Not sure where to begin?
Watch this short video to learn about the plans available to you. Read below for more information about health insurance basics and how the Marketplace works.
Defining Health Insurance Basics
Our glossary can help you understand common health insurance terminology.
Frequently Asked Questions
About the Marketplace
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The Marketplace is the Commonwealth’s official health insurance marketplace. It’s where Virginians can shop for, compare, and purchase affordable, high-quality health insurance plans with comprehensive coverage. Many households will be eligible for government subsidies that lower the costs of health plans.
Virginia created this state-based health insurance marketplace to enroll more residents in affordable coverage and tailor the insurance shopping experience to Virginians. The Marketplace is overseen by the State Corporation Commission.
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Virginians who are unemployed, are self-employed, or have jobs that don’t provide affordable insurance options can use the Marketplace. Individual and family plans are available to those who don’t have access to affordable health coverage.
To be eligible for Virginia's Insurance Marketplace coverage, individuals / households must:
1. Reside in Virginia.2. Be U.S. citizens, U.S. nationals, or lawfully present immigrants for the entire time they plan to have coverage.
3. Not be incarcerated (unless pending disposition of charges).
4. Be uninsured, generally not eligible for Medicaid or Medicare, not have an offer of affordable employer-based coverage.
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It allows you to get the care you need while also protecting you from life-altering medical expenses. Accidents can happen to anyone at any age, even if you’re healthy. Health insurance protects you from the unexpected.
Health insurance also may not be as expensive as you think. The Marketplace offers affordable coverage options, and financial assistance is available to Virginians who qualify.
Marketplace Health Plans
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All plans offered on the Marketplace cover these 10 essential health benefits:
- Ambulatory patient services. Outpatient care that is received without being admitted to a hospital.
- Emergency services.
- Hospitalization. Includes surgery and overnight stays.
- Pregnancy, maternity, and newborn care. For both before and after birth.
- Mental health and substance use disorder services. Includes behavioral health treatment such as counseling and psychotherapy.
- Prescription drugs.
- Rehabilitative and habilitative services and devices. Services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills.
- Laboratory services.
- Preventive and wellness services and chronic disease management.
- Pediatric services. Includes oral and vision care.
Note that adult dental and vision coverage are not considered essential health benefits.
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There are five categories of plans on the Marketplace. Plans are categorized based on the average percentage of health costs that the insurance plan pays, which is called the “actuarial value (AV).” The consumer is responsible for paying the remaining costs.
- Bronze – Plans that have an AV of 60% (consumers pay 40% of costs, on average).
- Silver – Plans that have an AV of 70% (consumers pay 30%, on average).
- Gold – Plans that have an AV of 80% (consumers pay 20%, on average).
- Platinum – Plans that have an AV of 90% (consumers pay 10%, on average).
- Catastrophic Plans – These plans primarily cover families and individuals in the event they are seriously hurt or injured. The plans generally have high deductibles and lower premiums. They are offered to young adults under age 30 at the time they enroll or to those who qualify for a hardship or affordability exemption.
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The Marketplace was created for Virginia, by Virginians, and lets you shop for, compare, and purchase affordable, high-quality health insurance plans with comprehensive coverage. The Marketplace is the only place to get financial assistance to help lower the cost of coverage and care. Virginians who are uninsured, are self-employed, or have jobs that don’t provide affordable insurance options can use the Marketplace to shop for health plans that fit their budget. Virginia Medicaid has low-cost and no-cost health coverage programs. There are programs for children, pregnant women and adults, including those with disabilities. The Marketplace will determine Medicaid eligibility and will let Virginians know if they qualify for Medicaid instead of a health plan on the Marketplace.
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When choosing a plan, it’s a good idea to think about your total health care costs, not just the premium you pay to your insurance company every month. Other out-of-pocket costs, like coinsurance or a copayment, can have a big impact on your total health care spending. To pick a plan based on your total care costs, you’ll need to estimate how much care you’re likely to use for the year ahead. When you compare plans in the Marketplace, you can choose each family member’s expected medical use as low, medium, or high. When you view plans, you’ll see an estimate of your total costs—including monthly premiums and all out-of-pocket costs—based on your household’s expected use of care.
Marketplace plans are put into 5 metal categories: Bronze, Silver, Gold, Platinum, and Catastrophic. These categories are based on how you and the health plan share the total costs of your care. Generally, plan categories with higher premiums (Gold and Platinum) pay more of your total costs of care. Categories with lower premiums (Bronze and Silver) pay less of your total costs.
If you’re under 30, you can enroll in a Catastrophic plan whether you have an exemption or not. If you’re 30 or older, you can enroll in this plan category only if you qualify for a hardship exemption (this includes affordability exemptions)
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If you expect a lot of doctor visits or need regular prescriptions: you may want a Gold or Platinum plan. These plans generally have higher monthly premiums but pay more of your costs when you need care. If you don’t expect to use regular medical services and don’t take regular prescriptions: you may want a Silver, Bronze, or Catastrophic plan. These plans cost you less per month, but pay less of your costs when you need care. If you qualify for extra savings on out-of-pocket costs: your best value may be a Silver plan.
NOTE: If you qualify for a “cost-sharing reduction” based on your income, you can have a lower deductible and pay lower out-of-pocket costs (including copayments and coinsurance) when you get care—but only if you enroll in a Silver plan.
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Once you create an account on the Marketplace, you can log in anytime and update your information in your profile settings.
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All plans offered by the Marketplace include vision coverage for children. Only some plans include vision coverage for adults. If adult vision coverage is important to you, check the details of any plan you're considering. If your plan doesn't include adult vision coverage, you can buy a 'stand-alone' vision plan to reduce your vision care expenses. However, the Marketplace doesn't offer stand-alone vision plans. To shop for stand-alone vision plans, contact an insurance agent or search for plans online.
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Pediatric dental care is considered an essential health benefit. This means if you're getting health coverage for someone 18 or younger, dental coverage must be available for your child as part of a health plan. However, dental coverage isn't an essential health benefit for adults. Insurers don't have to offer adult dental coverage as part of their qualified health plan; however, you can shop for stand-alone dental plans through the Marketplace. If you choose a separate dental plan, you’ll pay a separate, additional premium.
Health Plan Enrollment
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You can buy health insurance or make changes to your existing plan during the Open Enrollment Period. Open enrollment is a yearly period from November 1 to January 15.
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You can cancel your health insurance plan through the Marketplace anytime by contacting the Consumer Assistance Center at 1-888-687-1501 and requesting a termination. However, you will not be able to enroll in a new plan until the next Open Enrollment Period unless you experience a Qualifying Life Event. (This could result in a gap in coverage.)
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You can’t purchase a health plan or make changes outside the Open Enrollment Period — unless you qualify for a Special Enrollment Period.
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A Special Enrollment Period takes place outside the yearly Open Enrollment Period. You can enroll in a health plan through the Marketplace during a Special Enrollment Period only if you experience a Qualifying Life Event.
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Certain changes in your circumstances are known as “Qualifying Life Events.” They include, but are not limited to:
- Getting married or divorced.
- Having a baby or adopting a child.
- Experiencing the death of the insurer in the family.
- Losing health insurance coverage due to job loss.
- Losing eligibility for Medicare, Medicaid, or Children’s Health Insurance Program (CHIP).
- Turning 26 and losing coverage from a parent’s health insurance plan.
- Moving to a different ZIP code or county, or moving to the U.S. from a foreign country or U.S. territory.
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To apply for a plan on the Marketplace, you need the following materials for each adult who will be covered:
- Photo ID.
- Social Security number.
- Most recent tax return.
- Pay stubs from the last four weeks.
- Immigration documents, if applicable.
Financial Savings
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The first thing you need to do is estimate your household’s expected income for the intended year of coverage. Use our savings calculator to determine whether you qualify for financial assistance.
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Advance premium tax credits (APTCs) are tax credits you can use to lower your premium. This type of assistance is only available through the Marketplace and is based on household income level and family size.
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Cost-sharing reductions (CSRs) are discounts on the amount you pay for deductibles, copayments, and coinsurance. If you qualify for a “cost-sharing reduction” based on your income, you can have a lower deductible and pay lower out-of-pocket costs (including copayments and coinsurance) when you get care—but only if you enroll in a Silver plan.
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To see if you may qualify, visit coverva.org or call 1-855-242-8282, or you can visit your local Department of Social Services in the city or county in which you live. You can apply for free or low-cost coverage through Medicaid and FAMIS at any time throughout the year. The Marketplace can determine if you or someone in your family is eligible for Medicaid or FAMIS when applying through the Marketplace.
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Rates for plans sold on and off the Marketplace vary from person to person as they are based on age, family composition and geographic location. Visit our Get Covered page to see plans and estimated prices in your area. You may qualify for financial assistance that will lower your premium and other costs.
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Payment is due to the insurance company and not Virginia’s Insurance Marketplace. Follow the insurer’s instructions about how and when to make your premium payment. Once enrolled, you must pay your premium payment on time for coverage to be effective.
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Yes. If your application indicates you are not eligible for financial assistance, you may still enroll through the Marketplace.
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Can I use the Marketplace if my employer does not offer affordable health insurance?
In 2023, a employer sponsored health plan is considered "affordable" if your share of the monthly premium in the lowest-cost plan offered by the employer is less than 9.12% of your household income. If a family has to pay more than a certain percentage of household income (9.12% in 2023) for the employer-sponsored plan, they will potentially be eligible for premium tax credits in the Marketplace.
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If anyone in your household had a Marketplace plan in the previous year, you should receive a 1095-A Health Insurance Marketplace statement. Your 1095-A includes information about Marketplace plans anyone in your household had in the previous year. It comes from the Marketplace, not the IRS.
You should keep your 1095-As with your important tax information, like W-2 forms and other records. You must have your 1095-A before you file your taxes.
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For plan year 2023, consumers can continue to access their 1095-A forms through their accounts on Healthcare.gov. The federal marketplace will also send 1095-A forms via USPS to consumers.
For plan year 2024 and ongoing, consumers will receive a Form 1095-A each year on the Virginia’s Insurance Marketplace platform in their Secure Inbox, and from Virginia's Insurance Marketplace via USPS if they opt to receive one via postal mail. This is similar to the process used by Healthcare.gov.
Marketplace Assistance
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The Marketplace’s help center can assist you with enrolling in a new health plan, updating your personal information, and answering any questions. Assistance is available over the phone at 888-687-1501, online, and even in person with a local assister or agent.
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You may file an appeal. To file an appeal with the Marketplace, click here.
Need help?
Visit the Marketplace’s Help Center if you need assistance enrolling in a health plan, need to update your personal information, or have any questions.
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