How does health care in Virginia compare to the rest of the country? According to a study by US News, Virginia has the 29th best health care in America. This study looks at health care access, quality, and good public health.
Health insurance options in Virginia
According to the Virginia Bureau of Insurance, there are several ways residents can get health insurance:
Employer-provided
- From your employer
- Through your spouse's employer
Individual or family plans
- Through HealthCare.gov
- Directly from a health insurance company
Government-assisted
- Medicare
- Medicaid
Where do most Virginia residents get their health insurance coverage?
| Sources | Percent | ||
|---|---|---|---|
| Employer-Provided | 54% | ||
| Individual or family | 6% | ||
| Medicaid | 12% | ||
| Medicare | 14% | ||
| Military | 4% | ||
| Uninsured | 9% | ||
| Source: Kaiser Family Foundation, Health Insurance Coverage of the Total Population | |||
Nine percent of Virginia residents are uninsured, about the same as the national average. This isn't good news for policyholders, as a higher amount of uninsured people can raise costs for insured people.
Virginia health insurance companies
What are the top health insurance companies in Virginia? Luckily, the state has plenty of options to choose from to find the best provider for your needs. These companies offer individual and family plans in Virginia:
- CareFirst
- Cigna
- Group Hospitalization and Medical Services
- Health Keepers/Anthem
- Kaiser
- Optima
- Piedmont Healthcare
- Oscar
- Optimum Choice
Virginia health insurance costs and rate factors
How much should you expect to pay in your state? VA residents spend an average of $7,556 per year on health care expenditures, less than the national average. These rates are determined by factors that vary from person to person:
Plan type
How much you'll be paying in monthly premium costs depends on the plan you want. Marketplace plans use metal tiers: bronze, silver, gold, and platinum.
What's the average cost for health insurance in your state? This is how much a middle-aged Virginia resident tends to pay in monthly premiums in 2020:
| Bronze | Silver | Gold | |
|---|---|---|---|
| $380 | $506 | $510 | |
| Source: Kaiser Family Foundation, Change in Average Marketplace Premiums by Metal Tier | |||
Gold plans cost about 34 percent more than bronze plans. The increase in price is because bronze plans cover 60 percent of medical costs, whereas gold plans cover 80 percent of costs.
The lowest level of coverage is a catastrophic plan. You may be eligible for this type of plan if you are under 30 or have other exemptions. The monthly premiums for catastrophic plans are low, but they come with a $8,150 yearly deductible. If you need to use your insurance, your costs may be lower with a bronze plan.
Body mass index
A high BMI can increase your risk for serious diseases and health conditions. Your risk-level can depend on your BMI, so insurers use it to price your policy. A higher BMI leads to higher insurance rates.
In 2018, Virginia had a 29 percent obesity rate, the 26th highest in the country. Out of the many Virginia residents who use QuoteWizard to compare health insurance quotes, 33 percent have a BMI in the obese range.
Tobacco use
Smoking can lead to several serious health conditions. Because of this, providers charge tobacco users more for health insurance. 15.3 percent of Virginia residents are smokers, the 15th lowest rate in the country.
Age
Older people tend to pay up to three times more than younger people for health insurance coverage. On average, Virginia residents who use QuoteWizard to shop for health insurance are 39 years old.
Location
Every state has different rules, regulations, and providers surrounding their health care marketplace. Your location plays a big role in how much you'll be paying for health care.
Many insurers use a community rating system to price policies. This means that rates are based on how many claims the people around you file. If you have a neighbor that files a high amount of claims, your prices could spike.
Living in a health-conscious state should keep your monthly premiums low. According to America's Health Rankings, Virginia is the 19th healthiest state in the country.
Virginia health insurance laws
The Affordable Care Act makes it so that insurance companies can't use certain factors to price your policy:
- Pre-existing conditions: Insurance companies can't charge you more because of a pre-existing condition. Providers used to bump up prices for people with pre-existing conditions, if they even offered them coverage in the first place.
- Gender: In a study looking at gender and lifetime health care prices, researchers found that women pay more for health care. But the ACA mandates that it is illegal for insurance companies to charge men and women different prices for the same plan.
- Insurance and medical history: Insurance companies also made it difficult for people with previous medical problems and lapses in insurance to get health insurance. Now, providers can't use your past medical history or your past insurance coverage to price your policy.
There's a limit to how much you'll pay out-of-pocket for a marketplace plan. For 2020, the out-of-pocket maximum is $8,150 for an individual plan and $16,300 for a family plan.
Virginia law requires providers to offer at least some coverage for these services:
- Hospice care
- Diabetes equipment, supplies, and education
- Cancer clinical trials
- Childhood immunizations
- Baby visits and care
- Mental health and substance abuse services
- Postpartum services
There are more services insurers are required to cover in Virginia. Find the full list here.
Medicare and Medicaid in Virginia
Medicare and Medicaid are government-funded programs that offer health care to groups of people. Medicare assists senior citizens, and Medicaid helps low-income families and children.
Medicare
Virginia residents 65 years and over qualify for Medicare. There are different options within Medicare, including parts A, B, C, D, and supplemental coverage plans. You may also qualify for a Medicare Savings Program with these income restrictions:
- Individual monthly income limit: $1,456
- Married couple monthly income limit: $1,960
Medicaid
According to The Washington Post, Virginia plans to expand Medicaid coverage. The expansion is set to take effect January 1st, 2019. These are Virginia's Medicaid financial requirements:
| Household Size | Maximum Yearly Income |
|---|---|
| 1 | $16,971 |
| 2 | $22,930 |
| 3 | $28,888 |
| 4 | $34,846 |
| 5 | $40,805 |
| 6 | $46,763 |
| 7 | $52,722 |
| 8 | $58,680 |
Virginia Bureau of Insurance
- Website:
- Homepage
- Insurance Commissioner:
- Scott A. White
- Insurance Hotline:
- (800) 552 – 7945
- Office Hours:
- Monday - Friday
8:15 am to 5:00 pm
- File a Consumer Insurance Complaint
- Complaint Page
Sources:
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