FAQs

The Marketplace is the Commonwealth’s official health insurance marketplace. It’s where Virginians can shop for, compare, and purchase affordable, high-quality health and insurance plans with comprehensive coverage. Many households are eligible for government subsidies that lower the costs of health plans. Follow the links to see plans offering health and dental coverage for 2024.

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.

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, and not have an offer of affordable employer-based coverage. ​

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.

1. Ambulatory patient services. Outpatient care that is received without being admitted to a hospital.
2. Emergency services.
3. Hospitalization. Includes surgery and overnight stays.
4. Pregnancy, maternity, and newborn care. For both before and after birth.
5. Mental health and substance use disorder services. Includes behavioral health treatment such as counseling and psychotherapy.
6. Prescription drugs.
7. 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.
8. Laboratory services.
9. Preventive and wellness services and chronic disease management.
10. Pediatric services. Includes oral and vision care. 

Note that adult dental and vision coverage are not considered essential health benefits.

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. 

1. Bronze – Plans that have an AV of 60% (consumers pay 40% of costs, on average). 
2. Silver – Plans that have an AV of 70% (consumers pay 30%, on average).
3. Gold – Plans that have an AV of 80% (consumers pay 20%, on average).
4. Platinum – Plans that have an AV of 90% (consumers pay 10%, on average). 
5. 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.

Follow the links to see plans offering health and dental coverage for 2024.

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. 

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 effect on your total health care spending. To pick a plan based on your total care costs, you 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 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 sorted 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 types with higher premiums (Gold and Platinum) pay more of your total costs of care. Types with lower premiums (Bronze and Silver) pay less of your total costs. 

If you’re under age 30, you can enroll in a Catastrophic plan whether you have an exemption or not. If you’re age 30 or older, you can enroll in this plan category only if you qualify for a hardship exemption (this includes affordability exemptions). 

If you expect to have 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. 

Once you create an account on the Marketplace, you can log in anytime and update your information in your profile settings.

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. 

Pediatric dental care is considered an essential health benefit. This means that any health plans for children age 18 or younger must include dental coverage. 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; but 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. 

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. 

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.) 

You can’t purchase a health plan or make changes outside the Open Enrollment Period — unless you qualify for a Special Enrollment Period.

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. 

Some QLEs must be verified by Virginia’s Insurance Marketplace in order to enroll under a Special Enrollment Period. If one of the above situations applies to you, make sure to have your information when you apply.

Certain changes in your circumstances are known as “Qualifying Life Events.” Some QLEs must be verified by Virginia’s Insurance Marketplace in order to activate a Special Enrollment Period. If one of the below situations applies to you, make sure to have your information handy when you go to apply.

 They include, but are not limited to:

1. Getting married or divorced.
2. Having a baby or adopting a child.
3. Experiencing the death of the insurer in the family.
4. Losing health insurance coverage due to job loss.
5. Losing eligibility for Medicare, Medicaid, or Children’s Health Insurance Program (CHIP).
6. Turning 26 and losing coverage from a parent’s health insurance plan.
7. Moving to a different ZIP code or county, or moving to the U.S. from a foreign country or U.S. territory.

To apply for a plan on the Marketplace, you need the following materials for each adult who will be covered:

1. Photo ID.
2. Social Security number.
3. Most recent tax return.
4. Pay stubs from the last four weeks.
5. Immigration documents, if applicable. 

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. 

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. 

Cost-sharing reductions (CSRs) are discounts on the amount you pay for deductibles, copayments, and coinsurance. If you qualify for a CSR 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.

To see whether you 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  anytime 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.  

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.  

Payment is due to the insurance company, 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. 

Yes. If your application indicates you are not eligible for financial assistance, you may still enroll in a health plan through the Marketplace.  

In 2023, an 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 for the employer-sponsored plan, they will potentially be eligible for premium tax credits through the Marketplace. For 2024, the percentage is 8.39%.  

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.

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 through 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 through postal mail. This is similar to the process used by HealthCare.gov.

If you had Marketplace coverage at any point during 2023, you must file your taxes and "reconcile" your premium tax credit.

Use Form 1095-A to complete IRS tax Form 8962 and reconcile your 2023 premium tax credit when you file your 2023 taxes if you qualified for or used the premium tax credit. Once you do, you may:

• Owe taxes if you used more of the premium tax credit than you qualified for in 2023. You'll have to report the excess amount on your 2023 tax return by filing Form 8962, Premium Tax Credit (PDF, 110 KB).
• Get a refund or lower the amount of taxes you owe if you used less of the premium tax credit you qualified for or got an increase in the premium tax credit when you reconciled. You still need to include Form 8962 with your tax return.

If your tax return was rejected for not having Form 8962 and you didn't have Marketplace coverage in 2023, please visit the IRS website to correct your return.

• Resubmit your 2023 tax return if you filed electronically but it was rejected for a missing Form 8962. You'll need to complete Form 8962 or an explanation for why you're missing the form, and attach it when you refile. Learn how to fix it and correctly file electronically.

Get more details from the IRS about filing taxes when you get the premium tax credit.

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. 

If you believe your eligibility determination is incorrect, you may file an appeal with Virginia's Insurance Marketplace. 

File a complaint or discuss an issue with a Bureau of Insurance Consumer Services Representative.
Appeal an adverse decision with the Office of the Managed Care Ombudsman.
Check qualifications for an External Review.

Free translation services are available. Call the Consumer Assistance Center at 1-888-687-1501 for assistance.