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Affordable Health Insurance and Medicare/Medicaid For Virginia Residents

At EIMA Health, we help residents of Virginia get health coverage without the confusion.
Whether you need an ACA Marketplace plan, Medicare for seniors and people with
disabilities, or Cardinal Care and CHIP, we walk you through the process step-by-step.

Call Today: (804) 613-4796

Navigating Healthcare in the Old Dominion: Medicare, Medicaid, and the ACA for Virginia Families, Individuals, and Businesses

Virginia, a state rich in history and dynamic growth, is home to nearly 9 million residents. From the bustling Northern Virginia suburbs of Washington D.C. to the vibrant coastal cities of Virginia Beach and Norfolk, the historic capital of Richmond, the charming streets of Charlottesville, and the growing communities of Roanoke and Lynchburg, Virginians across the Commonwealth share a common need: accessible and affordable healthcare. However, the complexities of navigating Medicare, Medicaid, and the Affordable Care Act (ACA) can often feel daunting and overwhelming.

Understanding Virginia’s Health Landscape: Key Statistics and Trends

Virginia’s population has been steadily growing, with a 0.88% increase in 2024, bringing the total to over 8.8 million residents. This growth, particularly in urban and suburban areas, creates diverse healthcare demands.

Virginia has made significant strides in expanding health coverage. As of 2023, the uninsured rate for non-elderly Virginians was 7.6% (approximately 530,000 people). This is notably lower than the national average and a testament to the state’s efforts, including Medicaid expansion. However, despite this progress, 83.9% of uninsured Virginians under age 65 are part of working families, with most having at least one full-time worker. This highlights the persistent need for affordable options beyond employer-sponsored plans for many working Virginians. [Source: Virginia Health Care Foundation – Profile of Virginia’s Uninsured]

These statistics underscore the vital role that Medicare, Medicaid, and the ACA play in providing essential health coverage across the Commonwealth.

Medicare: Securing Your Golden Years in Virginia

For Virginians aged 65 and older, or those with certain disabilities, Medicare is the cornerstone of healthcare. As of 2023, approximately 1.29 million Virginians were enrolled in Medicare, representing 15.4% of the Commonwealth’s population. [Source: HealthJournalism.org – Virginia]

How Medicare Benefits Virginia Seniors:

  • Financial Protection: Medicare substantially reduces the financial burden of healthcare costs in retirement, covering a significant portion of hospital stays, doctor visits, and preventive care.

  • Access to Care: It ensures seniors have access to a vast network of healthcare providers across Virginia and the U.S.

  • Choice of Pathways: Virginia seniors can choose between Original Medicare (often supplemented by Medigap and Part D) or a Medicare Advantage plan, tailoring coverage to their specific needs.

Medicare FAQs for Virginia Residents:

What are the current costs for Original Medicare (Parts A & B) in Virginia for 2025?

Original Medicare consists of Part A (Hospital Insurance) and Part B (Medical Insurance).

Resource: For official Medicare information and current costs, visit Medicare.gov.

Part A covers inpatient hospital stays, skilled nursing facility care, and some home health care. Most Virginians don’t pay a monthly premium for Part A if they or their spouse paid Medicare taxes for enough years. The Part A deductible for an inpatient hospital stay in 2025 is $1,676 per benefit period.

Part B covers doctor’s services, outpatient care, and preventive services. The standard Part B premium for 2025 is $185.00 per month, and the annual deductible is $257. After your deductible, you typically pay 20% of the Medicare-approved amount for most services.

What is Virginia’s “Birthday Rule” for Medigap policies?

Effective in 2025, Virginia has a new “Birthday Rule” for Medicare Supplement (Medigap) policies. This rule allows individuals with an existing Medigap policy to switch to a different Medigap plan with the same or lesser benefits within 60 days of their birthday, without medical underwriting. This means insurers cannot deny coverage or charge higher rates due to health status during this period, offering Virginians greater flexibility to shop for better premiums or more suitable coverage. [Source: Croft Insurance Services – Understanding the New Medicare Supplement Policies in Virginia]

How many Medicare Advantage plans are available in Virginia, and do they include prescription drug coverage?

As of 2024 data (2025 numbers are typically finalized closer to AEP), 41% of Virginia Medicare beneficiaries are enrolled in a Medicare Advantage (MA) plan. Many MA plans in Virginia offer $0 monthly premiums beyond your standard Part B premium. Most MA plans are MAPD plans, meaning they bundle prescription drug coverage (Part D) along with Part A and Part B benefits, and often include extra benefits like dental, vision, and hearing care. * Resource: You can explore Medicare Advantage plans in your Virginia ZIP code through Anthem’s Medicare Advantage Plans in Virginia.

Do I need a separate Part D plan if I choose a Medigap policy?

Yes. If you choose Original Medicare and supplement it with a Medigap policy, you will need to enroll in a separate Medicare Part D Prescription Drug Plan (PDP) for your medication coverage. Medigap policies do not include prescription drug benefits.

Medicaid: A Vital Lifeline for Virginians

Virginia’s Medicaid program, known as Cardinal Care, provides essential health coverage to eligible low-income individuals and families. Significantly, Virginia adopted Medicaid expansion under the Affordable Care Act in 2019, extending coverage to many more low-income adults. As of 2023, approximately 1.42 million Virginians were enrolled in Medicaid or CHIP (Children’s Health Insurance Program), representing 17.1% of the state’s population. Of these, 758,000 eligible adults are covered under Medicaid Expansion. [Source: HealthJournalism.org – Virginia, Virginia Senate Finance Committee – Medicaid Trends and Health & Human Resources 2025 Session Outlook]

How Medicaid Benefits Virginia Residents:

  • Comprehensive Coverage: Cardinal Care provides extensive medical, dental, and vision care for eligible children, pregnant individuals, parents, adults with disabilities, and seniors.

  • Reduced Uninsured Rate: Medicaid expansion has played a crucial role in lowering Virginia’s uninsured rate, providing a critical safety net for many working families.

  • Support for Families: CHIP (Family Access to Medical Insurance Security – FAMIS) ensures children in families who earn too much for Medicaid but cannot afford private insurance still have access to care.

Medicaid FAQs for Virginia Residents:

Who is eligible for Medicaid (Cardinal Care) in Virginia?

Eligibility in Virginia is based on income and specific categories. Thanks to Medicaid expansion, eligibility extends to:

  • Adults up to 138% of the Federal Poverty Level (FPL).

  • Pregnant individuals and children (up to 148% FPL for Medicaid, up to 205% FPL for FAMIS/CHIP).

  • Parents and caretakers.

  • Individuals with disabilities.

  • Seniors.

Resource: For detailed eligibility guidelines, visit Virginia Department of Medical Assistance Services (DMAS).

How do I apply for Medicaid or FAMIS in Virginia?

You can apply for Medicaid and CHIP (FAMIS) in Virginia through several convenient methods:

  • In Person: At your local Department of Social Services (DSS) office.

  • By Phone: Call the Cover Virginia Call Center at 1-855-242-8282 (TDD: 1-888-221-1590)

What services are covered by Virginia Medicaid?

Cardinal Care covers a wide range of medically necessary services, including doctor visits, hospital stays, prescription drugs, mental health services, substance use disorder treatment, lab tests, X-rays, family planning, and transportation for medical appointments.

Is there an income limit for children to qualify for FAMIS (CHIP) in Virginia?

Yes. Children in Virginia can qualify for FAMIS if their household income is up to 205% of the Federal Poverty Level (FPL), provided they are under age 19, U.S. citizens or lawfully residing immigrants, and not eligible for full Medicaid (FAMIS Plus).

The Affordable Care Act (ACA): Expanding Access and Affordability

For Virginians who don’t have access to employer-sponsored insurance, including the self-employed, gig workers, and those working for small businesses that don’t offer coverage, the ACA Marketplace (Virginia’s own Enroll Virginia State-based Marketplace) is a crucial resource. Virginia transitioned to its own State-based Marketplace for the 2024 plan year, known as Enroll Virginia. In 2024, over 400,000 Virginia residents selected a plan through the ACA Marketplace. [Source: HealthJournalism.org – Virginia, CMS – Health Insurance Marketplaces 2024 Open Enrollment Report]

How the ACA Benefits Virginia Individuals, Families, and Small Businesses:

  • Affordability: Enhanced premium tax credits (subsidies) have made coverage significantly more affordable. For 2025, these enhanced subsidies are extended, meaning that no one purchasing coverage through the Marketplace has to pay more than 8.5% of their household income for the benchmark Silver plan. Many Virginians qualify for substantial subsidies, reducing their monthly premiums, sometimes to less than $100 or even under $10 a month.

  • No Pre-Existing Condition Denials: Insurers cannot deny coverage or charge more due to pre-existing health conditions. This is a fundamental consumer protection.

  • Essential Health Benefits: All plans cover 10 essential health benefits, providing comprehensive care from preventive services to emergency care.

  • “Family Glitch Fix”: The “family glitch” was fixed in 2023, allowing family members of workers who are offered “unaffordable” employer coverage (even if the employee’s individual portion is affordable) to qualify for Marketplace subsidies. This has opened up new affordable options for thousands of Virginia families.

Affordable Healthcare FAQs for Virginia Residents:

How do I apply for ACA health insurance in Virginia, and where do I find subsidies?

You apply through Virginia’s own state-based Marketplace, Enroll Virginia. During the application process, you’ll provide information about your household income and family size. If you qualify, premium tax credits (subsidies) will be automatically calculated and applied to reduce your monthly premiums. * Resource: Visit Enroll Virginia to begin your application.

What is “cost-sharing reduction” (CSR), and how can it help me in Virginia?

Cost-sharing reductions (CSRs) are an additional form of financial assistance available to eligible individuals and families who enroll in a Silver plan through the ACA Marketplace. CSRs lower your out-of-pocket costs, such as deductibles, copayments, and coinsurance. If you qualify for CSRs, choosing a Silver plan can offer significantly better value than other metal levels, as it reduces your costs when you actually use healthcare services.

When is Open Enrollment for ACA plans in Virginia, and when can I enroll outside of that time?

The annual Open Enrollment Period (OEP) for ACA plans in Virginia typically runs from November 1 to January 15 for coverage starting the following year. If you miss OEP, you may still be able to enroll during a Special Enrollment Period (SEP) if you experience a Qualifying Life Event (QLE), such as losing other health coverage, getting married, having a baby, or moving. You usually have 60 days from the QLE to enroll.

Can I use ACA subsidies for plans purchased directly from an insurance company in Virginia?

No. Premium tax credits and cost-sharing reductions are only available for plans purchased through the official ACA Marketplace (Enroll Virginia). If you buy a plan directly from an insurance carrier outside of the Marketplace, you will not be able to receive these subsidies, even if you would otherwise qualify.

The EIMA Health Advantage: Your Trusted Partner in Virginia Healthcare

For many Virginians, navigating the intricacies of Medicare, Medicaid, and the ACA can feel like deciphering a complex puzzle. The thought of comparing plans, understanding eligibility criteria, and completing lengthy applications can be overwhelming, leading some to postpone or avoid securing vital coverage.

This is where EIMA Health Insurance excels. While we may be headquartered in Dallas, our commitment to providing clear, comprehensive, and compassionate guidance extends across the Commonwealth of Virginia. We are your local experts, ready to:

  • Demystify the Process: We translate complex insurance jargon into easy-to-understand terms, ensuring you grasp every aspect of your options.

  • Offer Comprehensive Options: We work with all available carriers across Virginia’s Medicare, Medicaid, and ACA landscapes. We obtain and evaluate proposals, presenting you with a full spectrum of plans tailored to your specific needs.

  • Provide Personalized Guidance: We take the time to listen to your unique circumstances as a family, individual, or business owner in Virginia. Our goal is to find the perfect plan that aligns with your health needs, budget, and preferences.

  • Walk You Through Every Step: From initial eligibility checks and detailed plan comparisons to seamless application submission and ongoing support throughout your coverage, we are with you at every stage of your insurance journey.

Don’t let the complexity of healthcare prevent you from securing the coverage you deserve. Contact EIMA Health Insurance today for a complimentary consultation. Let us empower you with the information and support you need to make informed decisions about your health and financial future in Virginia.

Useful Local Resources for Virginia Residents: