of open enrollment, enrollment is possible if you qualify for a special enrollment period, usually triggered by a qualifying life event.
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Application methods
The Patient Protection and Affordable Care Act (also known as Obamacare) provides Virginians with access to the Federal Health Insurance Marketplace to purchase health insurance. Eligible persons can apply for Obamacare in Virginia through the following methods:
Online Application through CommonHelp
You can apply for Obamacare in Virginia through the CommonHelp online platform. This platform provides a convenient and secure way to submit your application and access information about your eligibility for different health insurance plans. The website is available 24/7, allowing you to apply at your own pace and from the comfort of your home.
Phone Application via Cover Virginia Call Center
If you prefer a more interactive approach, you can call the Cover Virginia Call Center at 1-855-242-8282. Their trained representatives will guide you through the application process and answer any questions you may have. They can assist you in determining your eligibility and selecting the most suitable health insurance plan for your needs.
Application through Local Department of Social Services
Another option is to submit your application through your local department of social services. You can visit the Virginia Department of Social Services website to access and download the "Cover Virginia Application for Health Coverage and Help Paying Costs" form. After completing the form, you can submit it by mail, fax, or in person to your local department of social services office. This method allows you to receive assistance from caseworkers who can help ensure your application is complete and accurate.
In-Person Application at VA Medical Center or Clinic
If you are a veteran or a family member of a veteran, you can apply for VA health care, which satisfies the requirements of the Affordable Care Act (ACA). You can visit your nearest VA medical center or clinic to initiate the application process. Their staff will assist you in determining your eligibility and guiding you through the necessary steps to enroll in VA health care benefits.
Application through Virginia's Insurance Marketplace
Virginia's Insurance Marketplace also offers assistance with the application and enrollment process. You can connect with assisters in your community, who provide free and unbiased enrollment assistance. They can meet with you virtually or in person to help you navigate the different health insurance options and complete your application. Additionally, you can contact Marketplace customer service representatives for personalized plan recommendations and enrollment support.
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Comparing Obamacare plans
The amount you pay for health insurance every month is called a "premium". You will pay this amount even if you don't use any medical services that month. In addition to this monthly premium, you will also have out-of-pocket costs. For example, with a $2,000 deductible, you would pay the first $2,000 of covered services yourself. Therefore, it is important to consider both the monthly premium and potential out-of-pocket costs when comparing plans.
Marketplace plans are also rated on a scale of 1-5 stars, which can help you compare the quality of different options. You can also compare plans based on their networks of participating providers. Some plans allow you to use almost any doctor or health care facility, while others limit your choices or charge you more if you use providers outside their network.
To compare specific plans and prices, you can enter your ZIP code, estimated income, and household information on HealthCare.gov. This will provide you with health insurance plans and estimated prices available to you. You can also use this website to search for specific doctors, medical facilities, and prescription drugs to see if they are included in each plan.
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Frequently asked questions
You can apply for Obamacare in Virginia through HealthSherpa, HealthCare.gov, or your state-based exchange.
You can apply for Obamacare during the annual Open Enrollment Period (OEP). In Virginia, the OEP lasts from November 1, 2024, to January 15, 2025.
If you miss the Open Enrollment Period, you may still be able to apply during a Special Enrollment Period (SEP) if you have experienced a Qualifying Life Event (QLE). QLEs include significant life changes such as getting married, having a baby, losing other health coverage, or moving to a new area.
Yes, you can also apply for Obamacare by phone, in person, or via mail. You can contact the HealthSherpa Consumer Advocate Team at (872) 228-2549 for assistance with enrolling by phone.
