Health Insurance in Virginia

Life in Virginia can be tough if you don’t have the right health care coverage. That’s why we created this website: to help people like you who are searching for affordable, comprehensive coverage get what you need to stay healthy and be well. You do have several options as a Virginia resident, and you shouldn’t make your decision lately. We will review several of your best options below so that you can make an informed decision that’s best for you and your family.

Major Medical Insurance in Virginia

The Patient Protection and Affordable Care Act was passed back in 2010. It took a few years, but eventually that legislation led to the creation of the Health Insurance Marketplace. Since then, HealthCare.gov has been the go-to website for Virginia residents who want qualifying major medical coverage, but can’t get it through their employer. This is the same health insurance exchange that many states across the country apply to, so you have several different choices when it comes to choosing an insurance provider and a policy that fits your needs.

People typically visit HealthCare.gov and apply during Open Enrollment, which starts November 1st each year. It usually lasts until at least December 15th, but that date sometimes changes based on demand. There are also special enrollment periods you may be able to qualify for outside of Open Enrollment if you have extenuating or life-altering circumstances. There are many different reasons you could qualify for a special enrollment period, so it’s a good idea to check with HealthCare.gov or to call the helpline just to double-check if you need insurance now but you’re outside of Open Enrollment.

Now let’s talk about why getting health insurance through the Health Insurance Marketplace is so popular. A lot of it has to do with the fact that these policies that are sold through the exchange are guaranteed issue. Even if you have a pre-existing condition (or more than one), you cannot be rejected for coverage and you cannot be charged more for your monthly premiums based on these pre-existing conditions. As a matter of fact, these four factors are the only things that can legally allow an insurance company to charge you more for your premium:

• Your age 
• Your location
• Your use of tobacco products
• Whether you are applying for an individual policy or a family policy

Health Insurance Marketplace major medical coverage is also preferred because of how comprehensive it is. According to the ACA laws, each policy sold through the Exchange must contain all of the 10 guaranteed Essential Health and Wellness Benefits in order to qualify. These benefits are judged the most important benefits for the general population because they give people money-saving and life-saving preventative care:

• Ambulatory/outpatient services
• Emergency services
• Hospitalization
• maternity/newborn care
• Mental health and substance abuse
• Prescription drugs
• hab/rehab services and devices
• Lab tests
• Preventive and wellness services and chronic disease management
• Pediatrics (including oral and vision)

As you might expect, these insurance policies can be pretty pricey – unless you qualify for a government subsidy, that is. All you have to do to qualify is make at least 138% of the annual federal poverty limit. We have a chart below that summarizes that poverty limit based on household size. Typically the subsidies are capped at 400% of the federal poverty limit, meaning that if you make more than that, the government assumes you don’t need any help paying for your health insurance coverage. If you make less than 138% of the federal poverty limit, you won’t qualify for a federal subsidy – but you have an alternative option within the state of Virginia.

Virginia was a late adopter of the Medicaid expansion program which was supposed to have been adopted by all 50 states back in 2014. But as of 2019, people who would normally fall into the Medicaid expansion gap became eligible to apply for Medicaid benefits. However, eligibility requirements are different compared to the requirements for a government subsidy. For more information on applying for Medicaid in Virginia, be sure to visit the website for the Department of Medical Assistance Services.

Short Term Health Insurance in Virginia

Currently, short-term health insurance in Virginia follows the federal rules with regard to plan duration and renewal eligibility. As of right now, you can purchase a short-term health insurance plan in Virginia for 364 days and you can renew it for a total of up to 36 months. But that might not be this way forever. The state legislature is considering changing the rules to shorten plan durations in order to encourage consumers to get more comprehensive plans through alternative sources. But if you need coverage now and you don’t qualify for a special enrollment period, you might be wondering what short-term health insurance in Virginia has to offer you.

Short-term health insurance works very similarly to the major medical coverage most people are used to, including monthly premiums, deductible payments, coinsurance, and more. But because there is medical underwriting, you cannot be protected from price increases or coverage denial based on pre-existing conditions. They also likely won’t offer all 10 of the Essential Health Benefits that the ACA promises you, but you might be able to negotiate for some extra forms of coverage you need. And these plans are usually more affordable than an unsubsidized Health Insurance Marketplace policy. You might be able to save as much as 33% off your monthly premiums with short-term health insurance (but your actual costs may vary). And you have plenty of consumer protections with short term insurance; unlike some of the options listed below, you can take your short-term health insurance provider to court if there is ever a dispute over your claims and you feel you have been unjustly denied.

Short-term health insurance doesn’t pay out as high of a percentage of your total medical costs as ACA major medical coverage will. You’ll likely also have to deal with high deductibles in the thousands of dollars and caps on your annual and lifetime benefits if you require too much or too expensive medical care. But if you absolutely need coverage and can’t get it anywhere else, short-term health insurance is a potentially affordable way to get it. 

Christian Health Plans/Health Share Plans in Virginia

As of 2019, the federal individual mandate was also removed from the books. This means that you will no longer pay a tax penalty if you cannot or if you refuse to purchase major medical coverage through an employer or through the ACA. Back when the individual mandate was still being enforced, it made Christian health plans very popular alternatives to ACA coverage. This is because you could get an exemption to the individual mandate due to the religious status of these plan providers. And, like short-term health insurance, you could usually get this coverage for up to 1/3 less in monthly premium costs.

And that’s not the only thing that short-term health insurance and Christian health plans (also known as health share plans) have in common. They also share the following attributes:

• These plans are NOT guaranteed issue
• They will likely have unlimited out-of-pocket costs
• Almost all plans come with lifetime and annual benefit caps
• These plans do not include all of the guaranteed Essential Health Benefits

But don’t think that just because these plans are so similar that they are interchangeable. They are still very different from one another. you have fewer consumer protections, and you cannot take your plan provider to court over a disputed claim. You will have to follow participation guidelines which can be as minimal as declaring a specific faith or as invasive as determining when and where you go to church or whether or not you can continue to use tobacco products. If you happen to be of a particular faith, though, it’s likely you won’t have any problems adhering to these guidelines as long as they dovetail with your own personal beliefs. One last difference is that the language is not exactly the same as major medical insurance. You pay a monthly share amount instead of a typical monthly premium, and you usually pay an unshared amount or a personal responsibility amount instead of things like co-pays, deductibles, and coinsurance – although these payments all basically still serve the same purpose, despite the name change. 

Fixed Indemnity Plans in Virginia

Are you thinking about putting some money into a fixed indemnity plan? Your reasons for doing so will make a big difference in determining whether or not this is a good decision. If you need a fixed indemnity plan in order to get access to care outside of your restrictive medical network or to help reduce out-of-pocket costs with something like short-term health insurance, Then a fixed indemnity plan could definitely help. But if you want to purchase one as a replacement for major medical coverage, that might not be a very cost-effective solution. This is especially true if you have pre-existing conditions, because medical underwriting will likely be involved. On top of that, fixed indemnity plans only pay out a fixed amount of money per claim as opposed to a fixed percentage of the total cost of the claim the way major medical does.

These claims are paid out on a daily, weekly, monthly, per visit, or per incidence basis depending on the details of your plan. Unlike major medical coverage, You won’t be restricted to any HMO or PPO networks with a fixed indemnity plan, so you can pretty much go anywhere to get the care you need. But if you do that, you may be paying higher out-of-pocket costs since fixed indemnity plans don’t cover as large of a share of the bill as major medical does. Based on all of these reasons, fixed indemnity plans are best for people who either need to supplement their current major medical coverage or who are relatively healthy and don’t expect to face a major medical emergency, but want something in their back pocket just in case the worst happens.

Discount Cards in Virginia

The final option we’re going to discuss Is a medical discount card program. Since these programs are not regulated very closely, they can be hit-or-miss. There are free programs like GoodRx or the Virginia Drug Card which offer free coupons and discounts for people who are having trouble paying for their prescriptions. There are also medical discount card programs that charge a nominal membership fee in exchange for some pretty decent discounts at health care providers, pharmacies, and other retailers where medical supplies are sold. Ideally, you would want to purchase a medical discount card which gives you back more money in discounts than you spend on your membership. But that isn’t always the case.

Not all medical discount card companies are honest and forthcoming about their fine print or about how the program works. For instance, some blatantly lie and claim that medical discount cards are a replacement for insurance. They are not. Out of all the options we’ve mentioned so far, a medical discount card would leave you paying all of your expenses out of pocket and offer you the least amount of financial aid in the form of discounts at the register. Medical discount cards are great as a supplement if you can find a free program like the two we mentioned earlier, or an affordably-priced one which offers a good variety of discounts at a good variety of providers in your area. But if you don’t do your homework and do some research into the companies that are providing medical discount cards near you, it’s easy to fall for a scam.