Virginia Health Insurance Guide

From the rolling Blue Ridge Mountains to historic landmarks and the scenic Chesapeake Bay, Virginia is a vibrant and diverse state — and understanding your health insurance options here is key to protecting your health and finances.

As of 2025, the uninsured rate in Virginia reflects steady enrollment and expanded access to coverage. If you’re currently without coverage, here’s what you need to know about getting insured in Virginia.

Health Insurance Options in Virginia

Virginia offers a range of health insurance options tailored to residents’ needs, depending on age, income, employment, and family size. Here are the most common coverage types available:

Employer-Sponsored Insurance

Many Virginians receive health insurance through their employer. If your workplace offers coverage, this is usually the most cost-effective and convenient option.

ACA Marketplace Plans

The Affordable Care Act (ACA) allows individuals and families to buy health insurance through federal or state Marketplaces. These plans offer essential health benefits, free preventive care, and protection for preexisting conditions.

If you don’t have employer coverage, you may qualify for subsidies to lower your premiums. Use our ACA Subsidy Calculator to check your eligibility.

Starting this year, the Centers for Medicare & Medicaid Services (CMS) is requiring income verification to confirm eligibility for premium subsidies. As part of this effort, CMS will reduce subsidies slightly for individuals automatically re-enrolled in fully subsidized plans without verified eligibility.

ACA Plan Types

ACA marketplace plans are available in four tiers: Bronze, Silver, Gold, and Platinum. These tiers vary in terms of monthly premiums, out-of-pocket expenses, and coverage benefits.

Marketplace Plans:

• Bronze: Low monthly premiums, higher out-of-pocket costs; ideal for minimal healthcare usage.
• Silver: Moderate costs; eligible for cost-sharing reductions (CSRs).
• Gold: Higher monthly premiums with lower out-of-pocket costs; best for frequent healthcare users.
• Platinum (if available): Highest premiums, lowest out-of-pocket costs.

Metal Tier Breakdown:

Medicaid

Virginia’s Medicaid program provides free or low-cost coverage for eligible low-income residents. Medicaid plan benefits typically include preventive care, hospital visits, mental health, prescriptions, and more. Virginia operates Medicaid through programs such as Medallion 4.0 and Commonwealth Coordinated Care Plus.

Short-Term Plans

Short-term medical (STM) plans offer temporary health coverage and can be a practical solution for individuals who are between jobs, recently lost employer coverage, waiting for ACA or Medicare eligibility, or need affordable protection during a coverage gap.

STM plans are available in Virginia and follow federal rules but are not regulated by the ACA. They may deny coverage based on pre-existing conditions and typically do not include comprehensive benefits such as maternity, mental health, or preventive services.

While short-term medical plans are not a substitute for long-term health insurance, they may be ideal in situations where you’re temporarily uninsured and want short-term protection from unexpected medical events.

STM Plan Enrollment: Unlike ACA-compliant plans, short-term health plans are available year-round.

Quick Coverage Start: Many short-term plans can begin as soon as the next day after your application is approved.

Children’s Health Insurance Program (CHIP)

Known as Family Access to Medical Insurance Security (FAMIS), this program helps children and pregnant women in families that earn too much for Medicaid but need affordable insurance. Learn more and apply at FAMIS website.

Student Health Insurance

College students in any state have multiple health insurance options, including staying on a parent’s plan until age 26, enrolling in a school-sponsored plan, or applying for coverage through the ACA Marketplace. Depending on your income and location, you may also qualify for Medicaid, CHIP, or low-cost catastrophic or short-term plans, making Virginia student health insurance accessible and flexible for a wide range of needs.

Medicare

Medicare plans are available for residents aged 65+ and younger individuals with qualifying disabilities.

• Medicare Advantage Plans (Part C): These plans are offered by private insurers and provide additional benefits beyond Original Medicare, often including prescription drug coverage. Learn more about Medicare Advantage.
• Prescription Drug Plans (Part D): Medicare Part D provides coverage for prescription drugs and vaccines, offered by private insurers.
• Medicare Supplement (Medigap): Medicare Supplement plans help cover the out-of-pocket costs that Original Medicare does not pay, such as deductibles, copayments, and coinsurance.

COBRA Coverage

If you’ve recently lost job-based insurance, COBRA allows you to continue your employer coverage temporarily, typically at full cost.

Enrollment Periods in Virginia

Open Enrollment for 2026 Coverage:

November 1, 2025 – January 15, 2026
During this window, all eligible residents can apply for, renew, or change their marketplace health plans.

Special Enrollment Period:

Available year-round for those experiencing qualifying life events, such as:

• Loss of coverage
• Marriage or divorce
• Birth or adoption of a child
• Relocation
• Major change in income

You typically have 60 days from the event to enroll.

Health Insurance Providers in Virginia

As of 2025, these insurers typically offer individual and family plans through Virginia’s marketplace:

• Aetna
• Bright Health
• CareFirst BlueChoice
• Cigna
• Kaiser Permanente
• Optima Health
• Oscar Health
• Piedmont Community HealthCare

Plan availability may vary by county or zip code.

Understanding Health Insurance Costs

When selecting a plan, be sure to understand these common cost terms:

• Premium: Monthly payment to maintain your plan.
• Deductible: What you pay before insurance covers services.
• Copayment (Copay): Fixed amount per visit/service.
• Coinsurance: Shared costs with your insurer after the deductible.
• Out-of-Pocket Maximum: Your yearly cost cap for covered services.
• In-Network vs. Out-of-Network: Staying in-network helps you avoid higher charges.

Understanding health insurance doesn’t have to be overwhelming. This glossary offers clear definitions of key terms to help you make confident coverage decisions.

Bottom Line

Health insurance in Virginia comes with many choices—whether from your employer, through the ACA marketplace, or public programs like Medicaid and Medicare. By staying informed and comparing plans during the right enrollment periods, you can secure affordable, reliable coverage that supports your well-being and budget.

Need help choosing a plan? Use our ACA Subsidy Calculator to see if you are eligible for ACA plan financial aid or speak with a licensed insurance agent about all your options.