Virginia Health Insurance Exchange Marketplace Rates

The Virginia  Health Insurance Exchange (also referred to as a "Marketplace") began Open Enrollment on October 1st for 2014 effective dates. Regardless of any pre-existing conditions, individuals, families and small businesses can apply for affordable medical coverage in Virginia from the top-rated companies. You can not be denied for medical conditions and a special federal subsidy helps reduce premiums.
 

About 900,000 Va residents are currently without coverage. About 800,000 persons should be eligible for government assistance, either through the State Exchange or the expansion of Medicaid, if approved in the future by legislation. Raising the Federal Poverty Level requirements would allow more persons to qualify for low-cost (sometimes free) Medicaid.

 

What Type Of Plans Are Available?

 

There are four available types of policies. They are Platinum, Gold, Silver and Bronze. The expected percentage of medical claims covered under each policy is 60%, 70%, 80% and 90% respectively.  The Platinum is the "Cadillac" of the four choices, offering the lowest  out-of-pocket costs if you have a claim. The Bronze plan will be the cheapest option, but you will incur higher charges when you submit a claim. However, it can be a big money-saver for persons that desire low premiums but are willing to assume more risk.
 

Also, a "Catastrophic" option is available for younger persons (under age 30) and applicants that have special financial needs. These policies are cheaper than other Metal plans but feature much lower benefits.
 

Each carrier must offer at least one Silver and Gold plan inside the State Exchange. By making these two options available, carriers will be allowed to sell coverage "away" from the Exchange. It is possible that contracts outside of the Marketplace will feature larger networks of doctors, specialists and hospitals with more competitive pricing (assuming you don't qualify for a subsidy).
 

There will also be policies that don't meet Obamacare requirements and will be subject to the 1% of income tax. However, in certain situations, paying the tax could be offset by the substantial savings of the plan premiums. But there may also be an unusually high deductible, which may be specifically what consumers are looking for.
 

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These plans will be "standardized," and contain very similar core benefits. The federal government, when passing "The Affordable Care Act," felt  there were  too many choices for consumers to properly make an informed decision. A set of "essential health benefits," or core coverages, must be included in all policies. Some of these benefits include maternity, prescriptions, preventive benefits, hospitalization and  mental health.
 

If only a few months of benefits are needed, then temporary medical plans would be the most appropriate. They'll get you from Point A to Point B without putting a big dent in your budget. Prices are often about one-half to one-third the cost of a standard plan.
 

Will The Same Policies Be Offered In All Counties?
 

No. The SCC Bureau has approved five individual policies with an additional four currently being considered (as of Aug 1 2013). Separately, there are six options for small businesses. The vast majority of areas will be able to choose among three or four options. But there will be some specific areas where only a single policy can be chosen. This will likely be in the Southwestern part of the state.
 

For example, Buchanan County will  only have one plan for individuals or businesses. Tazewell County will also only have one option for businesses. But private individuals and families will have two options. Residents of Wythe and Bland counties will also have limited choices.

 

How And When Do I Buy A Policy

 

There is a standard online or paper application. The good news is there are no medical questions! You can apply for coverage through our website by first requesting a quote near the upper part of this page. Your eligibility is virtually guaranteed and you can apply alone or with live assistance. The choice is yours.
 

If you are eligible for Medicaid or Medicare, there is a separate enrollment process. Medicaid eligibility guidelines have been expanded for lower-income residents of the state. Children may also be able to qualify for special low-cost or no-cost programs. The Department Of Medical Assistant Services administers Medicaid and CHIP, which is also known as FAMIS. There are both financial and non-financial requirements.
 

The Open Enrollment period begins in October and runs through February 28th, 2014. However, there are specific circumstances (triggering events) that will allow you to apply at any time. For instance, getting married, getting divorced, giving birth, or adopting a child will all qualify. If you wish to change from one metal plan to another, (Bronze to Gold, Platinum to Silver etc...) you will have to wait until the next Open Enrollment.

 

Who Is Operating The Program?

 

The federal government is running the show, which is not unusual. Because of the large cost of handling the entire operation and transformation, many states are saving hundreds of millions of dollars by allowing the federal government operate the Exchange. The same applies to smaller businesses (less than 100 employees). The "SHOP" will offer coverage and give employers an opportunity to select among numerous options.
 

The state will be involved with some of the management of plans,but essentially will play a backseat role. However, in the future, if the state government chooses, they can request to operate the Virginia Health Exchange Marketplace and take over the operation. A few years ago, Governor McDonnell discussed legislation regarding the state's roll, but no vote ever took place.

 

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What Are Navigators And Why Did Our State Get So Much Money For Them?

 

"Navigators" are not experienced licensed brokers that can compare and recommend the best plans for you. They are simply "workers" that will be hired to help with the enrollment process of uninsured consumers. They will not be licensed and their qualifications are very vague. They also may have access to your personal financial information. And yes, $2.5 million dollars is being spent on them.
 

Although their role is undefined, we believe they can best serve residents of the state that either have no internet access, or choose not to utilize the internet for comparing and applying for coverage. Also, it's possible that there are Virginia residents that do not have the needed transportation to travel, and will require an in-home visit.

 

Can I Hang On The Policy That I Have Now?

 

Despite promises from various sources, not everyone can keep their existing plan. If your policy was "grandfathered,' (your carrier will notify you if it is), you can keep coverage without having to be forced to purchase new coverage. Although it will mean that your existing contract is lacking some essential mandated benefits, it still may be the best choice for you.
 

Also, if your employer decides they are no longer offering medical coverage to their employees (and perhaps paying the fine instead), of course you would have to obtain new benefits. This specific risk was lessened a bit when the federal government waived the requirement in 2014 for certain businesses to offer healthcare to its workers. However, in 2015, it will be back on the books and many employers are expected to discontinue their worker's benefits.
 

What Are The "Cost-Sharing Plans?
 
These are found under the "Silver" Metal category of policies and it's a relatively unknown perk you can easily qualify for. If you are receiving any portion of the subsidy, you may automatically qualify for special reductions to your deductibles and copays.
 
Thus, if you are purchasing a policy with a $2,500 deductible, it's conceivable that it may be reduced to $2,000. Or perhaps $1,500 or lower. And other projected expenses would also reduce. It's a great way to save money throughout the year, but only the Silver options feature this benefit.
 

UPDATE: March 10 2014 -- Open Enrollment officially ends in three weeks, unless another extension is provided. Once it ends, consumers can continue to apply for medical coverage, although official Exchange plans will not be available. Short-term and Limited-Benefit policies will be two types of options offered.
 

UPDATE: April 9 2014 -- A private Marketplace may be created for Va residents later this year. The Senate Finance committee has given its approval in the budget that will provide an alternative to expanding Medicaid. The House is expected to review and vote on the proposal. The new legislation would keep costs down by requiring a copay and possible payment of up to 5% of their income in insurance premiums.