Navigating The Health Insurance Exchange

Frequently Asked Questions About Virginia’s Aca Marketplace

Virginia has a state-run exchange that uses the federally run enrollment platform. This means the state oversees the exchange, but applicants enroll via HealthCare.gov .

From a consumers standpoint, nothing has changed about Virginias exchange. Enrollments are still conducted through HealthCare.gov, just as they have been since the fall of 2013. But Virginia as described above, Virginia will have its own fully state-run exchange platform in place by late 2023, for enrollment in 2024 health plans. This is a result of 2020 state legislation , which directed the state to create its own health insurance exchange.

Virginias exchange will be funded with an assessment on insurers that wont exceed 3% of premiums . The fee for HealthCare.gov in 2022 is 2.75% of premiums, although its only 2.25% for state-run exchanges that use the federal enrollment platform. Since Virginia has transitioned to this model, the cost to use HealthCare.gov is lower than it would otherwise have been.

The open enrollment period for 2022 coverage ran from November 1, 2021 to January 15, 2022. Outside of that window, a special enrollment period is necessary in order to enroll or make a change to your coverage for 2022.

But overall average rate changes dont tell the whole story:

2015: Average rate increase of 10.2%

What Is The Cheapest Type Of Health Insurance In Virginia

The cheapest type of health insurance in Virginia is Medicaid, which offers free or low-cost coverage according to family size, income and other factors. If you don’t qualify for Medicaid, Catastrophic and Bronze plans are the lowest-cost plans available through the exchange to residents. The cheapest Catastrophic plan costs $195 per month and is available if you are under 30 years old or qualify for a hardship exemption, whereas Bronze plans are available to everyone and cost $386 per month on average.

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Can I Buy Dental Insurance Outside Of West Virginias Exchange

There are also a variety of dental insurers that sell stand-alone dental plans directly to consumers in the Mountain State. These plans are not subject to the ACAs essential health benefit rules for pediatric dental coverage, but they are regulated by the West Virginia Offices of the Insurance Commissioner. If you would like to purchase a non-ACA qualified dental plan, ask a dentist for recommendations or search online.

In West Virginia, there are also various dental discount plans available. Dental discount plans are not insurance, but can offer discounted rates at participating dentists. Heres what you need to know about the differences between dental insurance and dental discount plans.

To find plans in your area, search online for dental discount plans and the state you are looking to buy a plan in.

Are There Cost Breaks

Those who use the Health Insurance Marketplace may be able to get lower costs on their monthly premiums and out-of-pocket fees. Most people who apply will qualify for some kind of savings. Recent legislation makes financial assistance more generous for 2022. It also makes financial assistance available to individuals and families that may not have been previously eligible.

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Pediatric Dental Benefits In West Virginia

The pediatric stand-alone dental policies available on the West Virginia marketplace will comply with the ACAs pediatric dental coverage rules. For residents, this means out-of-pocket costs for childrens dental care will not exceed $375 per child in 2022 , and there isnt a cap on medically-necessary dental services.

As is the case for all essential health benefits, the specific coverage requirements for pediatric dental care are guided by the states essential health benefits benchmark plan.

You can see details here for West Virginias benchmark plan, which does include coverage for both basic and major dental services for children.

Va And Other Health Insurance

If you have other forms of health care coverage, such as a private insurance plan, Medicare, Medicaid or TRICARE, you can continue to use your VA health care benefits along with these plans. Remember: it is always a good idea to inform your doctors if you are receiving care by other doctors so that your health care can be coordinated.

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Special Enrollment Period On The Marketplace

A special enrollment period is a time outside of the open enrollment period during which you and your family have a right to sign up for health coverage. In the Marketplace, you qualify for a special enrollment period 60 days following certain life events that involve a change in family status or loss of other health coverage. Job-based plans must provide a special enrollment period of 30 days. If you dont have a special enrollment period, you cant buy insurance inside or outside the Marketplace until the next open enrollment period. Not all special enrollment periods are the same length, so visit for details.

Reinsurance Program Granted Federal Approval Will Take Effect As Of 2023

In March 2021, Virginia enacted legislation to create a reinsurance program. Virginia H.B.2332 called for the state to submit a 1332 waiver proposal to the federal government by January 1, 2022, seeking federal pass-through funding for the reinsurance program .

Virginias State Corporation Commission and Bureau of Insurance sorted out the specifics for the reinsurance program, and posted the waiver draft in early October. The final proposal was submitted to the federal government in December 2021. A public comment period ran from late January through the end of February .

The waiver proposal was still pending federal approval as of late March, when the Virginia State Corporation Commission/Bureau of Insurance held a teleconference with 2023 rate and plan filing information for insurers. The state instructed insurers to file their proposed rates without accounting for the reinsurance program. But it was noted that insurers would be able to revise their rate proposals if and when the waiver proposal was approved. The approval ultimately came in mid-May, around the time that the initial rate filings were due. The reinsurance program is expected to result in full-price premiums that are 15% lower than they would otherwise be, and potentially up to 20% lower.

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Insurance For Individuals In Virginia

If youre healthy with few or no prescriptions, you probably want a plan with a low monthly payment and a high deductible. On the other hand, if you have a chronic health condition, youll probably want to select a plan that offers a lower deductible but comes with a higher monthly premium.

The following are the types of plans youll have to choose from:

• A Health Maintenance Organization plan is a good choice for a healthy individual who makes few visits to the doctor and doesnt need many prescriptions. However, this plan has more restrictions in terms of how you access your health care. Whichever plan you select, youll need to use that plans in-network medical providers, obtain referrals to see any specialists, and name a primary care physician.
• There is more flexibility with a Preferred Provider Organization plan. You can see out-of-network providers, although this may cost a bit more. A PPO plan wont require you to name a primary care physician nor obtain a referral to see a specialist, so is a good choice for people with a chronic health condition who see specialists on a regular basis.
• A Point of Service Plan is an option with similarities to both an HMO plan and a PPO plan. You can see an out-of-network provider, but if you want to see a specialist youll still need to obtain a referral.

Need Health Insurance We Can Help You Get Covered

Enroll Virginia is a network of community-based organizations committed to helping Virginians access high quality, affordable health coverage. Our navigators and enrollment experts are trained and certified to provide free, unbiased assistance on health insurance options available through HealthCare.gov, Medicaid, and FAMIS.

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What Health Insurance Marketplace Plans Does Vcu Health Participate In

• Seven insurers will offer Marketplace options covering Richmond City and most of the surrounding counties in 2022: Oscar, Anthem, Cigna, Aetna, Bright Health, UnitedHealthcare and Optima. VCU Health providers, hospitals and facilities have in-network agreements with all of them except UnitedHealthcare.
• VCU Health also participates with all out of area Marketplace options from Optima and Piedmont Community Health Plan in Virginia.

Finding Your Best Health Insurance Coverage In Virginia

The overall best cheap health insurance plan for you in Virginia will depend on your level of coverage and health status. Individuals who expect to have a lot of medical costs may pay less overall if they choose a health plan with higher premiums â such as a Gold policy â and lower out-of-pocket costs. This is especially true if you select a Silver plan and you qualify for cost-sharing reductions, which further reduce your copays, coinsurance and deductibles.

Start by browsing Silver plans

For all but the healthiest consumers, we suggest you begin your search by looking at Silver plans. When compared to Bronze or Expanded Bronze health plans, a Silver plan will generally cost more each month, but the plans come with substantially lower costs for medical care. Furthermore, they are the only plans eligible for additional subsidies for cost-sharing reductions. If your income is less than 250% of the federal poverty level, your copays, coinsurance and deductibles will be more affordable.

Consumers with recurring medical bills will see the benefits of lower out-of-pocket expenses immediately. The cheaper out-of-pocket maximums and deductibles will limit the risk of large payments should you need urgent medical care. Silver plans are generally the best health insurance plans, as they strike a good balance between what you pay for premiums versus out-of-pocket costs.

Cheap Bronze plans are best for the healthy

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Group Coverage For The Self

The Charlottesville, Virginia area made headlines in the fall of 2017, when it became apparent that 2018 individual market rate hikes in that area would be roughly triple what they had been in 2017 for people who didnt qualify for premium subsidies .

The small group market, however, is much more stable than the individual market, as is the case in most states. In an effort to address the situation and provide access to affordable coverage for some people impacted by the subsidy cliff, Governor Northam signed S.B.672 into law in April 2018 it took effect in July 2018. The legislation, sponsored by Senator Creigh Deeds , allows self-employed people, including a sole member of an LLC or a sole shareholder of a corporation, to be considered small employers and thus purchase coverage in the small group market, as of July 2018. From the text of the legislation:

That appears to conflict with the ACA, which requires a small business to have at least one employee in addition to the owner in order to enroll in a plan in the small group market. Indeed, the impact statement for S.B.672 notes that the legislation may conflict with the federal Patient Protection and Affordable Care Act.

In other words, because the state is making ACA-compliant coverage more available rather than less available, the state is taking the position that the new law is not in conflict with federal rules. The federal government hasnt commented on Virginias new law.

Finding Affordable Va Individual & Family Medical Insurance

If both you and your spouse or domestic partner are looking for a new health insurance plan, we recommend that you look up health insurance quotes both together and separately to find the plan that is most affordable for you.

Depending on the health insurance company, Virginia individual and family health insurance rates for couples can be based on the age of the youngest person on the policy. Some couples with an age difference of several years may find they save money by applying for the same plan rather than individually. Couples that are only a few years apart might be able to reduce their total costs by applying for separate health insurance plans. If you decide to apply for a health insurance plan as a couple, make sure the plan you choose covers the benefits both of you need.

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What Is The Health Insurance Marketplace

The Health Insurance Marketplace is a way to find and buy health coverage that fits your budget and meets your needs. You can compare plans based on price, benefits and other features important to you before you make a choice. With one Marketplace application, you can:

• Compare plans and apply for health insurance
• Determine if you qualify for financial assistance
• Determine if you qualify for Medicaid or FAMIS

Applications may be submitted online, by phone, by mail or in person with the help of a trained counselor or navigator.

How Much Do These Plans Cost

The amount you pay monthly for your coverage will vary depending on where you live, the size of your household, your income, and other factors.

Nine out of ten people get financial help when enrolling in a plan through the Affordable Care Act4, and 43% pay less than $10/month after federal assistance.*

Learn more about health care subsidieshealth care subsidies

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What Are Virginias Medicare Options For Seniors And People With Disabilities

Medicare is the federal government program to provide health care for seniors aged 65 and older and those with qualifying disabilities.

• Original Medicare is the basic form of Medicare. Its composed of two parts: Part A and Part B . There are no limits on out-of-pocket expenses under Original Medicare and no prescription drug coverage. Youll need to purchase a Medicare Part D plan if you require regular prescriptions. The Medicare Part A Premium and Deductible for inpatient hospital stays is $1,556 in 2022, up from $1,484 in 2021. Medicare Part B enrollees pay a standard monthly premium of $170.10 for 2022, up from $148.50 in 2021.
• Medicare Advantage plans are sold by private insurance companies, but approved by Medicare. Also known as Medicare Part C, these plans are legally required to provide all the coverage that you would receive under Original Medicare however, the plans also offer vision, dental, and hearing coverage with many plans offering prescription drug coverage and fitness memberships. Medicare Advantage Plans come in four categories: HMOs, PPOs, Private Fee-For-Service Plans, and Special Needs Plans. As of 2022, there are 132 Medicare Advantage Plans available in the state, however, you can only select a plan thats available in your county.

Eligibility

To qualify for Medicare, you must be:

Enrollment

Medicare Resources

How Much Does Dental Insurance Cost In West Virginia

For adults who purchase their own stand-alone or family dental coverage through the exchange, premiums range from $24 to $56 per month.

IHC Specialty Benefits reports that the average monthly premium for a stand-alone family dental plan sold in West Virginia over a two-year period was $39.78.

If a family is purchasing coverage through the West Virginia health insurance exchange, the premiums associated with pediatric dental coverage may or may not be offset by premium tax credits . Heres more about how that works, depending on whether the health plan has integrated pediatric dental benefits.

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What Types Of Alternative Health Insurance Plans Are Available In Virginia

The most popular form of cost-sharing plans are faith-based plans. In a faith-based plan, members share health care costs with other members. You dont need to be a member of a particular denomination to participate in a plan. While these plans can be relatively low-cost, most faith-based plans dont cover pre-existing conditions, mental health care, or pregnancy. Since the federal government and Virginia dont consider them health care plans, these plans are unregulated. If you would like to join a faith-based plan, make sure you ask lots of questions before enrolling.

What To Look For When Choosing A Policy

The important words to remember when shopping for a policy are “premium” and “deductible.” The premium is the amount you pay each month for coverage. The deductible is the amount you need to pay each year for medical services before your health insurance kicks in. As a general rule, insurance plans with low premiums have high deductibles, and plans with high premiums have low deductibles.

These are the basic levels of coverage:

• Catastrophic insurance is designed to protect an otherwise healthy person in the event of a major injury or illness. It’s available only to people under age 30 and those who are exempt from other plans due to hardship. This type of insurance can have low premiums but very high deductibles. Plans generally cover less than 60% of the costs of health care.
• Bronze plans also have low premiums and high deductibles, but they offer better coverage than catastrophic insurance, typically paying for 60% of costs.
• Silver plans and gold plans have average-sized premiums and average-sized deductibles. Silver plans cover 70% of costs. Gold plans pay 80% of costs.
• Platinum plans, the highest level of coverage, have high premiums and low deductibles. These plans cover 90% or more of health care costs.

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