Health Insurance in Virginia: Marketplace Plans and Costs

Health insurance in Virginia has become more accessible since the state expanded Medicaid and moved to its own state-based marketplace. With multiple coverage pathways and steady insurer competition, the options health insurance Virginia residents can access are solid for individuals, families, and small businesses. That said, 2026 brought a significant change to the cost side — the ACA’s enhanced federal subsidies expired at the end of 2025 — so it is more important than ever to check your own current price rather than rely on last year’s numbers.

Virginia’s insurance landscape reflects the state’s economic and geographic diversity, from the densely populated Northern Virginia suburbs of Washington, D.C., to the rural communities of Southwest Virginia. This guide covers the marketplace, Medicaid, costs, 2026 subsidy changes, and enrollment details every Virginian should know. Because plan availability and pricing change every year, treat the figures here as general context and verify the current details at the state exchange before you enroll.

Virginia’s State-Based Marketplace

Virginia transitioned off the federal HealthCare.gov platform to its own fully state-based exchange — Virginia’s Insurance Marketplace (marketplace.virginia.gov) — for the 2024 plan year, with open enrollment on the new platform beginning in November 2023. Running its own exchange gives the state more control over outreach, enrollment assistance, and consumer communications, and it is now the single place Virginians go to shop for individual and family plans.

Key features of Virginia’s marketplace include:

• Streamlined enrollment: Virginia residents apply and enroll through the state’s own platform, with support tailored to local needs.
• Plan comparison tools: The marketplace allows side-by-side comparison of plans across all metal tiers from participating insurers.
• Integrated eligibility screening: The application checks eligibility for marketplace plans, premium tax credits, Medicaid, and FAMIS (Virginia’s CHIP program) at the same time.
• Local enrollment assistance: Navigators, certified enrollment assisters, and licensed agents are available across Virginia to provide free help.

Several hundred thousand Virginians enroll in marketplace coverage each year, with the majority historically receiving financial assistance to reduce their premiums. Enrollment totals shifted in 2026 as subsidy rules changed (see below), so check the state exchange for the latest figures and, more importantly, your own eligibility.

Average Health Insurance Costs in Virginia

Health insurance costs in Virginia vary by rating area, age, tobacco use, and plan selection. Northern Virginia, part of the Washington, D.C., metropolitan area, tends to have different pricing dynamics than the rest of the state. The pre-subsidy ranges below are illustrative for a 40-year-old and shift each plan year — 2026 premiums rose in Virginia and nationally after the enhanced subsidies expired, so confirm current prices at the exchange:

• Benchmark Silver plan premium: roughly $460–$550 per month before subsidies (varies by area and year).
• Bronze plans: around $310–$390 per month before subsidies.
• Gold plans: approximately $530–$640 per month before subsidies.
• After subsidies: subsidy-eligible enrollees pay less than the sticker price, though net premiums generally rose for 2026 compared with the enhanced-subsidy years. Your personalized after-subsidy price is the only one that matters — get it at the marketplace.

Virginia’s proximity to the nation’s capital means many Northern Virginia residents have access to insurer networks that include providers in both Virginia and the D.C. area, which can affect plan pricing and provider choice.

2026 Subsidy and Premium Changes

The biggest recent shift for Virginia marketplace shoppers is federal, not state. The ACA’s enhanced premium tax credits — the more generous subsidies first enacted in 2021 and extended through 2025 — expired at the end of 2025. According to KFF, this drove marketplace premiums up sharply for 2026 (a median increase in the neighborhood of 20% nationally) and, because Congress did not extend the enhanced credits, the pre-2021 subsidy structure returned in most states.

Two practical consequences for Virginians: first, the 400%-of-poverty “subsidy cliff” is back in most states, meaning households above that income line may no longer qualify for premium tax credits and could face the full premium. Second, many people who kept a subsidy are paying a larger share than they did during the enhanced-credit years. Policy in this area can change, and a small number of states added their own subsidies, so verify the current rules and your personalized cost at Virginia’s Insurance Marketplace rather than assuming last year’s amount still applies.

Medicaid Expansion in Virginia

Virginia expanded Medicaid in 2019, extending coverage to adults with incomes up to 138% of the federal poverty level. The expansion has been one of the most consequential health-coverage changes for Virginia residents in the past decade, and it remains in place independent of the marketplace subsidy changes described above.

Virginia’s Medicaid program covers:

• Expansion adults: individuals aged 19–64 with incomes up to 138% FPL.
• Children: through Medicaid and FAMIS (Family Access to Medical Insurance Security), covering children in families with incomes up to roughly 200% FPL (Medicaid) and up to about 300% FPL (FAMIS).
• Pregnant individuals: with expanded income limits (commonly cited around 205% FPL).
• Seniors and individuals with disabilities: based on specific eligibility criteria.

Virginia’s Medicaid program is administered largely through managed care organizations. Participating plans have included Anthem HealthKeepers, Aetna Better Health, Molina Healthcare, Sentara Community Plan (formerly Optima Health), UnitedHealthcare Community Plan, and others; the exact roster can change, so confirm current plans when you enroll. Medicaid and FAMIS enroll year-round — you do not have to wait for open enrollment.

Major Health Insurance Companies in Virginia

Virginia has a competitive individual market with several major carriers. Availability differs by county, and the list of participating insurers can change from year to year:

• Anthem Blue Cross Blue Shield: one of the largest insurers in Virginia, offering HMO and PPO networks across much of the state.
• CareFirst BlueCross BlueShield: serves Northern Virginia as part of the D.C.-area Blue Cross plan, with strong regional networks.
• Sentara Health Plans (formerly Optima Health): a Sentara-affiliated plan serving Hampton Roads, Central Virginia, and other regions with integrated care options.
• Kaiser Permanente: available in Northern Virginia and parts of Central Virginia, offering its integrated HMO model.
• Piedmont Community Health Plan: serves southwestern Virginia and the Roanoke area.
• Oscar Health: available in select Virginia markets with technology-focused plans.
• Aetna CVS Health: participates in select Virginia rating areas.
• Cigna: offers plans in Northern Virginia and other markets.

Northern Virginia residents typically have the most insurer choices, while rural areas in the western part of the state may have fewer options. Always confirm which insurers serve your ZIP code at the marketplace.

Open Enrollment and Special Enrollment

Open enrollment for Virginia’s marketplace typically runs from November 1 through January 15, though exact dates can vary by plan year — confirm them at the state exchange. During this window, residents can enroll in a new plan, switch plans, or change existing coverage.

Outside of open enrollment, a special enrollment period may be available if you experience a qualifying life event:

• Loss of other qualifying health coverage
• Marriage, divorce, or legal separation
• Birth, adoption, or foster care placement
• Relocation to a new coverage area
• Changes in income or household size that affect eligibility
• Loss of Medicaid or FAMIS coverage

Medicaid and FAMIS enrollment is available year-round through Virginia’s CommonHelp portal or your local Department of Social Services office.

Subsidies and Financial Assistance

Virginia marketplace enrollees may access several forms of financial assistance, subject to current federal rules:

• Premium tax credits: reduce monthly premiums for eligible households. With the enhanced credits expired for 2026, eligibility generally follows the standard ACA rules again (roughly 100%–400% FPL in most cases) — verify your eligibility at the exchange.
• Cost-sharing reductions: lower deductibles, copays, and out-of-pocket maximums on Silver plans for incomes between 100% and 250% FPL.
• Medicaid: free or very low-cost coverage for individuals and families who meet income and eligibility requirements.
• FAMIS and FAMIS Plus: free or low-cost coverage for children and pregnant individuals.

For more on how federal and state policy shapes these programs, explore our healthcare policy guide.

Where to Get Free Help Enrolling

You do not have to sort through this alone. Virginia’s Insurance Marketplace supports a network of navigators and certified enrollment assisters who provide free, unbiased help comparing plans and applying for subsidies, along with licensed agents and brokers. You can find local assisters through the marketplace website or its call center. Getting help is especially worthwhile in 2026, since the subsidy changes make it more important to run your specific numbers before choosing a plan.

Unique Features of Virginia’s Insurance Market

• State-based marketplace: running its own exchange gives Virginia more control over consumer outreach and marketplace operations.
• Northern Virginia’s D.C. connection: proximity to Washington, D.C., creates a cross-state dynamic, with some plans offering provider networks spanning Virginia, Maryland, and D.C.
• Integrated health system plans: insurers like Sentara Health Plans and Kaiser Permanente offer models where the insurer and provider system are closely connected.
• Rural health challenges: Southwest Virginia faces meaningful access challenges, with limited provider availability and higher rates of chronic disease.
• State employee and military populations: Virginia’s large government and military workforce means a significant share of residents get coverage through employer plans, TRICARE, or the VA health system.

Frequently Asked Questions

Does Virginia have a state individual mandate?

No. Virginia does not have a state-level individual mandate or penalty for being uninsured, and the federal penalty has been $0 since 2019.

Who qualifies for Virginia Medicaid?

Following Medicaid expansion, most adults aged 19–64 with household incomes up to 138% of the federal poverty level qualify. Children can qualify through Medicaid or FAMIS at higher income levels. Pregnant individuals, seniors, and individuals with disabilities have separate eligibility pathways. Apply year-round through CommonHelp or your local DSS office.

Did my marketplace subsidy change for 2026?

Possibly. The ACA’s enhanced premium tax credits expired at the end of 2025, so many enrollees pay more in 2026 and some households above 400% of poverty may no longer qualify for a subsidy. Rules can change and some states added their own help, so check your current, personalized price and eligibility at Virginia’s Insurance Marketplace.

How do I find which insurers are available in my area?

Visit Virginia’s Insurance Marketplace and enter your ZIP code to see which insurers offer plans in your county. You can also call the marketplace call center or work with a free navigator or a licensed broker for personalized help.

Can I get coverage if I work for the federal government in Northern Virginia?

Federal employees typically receive coverage through the Federal Employees Health Benefits (FEHB) program, which offers many plan options. If you leave federal service, you may qualify for a special enrollment period to buy marketplace coverage. FEHB counts as qualifying coverage under the ACA.

Practical Takeaway

Health insurance in Virginia offers a strong range of options, from the state marketplace to expanded Medicaid. Northern Virginia residents benefit from multiple insurer choices and cross-state provider networks, while rural Virginians should carefully evaluate network adequacy. Start at Virginia’s Insurance Marketplace to check your current subsidy eligibility and compare plans — this matters more in 2026 because of the subsidy changes — and lean on a free navigator if you need help. If your income qualifies you for Medicaid, apply year-round through CommonHelp for comprehensive coverage.

Sources

• Virginia’s Insurance Marketplace (marketplace.virginia.gov) / Virginia State Corporation Commission — state-based exchange status, enrollment, and open-enrollment dates (verify current plan-year details)
• HealthCare.gov — ACA metal tiers, premium tax credits, cost-sharing reductions, open enrollment, and special enrollment periods
• KFF (Kaiser Family Foundation) — expiration of the enhanced ACA premium tax credits at the end of 2025 and its effect on 2026 premiums (~20% median increase) and marketplace enrollment
• Virginia Department of Medical Assistance Services (DMAS) / Medicaid.gov — Virginia’s 2019 Medicaid expansion and eligibility criteria