Virginia offers affordable health insurance plans from many of the top companies in the US. Individual, family, Senior Medicare, and small business coverage is available throughout the entire calendar year. During Open Enrollment (and Special Enrollment Periods), persons under age 65 may be eligible for large federal subsidies. Current, past and potential future medical questions will not impact the price you pay for a policy, and extra out-of-pocket expenses and waiting periods will not be applied.
Senior and Under age-65 enrollment periods differ, with Medigap enrollment beginning in October, and Under-65 enrollment beginning in November. HSA-owners can use accumulated funds to pay for qualified expenses, although additional contributions can not be made. A high-deductible Supplement plan is offered (Plan F-HD) with a $2,340 deductible.
Here in the Old Dominion State, there are many top-rated health insurance companies that offer comprehensive benefits at a surprisingly low cost. Whether you need catastrophic, student, HSA, self-employed, or temporary coverage, there's a Va carrier that can provide the policy that fits your specific needs. You can keep policies long-term, or terminate coverage at any time. Each year, new companies become available, while occasionally, existing carriers exit the market. Often, new Medicare Part D prescription plans also become available. Tier 1 and Tier2 drugs receive the lowest copay (often $0).
We have listed below the major companies that do business in the state, and a brief description of some of the most competitive on-Marketplace products they offer. Both Obamacare and non-Obamacare plans are offered. Last year, enhanced short-term plans became available without a tax penalty, creating a low-cost option that benefits specific applicants. Many carriers offer Medicare Supplement, Part D, and Advantage plans, but do not participate in the private individual or Exchange market.
Aetna is a 150-year old company and is one of the nation's largest financial institutions. They previously offered plans in the Catastrophic, Bronze, and Silver tiers, but no longer offer private Marketplace plans to persons under age 65. Because of the nationwide network, you won't have trouble finding a doctor or specialist if you constantly travel out of the area. If you are eligible for Medicare, there are many additional Medigap options that are very popular. Small-business owner plans are also offered, along with many low-cost options for the self-employed.
Aetna acquired Coventry eight years ago, and markets their plans under a separate brand name in many states. The move made them the third largest carrier in the US, and expanded their market share in most of the country. However, they exited many state Exchanges, and previously offered plans in Virginia, Nebraska, Iowa, and Delaware, but they do not offer private coverage in 2020. Depending upon possible Administration legislation, individual coverage may be offered again in 2021.
Three Part D drug prescription plans were previously offered. They were Medicare Rx Value, Medicare Rx Select, and Medicare Rx Saver plans. However, as of 2020, WellCare acquired all Aetna standalone Part D plans. Currently, they offer the following options: Wellness Rx, Medicare Rx Select, Value Script, Classic, Medicare Rx Saver, and Medicare Rx Value Plus.
The CVS Health acquisition of Aetna added SilverScript to the Senior portfolio. The two available Virginia plans are:
SilverScript Choice -- $24.70 monthly premium with $415 deductible. 2,999 available formulary drugs and 4.0 Summary Star Rating. 30-day preferred pharmacy copays are $0 (Tier 1), $1 (Tier 2), $47 (Tier 3), 38% (Tier 4), and 25% (Tier 5). 90-day preferred pharmacy copays are $0 (Tier 1), $3 (Tier 2), $141 (Tier 3), 38% (Tier 4), and n/a (Tier 5).
SilverScript Plus -- $65.20 monthly premium with $0 deductible. 3,044 available formulary drugs and 4.0 Summary Star Rating. 30-day preferred pharmacy copays are $0 (Tier 1), $2 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 33% (Tier 5). 90-day preferred pharmacy copays are $0 (Tier 1), $6 (Tier 2), $141 (Tier 3), 50% (Tier 4), and n/a (Tier 5).
Medicare Advantage plans offered include Medicare Select Plan, Better Health Inc, Medicare Prime Plan, Medicare Choice Plan, and Medicare Essential Plan.
Medicare Supplement policies offered are Plans are A, B, F, F (HD), G, and N. One zip code rating area is 220-225, 232-237, 201, and 205. The other is the remainder of the state. Shown below are sample monthly preferred rates for a 65 year-old female residing in the two rating areas.
Plan A -- $97
Plan B -- $113
Plan F -- $143
Plan F (HD) -- $57
Plan G -- $113
Plan N -- $96
Plan A -- $80
Plan B -- $93
Plan F -- $118
Plan F (HD) -- $47
Plan G -- $94
Plan N -- $79
Previously-available Aetna Marketplace (under age-65) options in each Metal tier:
Leap Catastrophic Bon Secours -- $20 copay for first three pcp office visits. $7,150 deductible with 0% coinsurance.
Leap Basic Bon Secours -- $7,050 deductible with 0% coinsurance. $5 copay for preferred/non-preferred generic drugs.
Aetna Leap Everyday Bon Secours -- $10 copay on pcp office visits and lab tests. $6,075 deductible with 0% coinsurance. $5 copay for preferred/non-preferred generic drugs.
Aetna Leap Diabetes Bon Secours -- $5 copay on pcp office visits and lab tests. $6,300 deductible with 0% coinsurance. $5 copay for preferred/non-preferred generic drugs.
Aetna Leap Everyday Plus Bon Secours -- $5 copay on pcp office visits and lab tests. $5,050 deductible with 0% coinsurance. $5 copay for preferred/non-preferred generic drugs.
Aetna Leap Healthy Minds Bon Secours -- $5 copay on pcp office visits and lab tests. $5,600 deductible with 0% coinsurance. $5 copay for preferred/non-preferred generic drugs.
Anthem provides coverage for about all state residents, and has been offering policies in Virginia for more than 50 years. For a short time, they did not cover the Charlottesville area. Cigna, Kaiser, and Optima also have fairly significant private plan market shares in the state. As the nation's fifth-largest healthcare company, like Aetna and UnitedHealthcare, the nationwide network allows consumers to utilize thousands of different doctors and facilities. This is especially helpful for frequent travelers.
Group, individual and Medicare-eligible plans are provided in CDHP, PPO and HMO formats. Consumers can also purchase, life, dental and disability benefits, depending upon the specific policy. Temporary plans are no longer offered, but area available through many other companies. The A.M.Best rating is "A," which is considered "excellent."
Many of the most affordable and popular Anthem plans are listed below. All policies are considered "HealthKeepers" plans:
Catastrophic 7900 -- Cheapest catastrophic plan that features a $40 copay on first three pcp office visits. $7,900 Deductible and 0% coinsurance applies to most other non-preventive expenses. Must be under age 30 or prove financial hardship to apply.
Bronze X 6500 -- $6,500 deductible with 40% coinsurance. Deductible applies to all non-preventative expenses.
Bronze X 5250 -- $40 copay for pcp office visits. $5,250 deductible with 35% and 50% coinsurance.
Bronze X 5900 -- $35 pcp office visit copay for first five visits. $5,900 deductible with 35% and 50% coinsurance. $30 copay for Tier 1 drugs.
Bronze 5900 -- $40 pcp office visit copay for first two visits. $5,900 deductible with 35% coinsurance. All prescription drugs subject to 35% or 50% coinsurance.
Bronze X 4900 for HSA -- HSA-eligible plan. $4,900 deductible with 35% coinsurance. Deductible applies to all non-preventative expenses.
CareFirst BlueCross BlueShield
CareFirst is a non-profit company that provides coverage in Northern Virginia, along with Maryland and the District of Columbia. With more than 3 million subscribers, its the largest carrier in the region. Most importantly, its provider list of physicians, hospitals and facilities is extremely extensive, with about four out of five providers an active participant in one of the available networks. Alexandria and Fairfax are two of the largest cities included in the network. No referrals are needed, and up to $150 in Blue Rewards incentives can be applied towards deductibles and copays.
In addition to being voted "One Of The World's Most Ethical Companies" five years ago, they are a very customer-oriented carrier that heavily contributes to the local community. CareFirst is also quite active in the Federal Employees Health Program (FEP). With more than 80 years of service, they employ more than 5,000 workers, and are a large provider of coverage for the FEHBP (Federal Employees Health Benefits Program).
Previously, they contributed more than $1 million to increase access to behavioral medical treatment in rural and urban ares of Washington D.C. and Maryland. Also, the Centers for Medicare and Medicaid (CMS) gave $24 million to CareFirst to serve Medicare policyholders in Maryland. International coverage is also available in more than 200 countries.
Listed below are three of their most popular and affordable plans:
BlueChoice HMO Young Adult 7900 -- Catastrophic plan for applicants under age 30. $0 office visit copay for first three visits. Deductible is $7,900 with $7,900 maximum out-of-pocket expenses.
BlueChoice HMO HSA Silver $3,000 -- HSA-eligible plan with $3,000 deductible and $6,650 maximum out-of-pocket expenses. Office visit copays of $30 and $40 AFTER deductible has been met. Generic and preferred brand drug copays of $10 and $50 after deductible has been met.
HealthyBlue HMO Gold $1750 -- $0 and $30 office visit copays. Deductible is $1,750 with $6,650 maximum out-of-pocket expenses. Generic drug copay is $0.
Several ancillary policies are also offered. The three available adult dental plans are Select Preferred Dental, BlueDental Preferred, and Dental HMO. Each of the plans includes 100% coverage for cleanings, x-rays, and oral exams. BlueDental Preferred is the most comprehensive option, and costs about $30 per month. The low option has a $100 individual deductible ($300 family) and the high option has $50 and $150 deductibles. More than 5,000 providers are available in the area.
All health policies include one vision exam per year for each covered person. Davis vision provides network coverage. Additional discounts of about 30% are provided for other products and services.
Cigna has over 90 million customers and offers Senior and under-65 products in Virginia. A robust countrywide network is offered that provides easy access to physicians and hospitals. Medicare Advantage plans are offered in 17 states and Part D prescription drug coverage is available in all states.
The most affordable under-65 plans in Virginia are shown below:
Cigna Connect 7000 -- $7,000 deductible with 40% coinsurance.
Cigna Connect 6750 -- $6,750 deductible with 35% coinsurance. $25 copay for first three pcp office visits. $8 preferred generic drug copay.
Cigna Connect 6500 -- $6,500 deductible with 30% coinsurance. $20 copay for pcp office visits. $4 preferred generic drug copay and $20 generic drug copay.
Offering products to employers with two or more workers and Seniors, Innovation Health is the partnership of Aetna and Inova. Created in 2012, plans for small companies have been offered in Northern Virginia for the last six years. A limited portfolio was also offered to individuals and families through the Marketplace, but ended two years ago. Additional information can be found on the Va Department of Insurance website.
Some of the cities located within the network area include Arlington, Fairfax, Falls Church, Fredericksburg, Loudoun, Manassas, Prince William and Stafford. The Medicare service area covers the following counties: Alexandria City, Arlington, Fairfax, Fairfax City, Falls Church City, Fredericksburg City, Loudoun, Manassas City, Manassas Park City, Prince William, Spotyslvania, and Stafford. "Cheaper prices and higher customer satisfaction" are emphasized, according to Inova. Holistic treatment, wellness programs, supportive and coaching services, cost control, and managing chronic diseases are at the forefront of INOVA's vision.
Medicare Advantage plans offered include Connection Plan (HMO) and Voyager Plan (PPO). The Connection Plan features a $0 monthly premium and a $95 drug deductible. Tiers 1 and 2 drug copays are $2 and $5. Office visit and specialty copays are $5-$25 and $35-$50. Urgent Care and ER copays are $5-$65 and $80. The Voyager Plan features a $73 monthly premium and a $145 drug deductible. Tiers 1 and 2 drug copays are $2 and $5. Office visit and specialty copays are $15-$25 and $35-$50. Urgent Care and ER copays are $15-$65 and $80.
Listed below are several of Innovation's most popular and affordable plan under-65 options from two years ago (no longer offered):
Health Leap Catastrophic -- First three pcp office visits subject to $20 copay only. $7,150 deductible with 0% coinsurance.
Health Leap Bronze -- $7,050 deductible with 0% coinsurance. $5 copay on preferred and non-preferred generic drugs.
Health Leap Silver Basic -- $10 pcp office visit and Urgent Care copays, although specialist visits must meet deductible. $6,075 deductible with 0% coinsurance. $5 copay on preferred and non-preferred generic drugs.
Health Leap Silver Plus -- $5 pcp office visit copay, although specialist visits must meet deductible. Urgent Care copay is also only $5. $5,050 deductible with 0% coinsurance. $5 copay on preferred and non-preferred generic drugs.
Health Leap Gold Diabetes -- $5 pcp office visit and $100 specialist copays. Urgent Care copay is also only $5. $2,835 deductible with $6,000 maximum out-of-pocket expenses. $5 copay on preferred and non-preferred generic drugs and $50 copay for preferred brand drugs..
Kaiser is one of the larger healthcare companies, and offers plans in California, Hawaii, Colorado, Georgia, Washington, Oregon, Virginia, Maryland, and Washington, D.C. J.D. Power, a trusted rating resource, has consistently awarded Kaiser with a "Highest Member Satisfaction Among Commercial Health Plans In the Mid-Atlantic Region" designation. VA cities and counties that Kaiser services include Alexandria City, Arlington, Caroline Culpepper, Fairfax City, Fairfax, Falls Church City, Fauquier, Fredericksburg City, Hanover, King George, Louisa, Loudoun, Manassas City, Manassas Park City, Orange, Prince William, Spotsylvania, Stafford, and Westmoreland.
Listed below are several popular and affordable plan options:
KP VA Catastrophic 7900/0/Dental/PedDental -- First three pcp office visits covered at 100%. $7,900 Deductible and 0% coinsurance applies to most other non-preventive expenses.
KP VA Bronze 5500/50/Dental -- $50 and $70 office visit copays. Deductible is $5,500 with 35% coinsurance. $25 generic drug copay.
KP VA Silver 6000/35/Dental -- $35 and $55 office visit copays with $55 Urgent Care copay. Deductible is $6,000 with 35% coinsurance. $20 generic drug copay.
KP VA Gold 1500/20/Dental -- $20 and $40 office visit copays with $40 Urgent Care copay. Deductible is $1,500 with 35% coinsurance. $10 generic drug copay.
Optima (Sentara) provides coverage for more than 450,000 persons in the state, and features a provider network with more than 25,000 doctors, hospitals and other facilities. With four locations in Virginia Beach, Newport News, Richmond, and Roanoke, they provide service throughout the entire area for single, family, Medicare and Medicaid plans. HMO, PPO, Medicaid HMO, Medicare Advantage, and FAMIS coverage. Also offered are business options (Point of Service, Vantage, and Plus), integrated lines (design and equity), tiered plans, and self-funded contracts. Commercial plans offered are Point of Service, Vantage (HMO), and Plus (PPO).
Several Exchange plans are available for consumers that are subsidized contracts (eligible for the federal subsidy). There are also many policies offered "off-Exchange," which are not eligible for government financial aid. A unique partnership with Sentara Healthcare provides additional services and technology that are easily integrated to help consumers. A brief synopsis of popular under-65 options are listed below:
OptimaFit Bronze 7200 20% Select CH M -- $40 pcp office visit copay for first three visits. $7,200 deductible.
OptimaFit Bronze 6700 40% Direct CH M -- $6,700 deductible. $45 pcp office visit copay for first three visits. $25 generic drug copay.
OptimaFit Bronze 6000 20% HSA Select CH M -- HSA-eligible plan with $6,000 deductible and 10% coinsurance.
OptimaFit Bronze 5600 HSA Direct CH M -- HSA-eligible plan with $6.650 deductible and 25% coinsurance.
OptimaFit Silver 6600 30% Select CH M -- $25 pcp office visit copay. $6,600 deductible and 30% coinsurance. Generic and preferred brand drug copays are $20 and $40.
Piedmont Community Healthcare
Piedmont is a managed healthcare organization that services Central Va. The local network is very large and utilizes the Centra Health system for physicians, hospitals, and additional facilities. The primary service area includes the following counties: Prince Edward, Nottoway, Lunenburg, Cumberland, Campbell, Buckingham, Bedford, Appomattox, Amherst, and Albemarle.
Partial coverage is provided in the counties of Pittsylvania, Nelson, Mecklenburg, Halifax, and Charlotte. Lynchburg and Bedford (cities) are also "in-network." PPO and POS plans are available through several funding options, including self-insurance. HMO options are also offered at a lower cost, but with a more restrictive network. The home office is located in Lynchburg.
Some of Piedmont's most affordable and popular under-65 plans are:
Catastrophic 7900 -- $40 copay for first three pcp office visits. $7,900 deductible with 0% coinsurance. Must be under age 30 to apply.
Bronze Standard 6800 -- $35 office visit copay. $6,800 deductible with 40% coinsurance. $35 generic drug copay.
Bronze 7800 -- $7,800 deductible with 20% coinsurance. $25 generic drug copay.
Bronze HSA 5500 -- HSA-eligible plan. $5,500 deductible with 35% coinsurance.
Medicare Advantage Plans:
Piedmont Select Medicare Option One -- $119 monthly premium with $0 and $30 office visit copays. Outpatient hospital benefits subject to 20% coinsurance. Tier 1, 2, 3, and 4 copays are $5, $8, $30, and $80.
Piedmont Select Medicare Option Two -- $84 monthly premium with $0 and $45 office visit copays. Outpatient hospital benefits subject to 20% coinsurance. Tier 1, 2, 3, and 4 copays are $7, $12, $35, and $85.
Piedmont Select Medicare Option Three -- $0 monthly premium with $0 and $50 office visit copays. Outpatient hospital benefits subject to 20% coinsurance. Tier 1, 2, 3, and 4 copays are $10, $15, $40, and $90.
Virginia Premier Preferred
Virginia Premier Preferred was created in 1995 as a Medicaid Health Maintenance Organization. VCU Health System in Richmond provides coverage for more than 250,000 persons in the state. Individual, family, Medicare Advantage, and Medicaid coverage is offered. They also operate the Neighborhood Health Center in Roanoke, whose services include preventative and acute care, lab services, opioid treatment, behavioral health, and case management.
Under-65 plans partner with VCU Health and Bon Secours to provide Bronze, Silver, and Gold-tier plans. Available options are Bronze 6600, Silver 6500, Silver 4500, and Gold 1600 plans. Coverage is offered in Richmond City and the following counties: Amelia, Caroline, Chesterfield, Goochland, Hanover, Henrico, New Kent, and Powhatan.
Senior Medicare Advantage options are listed below:
Virginia Premier Advantage Gold -- $0 monthly premium with $250 deductible. Office visit copays are $0 and $45, and the Urgent Care and ER copays are $45 and $90. The inpatient hospital copay is $300 for 5 days. Tier 1, 2, and 3 prescription drug copays are $0, $15, and $47.
Virginia Premier Advantage Elite -- $0 monthly premium with $0 deductible for applicants that qualify for Medicare and Medicaid. Office visit copays are $0 and $0, and the Urgent Care and ER copays are $0 and $0. The inpatient hospital copay is $0. Tier 1, 2, and 3 prescription drug copays are $0, $0, and $0.