Virginia Health Insurance

Health insurance in Virginia

● Virginia uses the federally managed exchange so that candidates sign up through HealthCare.gov. But by 2023, Virginia will have its own exchange platform.

● Nine insurers will offer 2021 health insurance plans in the state's individual market (including a new insurer and an existing insurer leaving the market).

● The open enrollment for 2021 health plans is from 1 November to 15 December 2020. Outside of that window, residents can sign up or make changes to the plan if they have a qualifying event.

● Short-term health insurance plans are available in Virginia with initial plan terms of up to six months, but this will be further limited (to just three months) in mid-2021.

● About 270,000 Virginians signed up for 2020 coverage through Virginia's health insurance marketplace.

● Nearly 463,000 Virginians are enrolled in the state's extended Medicaid coverage (Virginia expanded Medicaid in January 2019).

This page is dedicated to helping consumers quickly find health insurance resources in the state of Virginia. Here you will find information about the many types of health insurance coverage available. You can find the basics of virginia's health insurance marketplace and the next open enrollment period; a brief overview of Medicaid expansion in Virginia; a quick look at the availability and rules of short-term health insurance; statistics on state-specific Medicare rules; as well as a collection of health insurance resources for Virginia residents.

Virginia's health insurance marketplace

Virginia's health insurance marketplace offers individual and family health insurance plans. And although small-group health insurance enrollment is conducted directly through insurance companies (instead of through exchange), Virginia is one of the states where small-business, exchange-certified health plans are still available, for companies with up to 50 employees. Persons who are employed by a company that offers employer-sponsored health insurance benefits (and who are entitled to such benefits) do not use the market, nor do people who are entitled to Medicare. Medicaid enrollment is available through the market in some circumstances, though some low-income residents, including the elderly, enroll in Medicaid instead through the Virginia Department of Medical Care Services.

Virginia uses federally managed exchange, so candidates sign up through HealthCare.gov. (Virginia is one of seven federally managed trading states that conducts its own plan management, so the state takes an active role in overseeing plans sold in the exchange.)

But Virginia is actively working toward a transition to a fully state-run market, under the terms of legislation the state enacted in 2020. Virginia will have a state-run exchange that uses the federal registration platform in the fall of 2020 and a fully state-run exchange by fall 2022. Residents may not notice a difference in the fall of 2020, as the call center's enrollment and help will still be done through HealthCare.gov.

Open enrollment period and dates in Virginia

Open enrollment for 2021 health plans runs from November 1 to December 15, 2020. This window is an opportunity for an individual or family in Virginia to change their coverage if they wish and for new enrollees to purchase coverage for 2021. Changes to the registration and floor outside of that window are only available (on the stock exchange or outside the exchange) if a person has a qualifying event.

Nine insurers offer 2020 coverage through virginia's health insurance marketplace, and five of them have reduced average premiums for 2020. Although the exchange has a solid total participation of the insurer, the availability of the plan varies from one part of the State to another, depending on the service area of each insurer. In the western part of the state, Anthem is the only insurer offering medical coverage in the Virginia exchange.

By 2021 there will still be nine insurers participating in the exchange, but there will be some changes: Virginia Premier will leave the market at the end of 2020, but Optimum Choice will enter the market for 2021. Among the eight return insurers, the average change in the proposed rate is a decrease of almost 7%.

Virginia enrollment in qualified health plans

As in most states that use HealthCare.gov, enrollment in the exchange peaked in Virginia in 2016, when 421,897 people signed up. Enrollment fell to 410,726 registered for 2017 and 400,015 people for 2018. A similar drop in enrollment has occurred in most other states that use federally managed exchange, in part because of cuts to the Trump administration's funding for exchange marketing, outreach, and enrollment assistance. In addition, confusion over the status of the ACA's individual mandate may have played a role.

Virginia expanded Medicaid in 2019, so, as expected, enrollment in private plans through the Virginia exchange decreased significantly by 2020. By the end of the open enrollment, 269,474 people had signed up for private plans for 2020 coverage. People with incomes between 100 and 138% of the poverty level were eligible for premium subsidies to offset the cost of private plans in the Virginia exchange. But now that Medicaid has been expanded, these people are eligible for Medicaid instead.

Medicaid expansion in Virginia

Virginia lawmakers passed a budget in 2018 calling for Medicaid expansion, and Governor Northam signed it into law in June 2018.

About 400,000 Virginia residents became eligible for Medicaid coverage in January 2019 and enrollment had exceeded 462,000 by September 2020. It had been around 388,000 in February 2020, but enrollment increased significantly amid job and income losses caused by the COVID pandemic.

The federal government will always pay most of the cost to cover the newly eligible population, but Virginia is responsible for paying 10% of the cost.

Short-term health insurance in Virginia

Despite relaxed federal regulations on short-term health insurance, the duration of short-term plans in Virginia is limited to six months without renewals.

Virginia lawmakers passed legislation in 2018 aimed at expanding access to short-term medical plans, but Governor Ralph Northam vetoed it in an effort to protect consumers and the ACA-compliant risk pool.

And the state enacted legislation in 2020 that will drastically limit short-term health insurance plans starting in July 2021. At that point, short-term plans in Virginia will be limited to three months and only one renewal will be allowed, for a maximum duration of six months. The new law will also prohibit the sale of a short-term plan if this translates into a person with short-term coverage for more than six months over a 12-month period and prohibits the sale of short-term health plans during the ACA's annual open enrollment period (November 1 to December 15; Washington and Maine have similar rules)

How did Obamacare help Virginia residents?

Prior to the implementation of the ACA, the uninsured rate in Virginia was 12.3%, according to U.S. Census data. It had fallen to 8.7% by 2016 and remained at 8.8% by 2018 - and has probably declined a little more since then, as Medicaid expansion fell in 2019.

Now that Medicaid has been expanded, total enrollment in Medicaid and CHIP in Virginia is 58% higher than at the end of 2013, while it had grown by only about 8% since 2018 (before the expansion took effect).

As of December 2020, there were more than 215,000 people receiving premium subsidies in Virginia's health insurance marketplace, out of more than 245,000 enrollees covered. Subsidies averaged nearly $554/month, offsetting most of the average monthly premium costs and making medical insurance affordable for people who would otherwise not have been able to afford it.

Medicare coverage and enrollment in Virginia

Medicare, a health care program run by the federal government, covers most Americans who are at least 65 years old. Medicare benefits are also available to disabled Americans. As of August 2020, there were 1,543,740 people enrolled in Medicare in Virginia, or about 18% of the state's population. 14% of Virginia Medicare beneficiaries are under the age of 65 and are eligible for Medicare due to a disability, while the other 86% are eligible because of their age.

Virginia Health Insurance Resources

● Cover Virginia (a state-run service that works with the federal market to provide Virginia residents with the information they need about Medicaid enrollment or a private plan through the market)

● Virginia Department of Medical Care Services (Medicaid)

● Virginia State Corporation Commission — Oversees and regulates health insurance companies, agents, and brokers; It also has the task of creating Virginia's new state health insurance exchange, which will be used to enroll in health plans for 2023 and beyond.

● Virginia Insurance Counseling and Assistance Program (VICAP) — A resource for Medicare beneficiaries and their caregivers; VICAP can provide a variety of useful information and assistance regarding Medicare coverage and enrollment.