Virginia Health Insurance — Marketplace Guide, Costs & Local Options

Under-65 coverage in the Commonwealth. Virginia runs its own state exchange and expanded Medicaid. Compare metal tiers, savings, enrollment dates, and alternatives—then enroll online with local help.

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Quick facts (VA)

Topic	Virginia specifics
Exchange	Virginia’s Insurance Marketplace (state-based exchange).
Open Enrollment (2026)	Nov 1, 2025 – Jan 30, 2026 (full window).
Special Enrollment	Available year-round with qualifying life events (move, newborn, loss of coverage, etc.).
Medicaid & FAMIS (CHIP)	Medicaid expansion for adults to ~138% FPL; children may qualify for FAMIS at higher FPLs.
Short-term plans	Initial term up to 3 months; total duration (with renewals) capped at about 4 months.
2026 rate outlook	Regulator notes proposed premium increases for 2026; net costs depend on tax credits.

Eligibility, plan availability, and deadlines vary by situation. We’ll confirm your dates and program options before submitting your application.

Overview & eligibility

Who can enroll

Virginia residents without affordable employer coverage can enroll in ACA plans during Open Enrollment or a Special Enrollment Period. Immigration and residency rules apply.

Financial help

Most households qualify for premium tax credits and many also get cost-sharing reductions on Silver plans, based on income and household size.

Medicaid & FAMIS

Adults up to ~138% FPL may qualify for Medicaid. Children and teens often qualify for no- or low-cost coverage through FAMIS.

Short-term coverage

Short-term, limited-duration plans are temporary and not ACA-compliant. They can help with brief gaps but have benefit limits and time caps.

Networks & referrals

HMO, EPO, and PPO options vary by county. Check your doctors and hospitals before you pick a plan.

Rx & mental health

ACA plans include essential health benefits, such as prescriptions, mental health, maternity, and pediatric dental/vision.

Metal tiers & savings

Metal level	Plan pays (actuarial)	Best for	Notes
Bronze	~60%	Lowest premiums; healthy, high-deductible tolerance	Consider if you rarely use care; pair with HSA when available
Silver	~70% (up to ~94% with CSR)	Balanced costs; eligible for CSR if income qualifies	Often the best value after tax credits and CSRs
Gold	~80%	Lower out-of-pocket at higher premiums	Good for frequent care or multiple prescriptions
Catastrophic	Varies	Under 30 or hardship exemption	Very high deductibles; limited eligibility

We’ll show your net premium after APTC (tax credits) and, if eligible, CSR-enhanced Silver options to reduce deductibles and copays.

Small-group options

Option	Who it’s for	Highlights	Considerations
ACA small-group	Employers with 1–50 FTEs	Broad EHBs, predictable renewals	Rates reflect group demographics/area
ICHRA/QSEHRA	Employers funding individual plans	Budget control; employee choice	Coordination with APTC/CSR required
Dental/vision add-ons	Any size group	Low cost, high satisfaction	Check network overlap with medical

We’ll compare group quotes and reimbursement arrangements to fit your budget and recruiting goals.

Virginia pricing snapshot

Factor	Impact in VA	What helps
Market change (2026)	Proposed rate increases in individual/small-group markets	Use APTC/CSR; compare multiple carriers and networks
Region & network	Plan availability/pricing varies by rating area	Check your providers and Rx across HMO/EPO/PPO
Income & household size	Credits scale with income vs FPL	Update income promptly to avoid repayment
Utilization & Rx	Chronic conditions and specialty meds drive OOP	Evaluate Gold vs CSR-Silver; review formularies

Your net premium depends on tax credits, plan selection, and county. We’ll price several plans and show the true annual cost (premium + likely OOP).

Service areas (near me)

States we serve
AZ, AL, TX, CA, NY, OH, FL, NC, VA, GA, OK, NM, IA, KS, MI, NE, SC, SD, WV

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Virginia health FAQs

What are Virginia’s Open Enrollment dates for 2026?

Open Enrollment for 2026 coverage runs from November 1, 2025 through January 30, 2026. Outside this window, you’ll need a qualifying life event for a Special Enrollment Period.

Does Virginia use HealthCare.gov?

No. Virginia operates a state-based exchange called Virginia’s Insurance Marketplace. We can enroll you online with local assistance.

Who qualifies for Medicaid or FAMIS?

Adults generally qualify up to about 138% of the federal poverty level. Children may qualify for FAMIS or Medicaid at higher income thresholds.

Are short-term health plans allowed in Virginia?

Yes, but new federal rules limit them to an initial term of up to 3 months and a total duration of about 4 months including renewals. They are not ACA-compliant and have exclusions.

Will 2026 premiums increase?

Regulatory filings indicate proposed increases for 2026. Your net cost depends on tax credits, plan type, and rating area—we’ll compare multiple carriers.

Disclosure

Blake Insurance Group LLC is an independent agency. Program eligibility, plan availability, subsidies, and rates vary by household, county, and carrier. Trademarks belong to their owners. Licensed producer (NPR/NPN 16944666).