Jane Dotson
If you're looking to get medical insurance in Virginia, there are a few things you should know. Virginia operates its own Health Insurance Marketplace where you can explore a range of plan options for individual and family coverage, including Medicaid and FAMIS, which are free state-sponsored health insurance programs. You can also receive financial assistance to help lower the cost of coverage and care. The open enrollment period for individual/family health coverage typically runs from November 1 to January 15, with special enrollment periods available for certain life events such as losing health coverage, getting married, or having a child. To find the best plan for your needs and budget, you can seek help from a Virginia Licensed Insurance Agent or a Navigator/Certified Application Counselor.
| Characteristics | Values |
|---|---|
| Insurance Type | Individual, Family, Small Business Owner |
| Plan Options | Bronze, Silver, Gold, Platinum, High-Deductible, Catastrophic |
| Coverage | Doctor Visits, Hospital Care, Mental Health Benefits, Preventive Services, Prescription Drugs, Medical Chats, Video Visits, Dental Coverage |
| Plan Providers | Anthem, Cigna Healthcare, Blue Cross Blue Shield Healthcare Plan of Georgia, HealthKeepers Inc. |
| Eligibility | Age, Dependent Status, Residency, Income |
| Enrollment Period | November 1 to January 15 |
| Enrollment Assistance | Free, In-Person or Virtual, Over the Phone |
| Additional Benefits | Financial Assistance, Premium Subsidies, Cost-Sharing Reductions, Medicaid, Medicare Insurance Counseling |
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What You'll Learn
Virginia's Insurance Marketplace
The Marketplace was created for Virginians who are unemployed, self-employed, or whose jobs do not provide an affordable insurance option. It also caters to individuals or families shopping for insurance. Virginia Licensed Insurance Agents can provide free personalized plan recommendations and enrollment support.
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Medicaid and FAMIS
Virginia offers Medicaid and FAMIS (Family Access to Medical Insurance Security) as state-sponsored health insurance programs. Medicaid was implemented in Virginia in July 1969, and FAMIS was created in 2000 following the creation of CHIP (Children's Health Insurance Program) by the federal government in 1997.
Medicaid Eligibility and Enrollment in Virginia
Most people who receive Medicaid are working, in school, caring for children or disabled family members, or unable to work due to disability, mental or physical illness, or other reasons. Adults under 65 are eligible for Medicaid with household incomes up to 138% of the FPL (Federal Poverty Level). Pregnant women are eligible with household incomes up to 143% of FPL, and children are eligible with household incomes up to 200% of FPL.
Virginia expanded its Medicaid program in 2019, and as of February 2025, more than 595,000 people were covered under the expanded guidelines. To enrol in Medicaid in Virginia, you can apply online at Cover Virginia, by phone, by mail, or in person at a Department of Social Services office. Project Connect outreach workers also provide free one-on-one help with the application process and can assist with gathering the necessary information and determining eligibility.
FAMIS Eligibility and Enrollment
FAMIS-eligible families can choose to enrol in available employer-sponsored insurance and receive help with premiums if it is more cost-effective than direct coverage through FAMIS. Household income for FAMIS eligibility should not exceed 205% of the poverty level.
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Medicare Insurance Counseling
Virginia offers a range of options for individuals and families seeking medical insurance. The state has its own insurance marketplace, known as the Virginia Health Benefit Exchange, which provides a platform for residents to find and enrol in a suitable insurance plan. This marketplace is designed to cater to a variety of circumstances, including those who are unemployed, self-employed, or lacking affordable insurance options through their employer.
The Virginia Insurance Counseling and Assistance Program (VICAP) is a free, unbiased, and confidential service that provides support to Medicare beneficiaries. VICAP counselors are trained and certified to help individuals understand and compare the benefits offered by different health and prescription drug plans. They assist with filing for benefits, including medical benefits and low-income subsidies, and can provide guidance on health care appeals and denials. VICAP also collaborates with the Senior Medicare Patrol to educate beneficiaries about healthcare fraud, empowering them to take an active role in its detection and prevention.
To access VICAP services, individuals can contact their local Area Agency on Aging (AAA). This agency can connect them with a trained counselor who will provide personalized assistance in maximizing their benefits. The COMPASS team is a volunteer program associated with VICAP, offering additional support and education to Medicare beneficiaries.
Private Insurance Options:
In addition to the state's marketplace and VICAP, individuals in Virginia can explore private insurance options. Companies like Anthem offer a range of individual and family health insurance plans, including Bronze plans with low monthly payments and higher deductibles, suitable for those who only require coverage for medical emergencies.
Financial Assistance:
Virginia's Insurance Marketplace is the only place in the state where individuals can receive financial assistance to lower the cost of coverage and care. This assistance is available to those who meet certain income and resource criteria, as outlined by programs such as the Extra Help Program and the Medicare Savings Programs. These programs can provide support in paying for premiums and other medical expenses.
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Bronze health insurance plans
Virginia's Insurance Marketplace offers a range of health insurance plans to cater to the needs of individuals, couples, and families. One such option is the Bronze health insurance plan, which is ideal for those who want to keep their monthly costs low and do not require extensive healthcare services.
Bronze plans are characterized by lower monthly premiums, which means you pay less each month compared to higher-tier plans like Silver, Gold, or Platinum. However, the trade-off is that Bronze plans have higher deductibles. The deductible is the amount you need to pay out-of-pocket before your insurance plan starts covering the costs of your healthcare services. So, with a Bronze plan, you can expect to pay more when you actually use healthcare services.
Despite the higher deductible, Bronze plans still cover preventive services, such as annual physicals and routine check-ups, without you having to meet the deductible. This means that even with a Bronze plan, you can still access essential healthcare services without incurring high out-of-pocket costs. Additionally, these plans usually cover doctor visits, hospital care, and mental health benefits, ensuring that you are protected in case of medical emergencies.
The specific features and costs of a Bronze plan can vary depending on your age, with older individuals typically paying higher premiums for the same level of coverage. For example, a 40-year-old with a Bronze plan in Virginia can expect to pay around $331 per month, while a Silver plan for the same age group would cost around $415 per month.
If you're considering a Bronze health insurance plan in Virginia, it's important to weigh your options and assess your healthcare needs. These plans are best suited for individuals or couples who rarely visit the doctor and only require coverage for unexpected medical emergencies. By choosing a plan with lower monthly costs, you can ensure you're prepared for the unexpected without breaking the bank.
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Eligibility requirements
Virginia's Insurance Marketplace:
The Virginia Insurance Marketplace is a platform created by the state to help residents find affordable health insurance plans. It offers financial assistance to lower the cost of coverage and care. Anyone can use the Marketplace, regardless of their employment status or whether their job provides insurance. This platform can also help determine eligibility for Medicaid or subsidized private plans.
Medicaid:
Medicaid is a jointly funded state and federal program administered by Virginia's Department of Medical Assistance Services (DMAS) and local Departments of Social Services (DSS). Eligibility criteria include income, assets, and functional need, with specific limits varying annually and based on geographic region and marital status. For 2025, the income limit for a single Nursing Home Medicaid applicant is $2,901 per month, with assets under $2,000, and they must require a Nursing Home Level of Care (NHLOC). Virginia also has a Medically Needy Program for seniors with income above Medicaid's limit, who can become eligible by spending most of their income on medical expenses.
Pregnant individuals with household incomes up to 148% of the poverty line are eligible for Medicaid, and this coverage extends for 12 months postpartum. Adults under 65 are eligible if their income does not exceed 138% of the poverty level due to Medicaid expansion in 2019. Children are eligible for FAMIS Plus (Medicaid for Children) with household incomes up to 148% of the poverty line, and above that, they are eligible for the FAMIS program if the household income does not exceed 205% of the poverty level.
Individual and Family Health Insurance Plans:
Virginia offers individual and family health insurance plans through private companies like Anthem. These plans typically cover doctor visits, hospital care, and mental health benefits. The specific eligibility requirements for these plans may vary, but they generally cater to individuals or couples who want coverage for medical emergencies and have varying deductible and premium options.
Employer-Provided Insurance:
Eligibility for employer-provided insurance in Virginia will depend on your specific employer's policies and requirements. This type of insurance is often offered as part of a benefits package to full-time employees.
It is always recommended to review the specific eligibility criteria and plan details for any health insurance option you are considering.
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Frequently asked questions
Some options for medical insurance in Virginia are Anthem, Cigna, and Blue Cross Blue Shield. Virginia also has its own state-based insurance marketplace, which offers financial assistance to help lower the cost of coverage and care.
The Virginia Insurance Marketplace is the only place to get financial assistance to help lower the cost of coverage and care. It offers free enrollment assistance with options to meet virtually or in-person.
The open enrollment period for individual/family health coverage in Virginia runs from November 1 to January 15. If you need your coverage to start on January 1, you must apply by December 15.
Virginia has state-sponsored health insurance programs called Medicaid and FAMIS. These programs provide free coverage for children, pregnant individuals, and adults, including those with disabilities.
Medicare Insurance Counseling is a program for adults aged 65 and older, or those with certain disabilities and/or illnesses. Free Medicare insurance counseling help is available through the Virginia Insurance Counseling and Assistance Program (VICAP) at your local Area Agency on Aging (AAA).
