Virginia Health Insurance Consumer Guide

To qualify for health coverage through the Virginia Marketplace, you must: ⁴

• Live in Virginia
• Be lawfully present in the United States
• Not be incarcerated
• Not be enrolled in Medicare

Eligibility for financial assistance (premium subsidies and cost-sharing reductions) depends on your income and how it compares with the cost of the second-lowest-cost Silver plan in your area – which depends on your age and location. In addition, to qualify for financial assistance with your Marketplace plan you must:

• Not have access to affordable health coverage through your employer. If your employer offers coverage but you feel it’s too expensive, you can use our Employer Health Plan Affordability Calculator to see if you might qualify for premium subsidies in the Marketplace. 
• Not be eligible for Medicaid or CHIP.
• Not be eligible for premium-free Medicare Part A.⁵
• File taxes jointly with your spouse, if you’re married⁶ (with very limited exceptions)⁷
• Not be able to be claimed as a tax dependent by someone else.⁸

The open enrollment period for individual/family health coverage runs from November 1 to January 15 in Virginia.⁹

If you need your coverage to start on January 1, you must apply by December 15. If you apply between December 16 and January 15, your coverage will begin on February 1.¹⁰

Outside of open enrollment, a special enrollment period (generally linked to a specific qualifying life event) is necessary to enroll or change your coverage. 

If you have questions about open enrollment, you can learn more in our comprehensive guide to open enrollment. We also have a comprehensive guide to special enrollment periods.

To enroll in an ACA Marketplace plan in Virginia, you can: 

• Visit Virginia’s Insurance Marketplace to access an online platform to shop, compare, and choose the best health plans.
• Purchase individual and family health coverage with the help of an insurance agent or broker, a Navigator or certified application counselor.
• Call Virginia’s Insurance Marketplace at 888-687-1501.

You may find affordable health insurance options in Virginia by signing up through Virginia’s Insurance Marketplace.

For those who enrolled in private plans through Virginia’s Insurance Marketplace during the open enrollment period for 2024 coverage, more than 87% were eligible for advance premium tax credits (APTC, or premium subsidies). These subsidies averaged $405/month, reducing the average net premium of subsidy-eligible enrollees to $86/month after subsidies.¹¹

The Affordable Care Act provides the income-based APTC to make premiums much more affordable than they would otherwise be. People with household incomes up to 250% of the federal poverty level also qualify for cost-sharing reductions (CSR) that reduce out-of-pocket expenses on Silver plans (CSR benefits aren’t available at other metal levels).

Due to premium subsidies and cost-sharing reductions, you may find that a plan obtained through Virginia’s Insurance Marketplace is the best option.

Source: CMS.gov¹²

Eleven insurers offer health plans in Virginia’s exchange for 2024, including two separate Aetna entities.²

For 2025, there will be ten insurers offering on-exchange plans in Virginia. Aetna has two on-exchange entities in 2024: Aetna Health HMO and Aetna Life EPO, but only Aetna Health appears on the state’s summary of rate proposals for 2025,¹³ and the state’s rate review presentation notes that ten carriers will offer on-exchange plans in 2025.¹⁴ 

One carrier that offered plans in 2023, Piedmont Community Healthcare, opted to withdraw from the individual/family market in Virginia at the end of 2023, so their plans are not available for 2024.¹⁵

According to SERFF, the following average rate changes have been approved for 2025 for the insurers that offer coverage through Virginia’s health insurance Marketplace, calculated before subsidies are applied (but most enrollees qualify for subsidies). Based on each carrier’s market share, the approved rate changes amount to a weighted average increase of 3.9% for 2025.¹⁶

Source: Virginia State Corporation Commission, Bureau of Insurance¹⁷¹⁸ 

For perspective, here’s a summary of how overall average pre-subsidy premiums have changed in Virginia’s Marketplace over the years:

• 2015: 10.2% increase
• 2016: 8.5% increase¹⁹
• 2017: 16.4% increase²⁰
• 2018: 57.7% increase²¹
• 2019: 9.6% increase²²
• 2020: 3.6% decrease²³
• 2021: 3.7% decrease²⁴
• 2022: 3% decrease²⁵
• 2023: 12.9% decrease²⁶ (reinsurance took effect)
• 2024: 1.1% increase²⁷ (much lower than proposed, due to extension of reinsurance)

During the open enrollment period for 2024 coverage, 400,058 Virginia residents enrolled in private qualified health plans (QHPs) through the Virginia ACA marketplace.¹¹

This was the highest enrollment the state had seen since 2017 (see chart below). The enrollment growth in recent years stems from the subsidy enhancements under the American Rescue Plan (ARP) and Inflation Reduction Act, as well as the “unwinding” of the pandemic-era Medicaid continuous coverage rule. Virginia began disenrolling people from Medicaid in 2023 (after a three-year pause on disenrollments), and more than 27,000 people had transitioned from Medicaid to a Marketplace plan in Virginia by April 2024.²⁸

Source: 2014,²⁹ 2015,³⁰ 2016,³¹ 2017,³² 2018,³³ 2019,³⁴ 2020,³⁵ 2021,³⁶ 2022,³⁷ 2023, ³⁸ 2024³⁹

Virginia’s Insurance Marketplace
The state-run exchange began to be used starting in November 2023, and is used for all plans with effective dates of 2024 or later.

Virginia Health Care Foundation

Virginia Consumer Assistance Program
Assists people insured by private health plans, Medicaid, or other plans in resolving problems pertaining to their health coverage; assists uninsured residents with access to care.
(877) 310-6560 / [email protected]

State Exchange Profile: Virginia
The Henry J. Kaiser Family Foundation overview of Virginia’s progress toward creating a state health insurance exchange.