Compare Best Health Insurance Companies In Virginia

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 G-HD) with a $2,490 deductible. Plan F (HD) is still offered to applicants that owned a policy prior to 1-1-20. Advantage (MA) plans and Part D prescription drug plans are also widely available, with many contracts offering $0 monthly premiums. 2023 Plan G (HD) are once again the least expensive Supplement plan option.

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 Tier 2 drugs receive the lowest copay (often $0).

Which health carrier is the best in Virginia? View the major companies that conduct business in the state, and a brief description of several of the most competitive on-Marketplace and Medicare 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 Senior Medigap options, but do not participate in the private individual or Exchange market. Additional carriers offer non-traditional medical options, including short-term plans. The best health insurance companies in Virginia are listed below:

 

Aetna

 

Aetna is a 150-year old company and is one of the nation's largest financial institutions and one of the top health insurance companies in Virginia. They were acquired by CVS three years ago at an approximate purchase price of $69 billion. They previously offered plans in the Catastrophic, Bronze, and Silver tiers, and once again 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 nine 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. Previously, they exited many state Exchanges, and offered plans in Virginia, Nebraska, Iowa, and Delaware. Upon returning to Virginia, a full portfolio of Aetna CVS 2023 Marketplace plans are offered:

Aetna CVS Silver -- $5,800 deductible with 40% coinsurance. $40 and $80 office visit copays. $20 and $40 generic and preferred brand drug copays. $60 Urgent Care copay.

Aetna CVS Silver 2 -- $4,400 deductible with 40% coinsurance. $25 and $50 office visit copays. $10 and $60 preferred generic and preferred brand drug copays. $50 Urgent Care copay.

Aetna Gold S -- $2,000 deductible with 25% coinsurance. $30 and $60 office visit copays. $15 and $30 generic and preferred brand drug copays. $60 non-preferred drug copay. $45 Urgent Care copay.

Aetna Gold -- $1,500 deductible with 20% coinsurance. $20 and $40 office visit copays. $8 preferred generic drug copay. $40 Urgent Care copay.

Three Part D drug prescription plans were previously offered. They were Medicare Rx Value, Medicare Rx Select, and Medicare Rx Saver plans. However, last year, WellCare acquired all Aetna standalone Part D plans. Currently, they offer the following options: Wellcare Classic, Wellcare Medicare Rx Value Plus, and Wellcare Value Script.

The CVS Health acquisition of Aetna added SilverScript to the Senior portfolio. The three available Virginia PDP  plans are:

SilverScript Choice -- $34.70 monthly premium with $505 deductible. 3,509 available formulary drugs and 3.5 Summary Star Rating. 30-day preferred pharmacy copays are $2 (Tier 1), $7 (Tier 2), 17% (Tier 3), 40% (Tier 4), and 25% (Tier 5). 90-day preferred pharmacy copays are $6 (Tier 1), $21 (Tier 2), 17% (Tier 3), 40% (Tier 4), and n/a (Tier 5).

SilverScript Plus -- $70.40 monthly premium with $0 deductible. 3,595 available formulary drugs and 3.5 Summary Star Rating. 30-day preferred pharmacy copays are $0 (Tier 1), $0 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 33% (Tier 5). 90-day preferred pharmacy copays are $0 (Tier 1), $0 (Tier 2), $141 (Tier 3), 50% (Tier 4), and n/a (Tier 5).

SilverScript SmartSaver -- $5.10 monthly premium with $505 deductible. 3,661 available formulary drugs and 3.5 Summary Star Rating. 30-day preferred pharmacy copays are $2 (Tier 1), $15 (Tier 2), 25% (Tier 3), 50% (Tier 4), and 25% (Tier 5). 90-day preferred pharmacy copays are $6 (Tier 1), $45 (Tier 2), 25% (Tier 3), 50% (Tier 4), and n/a (Tier 5).

Medicare Advantage plans offered include Innovation Health -- Aetna Better Health Of Virginia, Aetna Medicare Assure Premier, Aetna Medicare Essential Plan, Aetna Medicare Premier Plan, Aetna Medicare Assure Value, Aetna Medicare Choice Plan, Aetna Medicare Prime Plan, and Aetna Medicare Select 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. The household discount is included.
Plan A -- $99
Plan B -- $117
Plan F -- $140
Plan G (HD) -- $42
Plan G -- $117
Plan N -- $84

 

Plan A -- $82
Plan B -- $97
Plan F -- $116
Plan G (HD) -- $34
Plan G -- $97
Plan N -- $69

 

Previously-available Aetna Marketplace (under age-65) options in each Metal tier:

Catastrophic

Leap Catastrophic Bon Secours -- $20 copay for first three pcp office visits. $7,150 deductible with 0% coinsurance.
Bronze

Leap Basic Bon Secours -- $7,050 deductible with 0% coinsurance. $5 copay for preferred/non-preferred generic drugs.

 

Silver

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.

 

Virginia BCBS Healthcare Plans

Anthem BCBS Offers Low Rates In Virginia

 

Anthem Blue Cross Blue Shield

 

Anthem provides coverage for most 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 are available through many other companies. The limited-duration "Enhanced Choice" plan may possibly be offered in the state by 2024. The A.M.Best rating is "A," which is considered "excellent."

The most affordable and popular Anthem plans are listed below. All policies are considered "HealthKeepers" plans:

Catastrophic 9100 -- Cheapest catastrophic plan that features a $40 copay on first three pcp office visits. $9,100 Deductible and 0% coinsurance applies to most other non-preventive expenses. Children's glasses and children's eye exams covered at 100%. Must be under age 30 or prove financial hardship to apply for this plan.

Bronze 9100 Standard -- $9,100 Deductible and 0% coinsurance. $9,100 maximum out-of-pocket expenses.

Bronze 8200 -- $8,200 deductible with 40% coinsurance. Deductible applies to all non-preventative expenses. $9,100 maximum out-of-pocket expenses.

Bronze 5500 -- $30 copay for pcp office visits. $5,500 deductible with 35% coinsurance. $60 Urgent Care copay. $9,100 maximum out-of-pocket expenses.

Bronze 5800 -- $25 pcp office visit copay. $5,800 deductible with 30% coinsurance. $20 Tier 1 drug copay ($60 mail order). $50 Urgent Care copay. $9,100 maximum out-of-pocket expenses.

Bronze X 5900 for HSA -- HSA-eligible plan. $5,900 deductible with 35% coinsurance. Deductible applies to all non-preventative expenses. $7,450 maximum out-of-pocket expenses.
 

Anthem Virginia Medicare Part D Plans are listed below:

MediBlue Rx Standard -- $61.20 per month premium with $505 deductible. Preferred generic, generic, preferred brand, non-preferred and specialty drug copays are $1, $3, $47, 46%, and 26%. Additional gap coverage not offered.

MediBlue Rx Plus -- $48.40 per month premium with $0 deductible. Preferred generic, generic, preferred brand, non-preferred and specialty drug copays are $1, $4, $47, 50%, and 33%. Additional gap coverage not offered.

 

Anthem Virginia Medicare Advantage (MA) Plans are listed below:
 

Anthem MediBlue Care To You (HMO)
Anthem MediBlue Dual Advantage (HMO)
Anthem MediBlue Full Dual Advantage (HMO)
Anthem MediBlue Plus (HMO)
Anthem MediBlue Access (PPO)
Anthem MediBlue Care on Site (HMO)
Anthem MediBlue COPD (HMO)
Anthem MediBlue Diabetes and Heart Care (HMO)
Anthem MediBlue Dual Access (PPO)
Anthem MediBlue ESRD Care (HMO)
Anthem MediBlue Extra (HMO)
Anthem MediBlue Local (HMO)
Anthem MediBlue Service (PPO)
Anthem MediBlue Smart Fit (HMO)
Anthem MediBlue + Kroger (HMO)
Anthem MediBlue + Kroger Access (PPO)
Anthem MediBlue Essential (HMO)

 

CareFirst BlueCross BlueShield

 

CareFirst, a BCBS licensee, 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" six 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). Congressional employees are able to utilize more than 95% of all physicians and hospitals throughout the US.

Previously, they contributed more than $1 million to increase access to behavioral medical treatment in rural and urban areas 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 the three available under-65 plans:

BlueChoice HMO Young Adult 8700 -- Catastrophic plan for applicants under age 30. $0 office visit copay for first three visits. Deductible is $8,700 with $8,700 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. The non-preferred brand deductible is $70. Non-hospital Lab test and x-ray copays are $25 and $55 after the deductible has been met.

BlueChoice HMO Gold $1750 -- $0 and $30 office visit copays. $50 Urgent Care copay. Deductible is $1,750 with $6,650 maximum out-of-pocket expenses. Diagnostic lab test copay is $15 at non-hospitals. Imaging copay is $250 at non-hospitals. Generic drug copay is $0. Other drugs are subject to policy deductible. Non-hospital Lab test and x-ray copays are $15 and $65 after the deductible has been met.

 

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. Oral exams, cleanings, and x-rays are fully covered when a network provider is utilized. Referrrals and claim forms are not required. 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.

 

CareFirst BCBS Medicare Supplement plans are also offered in available counties. Shown below are current monthly rates.

MedPlus Level 1 Female Age 65

$552.77 -- Plan A
$148.79 -- Plan B
$133.22 -- Plan G
$32.00 -- Plan G (HD)
$105.54 -- Plan L
$162.63 -- Plan M
$118.51 -- Plan N

 

MedPlus Level 1 Male Age 65

$588.80 -- Plan A
$158.49 -- Plan B
$141.91 -- Plan G
$34.09 -- Plan G (HD)
$112.42 -- Plan L
$173.23 -- Plan M
$126.23 -- Plan N

 

VA Marketplace Plans Innovation Health

Virginia Innovation Health Offers Low-Cost Medical Coverage

 

Cigna

 

Cigna has more than 180 million customers in 30 countries, 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 16 states and Part D prescription drug coverage is available in all states.

Under-65 plans offered in Virginia are shown below:

Cigna Connect 7000 -- $7,000 deductible with 40% coinsurance. No charge for virtual medical visits with a dedicated virtual pcp.

Cigna Connect 6750 -- $6,750 deductible with 40% coinsurance. $30 pcp office visit copay. $8 ($24 mail order) preferred generic drug copay.

Cigna Connect 5500 -- $5,500 deductible with 40% coinsurance. $20 pcp office visit copay. $10 ($30 mail order) preferred generic drug copay.

Cigna Connect 1500 -- $1,500 deductible with 25% coinsurance. $25 pcp office visit copay. Prescription drugs must meet coinsurance and deductible.

Cigna Connect 2000 -- $2,000 deductible with 25% coinsurance. $20 and $65 office visit copays. $8 preferred generic drug copay and $20 generic drug copay ($24 and $60 mail order copays). Preferred brand drug copays is $50 ($150 mail order).

Cigna Connect 6500 -- $6,500 deductible with 40% coinsurance. $20 pcp office visit copay. $4 preferred generic drug copay and $20 generic drug copay ($12 and $60 mail order copays). Preferred brand drug copays is $60 ($180 mail order). $30 Urgent Care copay.

Cigna Connect 3500 -- $3,500 deductible with 40% coinsurance. $25 and $75 office visit copays. $5 preferred generic drug copay and $25 generic drug copay ($15 and $75 mail order copays). Preferred brand drug copays is $75 ($225 mail order). $35 Urgent Care copay. $500 copay per day facility fee.

Cigna Connect 3500 Diabetes Care -- $3,500 deductible with 30% coinsurance. $10 office visit copay. $5 preferred generic drug copay and $20 generic drug copay ($15 and $60 mail order copays). Preferred brand drug copays is $70 ($210 mail order). $35 Urgent Care copay.

Cigna Connect 4500 With Acupuncture -- $4,500 deductible with 20% coinsurance. $15 office visit copay. $4 preferred generic drug copay and $20 generic drug copay ($12 and $60 mail order copays). Preferred brand drug copays is $55 ($165 mail order). $30 Urgent Care copay. $500 copay for ER visits. Acupuncture visits included ($30 copay).

 

Part D Prescription Drug Plans

 

Cigna Secure-Essential Rx -- $24.00 per month with $445 deductible. Preferred generic, generic, preferred brand, and non-preferred drug 30-day supply copays are $0, $2, 18%, and 40%. 3,178 formualry drugs are available.

Cigna Secure Rx -- $26.10 per month with $445 deductible. Preferred generic, generic, preferred brand, and non-preferred drug 30-day supply copays are $1, $3, $42, and 50%. 3,218 formulary drugs are available.

Cigna Secure-Extra Rx -- $68.10 per month with $100 deductible. Preferred generic, generic, preferred brand, and non-preferred drug 30-day supply copays are $4, $10, $42, and 50%. 3,314 formulary drugs are available.

 

Innovation Health

 

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 three years ago. Their coordinated local-care treatment has become very popular. Included in the provider network are more than 1,200 primary-care physicians, 5,000 specialists, 20 hospitals, and 21 Urgent Care locations. 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.

Three Medicare Advantage plans are offered:

Innovation Health-Aetna Medicare Connect -- $0 monthly premium, $200 deductible, and $7,550 maximum out-of-pocket expenses. Preferred generic, generic, and preferred brand drug copays are $0, $10, and $47. Primary doctor and specialist office visit copays are $0-$35 and $35-$50. Urgent Care visit copays are $0-$65. The inpatient hospital copay is $315 for the first 7 days. The ground ambulance copay is $275.

Innovation Health-Aetna Medicare Voyager -- $99 monthly premium, $200 deductible, and $7,550 maximum out-of-pocket expenses. Preferred generic, generic, and preferred brand drug copays are $0, $10, and $47. Primary doctor and specialist office visit copays are $0-$25 and $35-$50. Urgent Care visit copays are $0-$65. The inpatient hospital copay is $315 for the first 7 days.

Innovation Health-Aetna Medicare Premier -- $149 monthly premium, $150 deductible, and $7,550 maximum out-of-pocket expenses. Preferred generic, generic, and preferred brand drug copays are $0, $5, and $47. Primary doctor and specialist office visit copays are $0-$25 and $35-50. Urgent Care visit copays are $0-$45. The inpatient hospital copay is $225 for the first 7 days.

Listed below are several of Innovation's most popular and affordable plan under-65 options from three 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..

 

List Of Virginia Health Insurance Companies

Affordable Kaiser Health Plans Are Available

 

Kaiser Permanente

 

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 Marketplace plan options:

 

KP VA Catastrophic 8550/0/Vision -- First three pcp office visits covered at 100%. $8,550 Deductible and 0% coinsurance applies to most other non-preventive expenses.

KP VA Bronze 7500/40%/Vision -- $7,500 deductible with 40% coinsurance.

KP VA Bronze 6000/55/Vision -- $55 and $75 office visit copays with $75 Urgent Care copay. Deductible is $6,000 with 35% coinsurance. Generic and preferred brand drug copays are $35 and $100.

KP VA Gold 1700/25/Vision -- $25 and $60 office visit copays with $60 Urgent Care copay. Deductible is $1,700 with 30% coinsurance. Generic and preferred brand drug copays are $15 and $60.
 

Kaiser Medicare Advantage Plans:

Kaiser Permanante Medicare Advantage Value VA -- $0 monthly premium with $0 deductible and maximum out-of-pocket expenses of $6,700. Preferred generic and generic 30-day prescription drug copays are $5 and $15.

Kaiser Permanante Medicare Plus Basic w/o D -- $10 monthly premium with maximum out-of-pocket expenses of $6,700. Preferred generic and generic 30-day prescription drug copays are $5 and $15.

Kaiser Permanante Medicare Advantage Standard VA -- $25 monthly premium with $0 deductible and maximum out-of-pocket expenses of $6,700. Preferred generic and generic 30-day prescription drug copays are $3 and $12.

Kaiser Permanante Medicare Standard w/o D -- $25 monthly premium with maximum out-of-pocket expenses of $6,700. Preferred generic and generic 30-day prescription drug copays are $5 and $15.

Kaiser Permanante Medicare Advantage Std with Part D -- $54 monthly premium with $280 deductible and maximum out-of-pocket expenses of $6,700. Preferred generic and generic 30-day prescription drug copays are $5 and $15.

 

Optima Health

 

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 Catastrophic 8150 M -- $40 pcp office visit copay for first three visits. $8,150 deductible. Must be under age 30 or qualify for a hardship exemption.

OptimaFit Bronze 7500 40% Select RK M -- $7,500 deductible and 40% coinsurance. $25 generic drug copay.

OptimaFit Bronze 7200 40% Direct M -- $7,200 deductible. $45 pcp office visit copay for first three visits. $20 generic drug copay.

OptimaFit Bronze 6000 20% HSA Select CH M -- HSA-eligible plan with $6,000 deductible and 20% 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.

OptimaFit Silver 2700 40% Select RK M -- $25 pcp office visit copay. $2,700 deductible and 40% coinsurance. Generic and preferred brand drug copays are $15 and $50.

OptimaFit Silver 6600 30% Direct M -- $25 and $50 office visit copays. $6,600 deductible and 30% coinsurance. Generic and preferred brand drug copays are $20 and $50.

OptimaFit Gold 1600 15% Select RK M -- $30 and $60 office visit copays. $1,600 deductible and 15% coinsurance. Generic and preferred brand drug copays are $15 and $40.

Optima Medicare Advantage Plans:

Optima Medicare Value -- $0 monthly premium with $3,600 maximum out-of-pocket expenses. Preferred generic, generic, and preferred brand drug copays are $0,12, and $47. Primary doctor and specialist copays are $0 and $30 with $30 Urgent Care copays. Diagnostic tests, lab services and x-rays are subject to $0-$85 copays.

Optima Medicare Prime -- $55 monthly premium with $3,400 maximum out-of-pocket expenses. Preferred generic, generic, and preferred brand drug copays are $0,8, and $45. Primary doctor and specialist copays are $0 and $25 with $25 Urgent Care copays. Diagnostic tests, lab services and x-rays are subject to $0-$80 copays.

 

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.

 

Piedmont's five under-65 plans are:

Bronze 7900 -- $7,900 deductible with 30% coinsurance. $35 generic drug copay.

Bronze 6500 -- $6,500 deductible with 30% coinsurance. $50 and $75 office visit copays. $15 generic drug copay ($38 mail order).

Bronze HSA 5500 -- HSA-eligible plan. $5,000 deductible with 35% coinsurance.

Silver 6500 -- $6,500 deductible with 30% coinsurance. $40 pcp office visit copay. $25 generic drug copay ($63 mail order). $65 Preferred brand drug copay ($163 mail order).

Gold 1800 -- $1,800 deductible with 20% coinsurance. $25 pcp office visit copay. $10 generic drug copay ($25 mail order). $30 Preferred brand drug copay ($75 mail order).

 

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, and is currently a nonprofit managed care organization. VCU Health System in Richmond provides coverage for more than 280,000 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 five Bronze, Silver, and Gold-tier plans. Coverage is offered in Richmond City and the following counties: Amelia, Caroline, Chesterfield, Goochland, Hanover, Henrico, New Kent, and Powhatan. Plan descriptions are shown below.

Virginia Premier Preferred Bronze 7200 -- $7,200 deductible and 50% coinsurance.

Virginia Premier Preferred Bronze 7000 -- $7,000 deductible and 50% coinsurance. PCP office visit copay is $25 and Urgent Care copay is $50. Preferred generic and non-preferred generic drug copays are $8 and $25 ($16 and $50 mail order).

Virginia Premier Preferred Silver 6900 -- $6,900 deductible and 50% coinsurance. PCP office visit copay is $20 and Urgent Care copay is $50. Preferred generic and non-preferred generic drug copays are $4 and $8 ($20 and $40 mail order). Preferred brand drug copays are $60 and $120.

Virginia Premier Preferred Silver 5000 -- $5,000 deductible and 20% coinsurance. PCP office visit copay is $15 and Urgent Care copay is $50. Preferred generic and non-preferred generic drug copays are $4 and $8 ($20 and $40 mail order). Preferred brand drug copays are $55 and $110.

Virginia Premier Preferred Gold 1700 -- $1,700 deductible and 15% coinsurance. PCP office visit copay is $25 and Urgent Care copay is $50. Prescription drugs are subject to 15% coinsurance.

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.

Virginia Premier Advantage Platinum -- $29 monthly premium with $100 deductible. Office visit copays are $0 and $35, and the Urgent Care and ER copays are $35 and $90. The inpatient hospital copay is $250 for 5 days. Tier 1, 2, and 3 prescription drug copays are $2, $12, and $47.

Three Medicaid options are offered. Virginia Premier Elite is a Medallion Medicaid plan for single adults and families. Virginia Premier Elite Family is a Medallion FAMIS plan for children of working parents who do not meet Medicaid income requirements. Virginia Premier Elite Plus is a Commonwealth Coordinated Care plan for persons that have reached age 65 and qualify for Medicaid.

 

Oscar

 

Oscar was founded 10 years ago as the initial direct-to-consumer healthcare carrier. Telemedicine, Care Teams, and mobile apps are prominently utilized by this unique insurer. Prescriptions are easier to refill, and scheduling physician appointments is a simple process. Last year was the first year Oscar offered plans in Virginia. Currently, they underwrite business in 19 states.

Oscar VA plans include Bronze Simple, Bronze Classic, Bronze Classic Next, Bronze Saver, Silver Simple, Silver Classic, Silver Classic Next, Silver Saver, and Gold Classic. Initially, they entered the State in the Richmond area.