Virginia Health Insurance: 2023 Coverage Guide

Virginia Affordable Healthcare Insurance

In Virginia, residents have some options for health insurance plans but everyone should compare rates carefully before deciding. If you’re an individual or family, you can get the coverage you need at the best prices by comparing your coverages with SmartFinancial. However, you may only enroll in a health plan during open enrollment, unless you are eligible for the Special Enrollment Period due to a qualifying event. 

When Is Open Enrollment in Virginia?

November 1, 2022 – January 15, 2023

How to Get Health Insurance in Virginia

Figure out what you spent on doctor bills and out-of-pocket costs. Better yet, mark down how many times you visited a doctor or specialist. Mental health care also counts because it’s covered by health insurance. Use your findings to estimate what kinds of costs you’ll have the following year. You’ll need this to decide which type of coverage is right for you, and which level tier suits your needs and will be most economical. Sometimes, higher premiums end up saving you money if you frequently visit care providers.

The smartest way to get the most competitive rates for the coverage you need is to compare health insurance companies and health insurance quotes. After you submit the form you’ll get several competing health insurance rates to choose from, and we’ll connect you with an agent in your area so you can buy the coverage or ask questions about the plan you’re considering.

What Types of Health Insurance Are Available in Virginia?

HMOs, EPOs, PPOs and POS plans are available in Virginia. These plans differ according to whether or not you choose to have a primary care physician manage your health care or not and whether you elect to see doctors outside the network of providers. Some plans bill the provider billed directly while a few reimburse you for medical costs. You’ll also find health plans in all four metal tiers in Virginia. These include platinum, gold, silver and bronze plans. Platinum is the most expensive but covers 90 percent of expenses, leaving little to no out-of-pocket costs when you see a provider. With a bronze plan, you’re looking at 60 percent coverage, so you’re paying for 40% of costs.

Does Health Insurance Cover Pre-existing Conditions?

Under the Affordable Care Act, it is now illegal for marketplace health plans to deny anyone health insurance coverage based on pre-existing conditions.

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Do I Qualify for a Special Enrollment Period?

Common reasons people qualify for a special enrollment period:

• Lost or quit a job. If you lost or changed jobs or started your own business, you’re eligible for health insurance. If you changed jobs and are not offered health insurance, you qualify to buy health insurance outside the enrollment period.
• Turned 26. When you turn 26 outside the enrollment period, you can enroll in an individual health plan.
• Moved out of state or out of the coverage areaYou may have had a health plan that was only valid in one state but you moved to another state after the enrollment period. You can sign up for a new health plan.
• Cobra coverage ended. If you had extended Cobra coverage which ended, you can enroll in a new health plan.
• Divorce. If you shared a health plan with your spouse but divorced, you may enroll in a new health plan.
• Marriage. If you just got married, you can be added to your spouse’s policy or start a new one together.
• Birth or adoption of a child. If you had a baby after the open enrollment date, you can still buy health insurance for that child.
• Death of spouse or partner. If your spouse or partner passed away, you can take advantage of the special qualifying events exception to enroll in an individual plan.
• Spouse of partner loses coverage. If you previously had health insurance through a partner or spouse who lost his/her coverage for any qualifying reason, you are eligible to buy an individual plan or buy coverage with that spouse/partner again.

Is Health Insurance Required in Virginia?

No, only California, Massachusetts, New Jersey, Vermont, Rhode Island, and DC still require health insurance. Otherwise, there is a tax penalty. Even though it’s not required in every state, buying health insurance is necessary to avoid medical bankruptcy.

How Much Is Health Insurance in Virginia?

The average cost of health insurance in Virginia for a 40-year-old is about $466 a month. Health insurance is less expensive, the younger you are. Tobacco use increases health insurance rates.

How to Save on Health Insurance in Virginia

The best way to save on health insurance in Virginia is to compare rates based on the tier system. Beforehand, you’ll want to estimate your medical costs.

Medicare in Virginia

Medicare is health insurance coverage for Americans ages 65 years and older. The government also allows younger people with disabilities to enroll in the program. Individuals with End-Stage Renal Disease (a permanent kidney failure treated with dialysis or a transplant) can also sign up as can some individuals with severe mental health issues. Others who qualify for Medicare disability coverage are individuals with Amyotrophic Lateral Sclerosis (also called Lou Gehrig’s Disease). Most beneficiaries will receive Original Medicare (Parts A and B). Some people buy Medicare Advantage, which includes Part A and B as well as offering vision, dental and prescription drug coverage.

How Many People Are on Medicare in Virginia?

1,518,884 Virginia residents were on Medicare as of 2019.

How Much Is Medicare in Virginia?

If you do not qualify for Medicare, you can buy it for $499 a month for Part A in 2022 and a standard monthly premium for Medicare Part B was $170.10, or even higher depending on income.

Original Medicare vs Medicare Advantage: What’s the Difference?

Medicare is a government subsidized health plan that is available to qualified Americans age 65 and older. Medicare Advantage is sold through private health insurance companies, but these policies are also regulated by the government. Medicare Advantage plans offer the same benefits as Medicare Parts A and B. Medicare Advantage plans also offer more coverage for dental, vision, hearing and prescription drugs. Medicare Advantage plans have a maximum out-of-pocket limit. For 2022, it was $7,550 but many plans set their maximums at a much lower cost. That is why it’s important to compare companies. People who opt for original Medicare can buy Medicare Supplements to help with out-of-pocket costs. You cannot buy both Medicare Advantage and Medicare Supplements. If you enroll in a Medicare Advantage Plan during open enrollment, you will automatically be disenrolled from original Medicare.

How to Get Medicare Coverage in Virginia

If you receive social security payments, you may automatically enroll in Medicare, but you may have to sign up if you do not receive payments. The easiest way to enroll in Medicare is by working with a trusted insurance agent to get the coverages you want. Just enter your zip code and answer a few simple questions.

Types of Medicare Plans Available

Original Medicare, Medicare Advantage, Medicare Cost Plans (only offered in certain areas), Demonstration/Pilot Programs (also called Research Studies; only offered in certain areas) and Programs of All-Inclusive Care for the Elderly (PACE).

How Do I Qualify for Medicare?

To qualify for Medicare you must be a citizen of the U.S. or have been a legal resident for at least five years. If you are age 65 or older and you/your spouse have worked for at least 10 years (40 quarters) or you have a disability, Amyotrophic Lateral Sclerosis (ALS) or end-stage renal disease (ESRD), you most likely qualify for Medicare.

How Can I Save on Medicare in Virginia?

You can save on Medicare by signing up for Part B as soon as you’re eligible. People who enroll late must pay a penalty every year. If you’re interested in buying Medicare Advantage, you can shop and compare Medicare plans for the best value.

Virginia State Health System Ranking

Ever wonder how your state stacks up when it comes to quality healthcare? The Commonwealth Fund published a report in 2020 on State Health System Performance. They took into consideration the access to quality care, health outcomes, and disparities in all 50 states. The scores for the Virginia Health System are listed below:

• Virginia: Overall Ranking: 25 of 51
• Virginia: Overall Performance: Above U.S. Average
• Virginia: Access and Affordability: 26
• Virginia: Prevention and Treatment: 8
• Virginia: Avoidable Hospital Use and Cost: 19
• Virginia: Healthy Lives: 18
• Virginia: Health Care Disparities: 45

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Virginia Health Insurance Coverage

The people of Virginia have different kinds of health insurance while some residents are not insured at all. See the breakdown below:

• Private coverage: 50.5%
• Medicaid: 22%
• Medicare: 17%
• Uninsured: 10.5%

Report: America's Health Insurance Plans

Virginia Health Insurance Companies

The following carriers offer health insurance and/or Medicare in Virginia.

• Anthem Blue Cross and Blue Shield of VA
• CareFirst BlueCross BlueShield
• CareFirst BlueChoice, Inc.
• Cigna Health and Life Insurance Company
• HealthKeepers, Inc.
• Optima Health Plan
• Oscar Insurance Company
• Piedmont Community HealthCare HMO, Inc.
• Virginia Premier Health Plan, Inc.
• Kaiser Mid-Atlantic
• Optima Health Plan