The Virginia Health Insurance Marketplace
Virginia defaulted to a federally-facilitated health insurance exchange to provide a broader population with coverage, beginning in October 2013. As a more costly state for coverage, including previously rigid underwriting, the rural towns, suburbs and urban locales of Old Dominion can now benefit from subsidized individual health plans under the Affordable Care Act. The health reform law enabled every state to create a marketplace in which insurers can sell reasonable coverage with a variety of benefits. This law also requires each Virginian to enroll in a health plan, whether Medicaid or the marketplace, and the exchange helps bridge the gap for many individuals and families in need of medical insurance by offering financial assistance.
Insurers selling plans on the exchange factor in subsidies to lower premiums and cost sharing for eligible enrollees. Many individuals applying for health plans on the Virginia exchange qualify for reduced rates and medical expenses, including residents who earn between 100-400 percent FPL. In addition to cost reductions, the marketplace guarantees certain types of services will be covered, known as essential health benefits. This includes services such as maternity care, doctor’s office visits, prescription medications, and emergency room care. Plans are sold by a selection of Virginia insurers, both small and national.
The exchange provides beneficial coverage options for individuals, families and small businesses at affordable prices. For help and guidance with costs and coverage options, contact a licensed agent at 888 803 5917.
Each plan sold through the Virginia marketplace for individuals falls under one of four “metallic” coverage tiers: bronze, silver, gold or platinum. These levels indicate how much your plan covers for qualified medical services and how much cost sharing you are responsible for. Bronze and silver plans are also more reasonable in terms of monthly premiums, while gold and platinum plans tend to be higher as they offer more coverage.
For young, healthy Virginians, catastrophic plans are also available aside from these four coverage levels. They don’t cover the majority of health care services, but only a few necessities. Four office visits and preventive care are covered in full, and emergency room visits are covered at deductible. These plans cost slightly less than the bronze level policies. Use the cost comparison tool below to view estimates of your rates in Virginia.
Premium Tax Credit
The health insurance exchange offers financial assistance to residents with family income between 100 and 400 percent of poverty. Lower income enrollees will receive the greatest amount of assistance, including help paying for monthly premiums and covered medical expenses. While it doesn’t offer the best coverage, some applicants can even qualify for a zero-premium bronze plan after their subsidy is factored in. Marketplace applicants in Virginia earning between 100 and 250 percent of federal poverty qualify for a cost sharing subsidy to help pay for coinsurance, copays and deductibles. If you earn up to 400 percent of FPL, the government will provide you with a premium tax credit.
Subsidies are calculated by income and household size, and the percentage of annual income the second lowest-cost silver plan in your region would consume. According to income, you can determine about how much your premium share will be in the table below. The remainder is paid for by the tax credit.
A variety of Virginia insurers participate in the exchange, selling subsidized individual and small group plans. Different companies are available in different areas, with about 1-3 carriers per region. You may find that the insurers’ provider networks are smaller than usual, which is typical of marketplace plans. Reducing provider networks allows insurers to afford to offer these plans. Please check that your doctors are included in your plan’s network prior to applying. If not, you may check which plans outside the marketplace can connect you with your providers of choice. The following carriers sell plans on the marketplace in Virginia. Use the tool below or call us to find out what plans are in your area at 888 803 5917.
- Anthem Blue Cross and Blue Shield of Virginia
- Anthem Health Plans of Virginia
- CareFirst BlueChoice, Inc.
- CareFirst BlueCross BlueShield
- Innovation Health Insurance Company
- Kaiser Foundation Health Plans
- Optima Health Insurance Company
To simplify shopping for health plans on the marketplace, each insurer is required to cover ten types of benefits, providing a general idea of what you can expect. Copays, coinsurance and other costs vary between plans and companies, as do the specifics of covering the ten essential health benefits. Certain services, such as preventive immunizations or exams, are covered in full, and others, like ER visits and hospital care, require some amount of cost sharing. Always read the fine print of your plan, notably the outline of benefits, to be sure a service is covered.
Essential Health Benefits include:
- Preventive, wellness, and chronic disease management services
- Emergency care
- Office visits
- Prescription medications
- Maternity and newborn care
- Laboratory tests
- Pediatric care, including dental and vision
- Mental health and substance abuse services, including behavioral health care
- Rehabilitative and habilitative services and devices
Small Business Health Options Program
The exchange is not only beneficial for individuals and families, but the Small Business Health Options Program (SHOP) provides small group plans at a reduced rate for qualifying businesses. Virginia’s small business owners across the state can insure their workers for a lower rate if they have less than 25 full-time workers who earn $50,000 per year per person. The Small Business Health Care Tax Credit is offered to employers who meet these criteria, and those who employ up to 49 workers may qualify for a plan through the SHOP. The highest tax credit an employer can receive covers half of their premium contribution, which is given to companies with 10 or fewer workers with annual income up to $25,000 each.
How to Apply
You can apply for Virginia marketplace plans by calling a licensed insurance agent at 888.803.5917. Additionally, you can locate a facility where navigators are staffed, such as public health centers. HealthCare.gov is the federal portal for coverage, but as it’s helpful to receive professional assistance when choosing a 12-month health plan, experienced agents are a great resource. Our agents are licensed to sell non-marketplace individual health plans throughout the state, and have also been certified to enroll Virginians in subsidized marketplace policies. Regardless of how you apply, it is important to know your options for affordable coverage and get connected to a good policy from a reliable carrier.
Compare Virginia Marketplace Plans
Below is a cost comparison tool providing a closer look at the marketplace policies. These rates are calculated by average premiums released by Virginia insurers on the exchange. If you’re interested in one of the plans you find in your results, or for a more precise quote of exchange plans and subsidy eligibility, call an agent at 888 803 5917.
*The above disclaimer pertains to the creator of this comparison tool, not East Coast Health Insurance, a licensed broker of insurance products.