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Virginia Health Insurance

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Virginia Health Insurance

There are many health insurance options open to those in the state of Virginia who are uninsured or underinsured, but there are several questions to keep in mind. If your employer does not offer health insurance, are you healthy enough to obtain health insurance on the individual market? If so, HealthPlanOne can help in quoting plans tailored to your needs and price range. Are you self-employed? HealthPlanOne can also assist sole proprietors and small business owners in obtaining small group coverage. Do you have any pre-existing conditions, disabilities, or are you below an income level which could qualify you for free or low-cost health care programs offered by the government? You may be eligible in Virginia for Medicaid, FAMIS, or the high risk pool alternative. See if you're eligible for any of these options by reviewing the information on this page.

What Every Virginian Should Know About Health Insurance

The type of health insurance familiar to most consumers is group coverage offered by an employer. With group health insurance through your employer the policy is partially paid for by the company on behalf of their employees. The company will contribute a large percentage toward the monthly premium and you (the employee) will be responsible for paying the difference, about 16-27%. With group plans you have little choice in the specific benefits of the plan (these are determined by negotiations between the company and the insurance carrier) but you also cannot be denied coverage under the group plan no matter what prescriptions you may take or preexisting conditions you may have. By insuring a large group of employees together under one plan of the company's choosing, individual employees are not medically underwritten, rather the entire group is underwritten as a whole to determine the premium level everyone will pay. Therefore, the amount you pay in premiums as well as the quality of the coverage you receive are dependent not on how healthy you are or what benefits you would like to have, but how healthy your group is as a whole and what benefits the company has chosen for you.

Unfortunately, companies frequently have a waiting period before new employees can qualify to receive health insurance benefits. If this is the case with your new job, consider getting a short-term policy from the point where your previous coverage ends to the time when your new company's insurance kicks in. Such options are available through HealthPlanOne. Simply visit our Short-Term information page for your free quotes.

What If I'm Between Jobs?

It is important not to have a lapse in coverage of more than 63 days. If you do, your new insurance carrier may refuse to cover treatment for pre-existing conditions you may have such as asthma or acne for up to a year after your policy goes into effect. For this reason, having continuous health insurance coverage is particularly important.

Because it is important not to have a break in coverage, if you've recently lost your job, look into extending the coverage you had with your employer through COBRA. With the COBRA program through the federal government you can extend your plan for up to 18 months after losing your job. You will however have to pick up the entire premium cost which your employer had previously been paying. For this reason, it is frequently more economical for people who've lost their jobs to invest in an individual/family insurance policy through HealthPlanOne. With individual coverage, you choose the health insurance carrier and benefits you want with the help of HealthPlanOne. We will quote plans for you and your family from all the different carriers available in Virginia so that you can choose from a wide price range and spectrum of options to tailor a plan that fits your needs. Even if you are not between jobs, a plan on the individual market through HealthPlanOne could still be the best option for your family. Many companies do not offer benefits to their employees, and often those companies that do offer benefits do so at an exorbitant cost for low quality plans. It is important to note that with individual coverage in Virginia each person who applies is medically underwritten and may be approved, denied, or rated-up by the carrier depending on their health history in recent months.

If you're healthy and are unhappy with the health insurance offered by your employer, are between jobs, or are not offered benefits by your company, enter your zip code into the HealthPlanOne quoting engine at the top of this page to view the most competitively priced plans in your area with benefits tailored to your needs. Quotes are absolutely free, and you're under no obligation to buy. Our licensed insurance specialists are also available via LiveChat (see the button to the right) or toll-free at (877) 567-5267 to answer any questions.

Small Group Plans

If you are self-employed you could qualify for a small group plan in Virginia. You must have 2 or more eligible employees, who each work at least 30 hours per week. There is no standard amount of time in business required prior to applying for coverage, but this varies by carrier as some carriers require one month of payroll . All carriers in Virginia do medically underwrite for small group plans. This means that though no one in the group can be denied coverage, the carrier can increase the rates based on the health history of employees enrolling. HealthPlanOne can help you by quoting plans for small groups. Simply call us at (877) 567-5267.

If you're not healthy there are still many programs available to you. See below for details on the options which best fit your medical and financial situation.

Visit our Virginia Small Business Group page for more information

Medicaid and Medicare in Virginia

Your first option is to see whether you qualify for the Medicaid program. Medicaid works in practice much like having regular health insurance; if you qualify you'll receive a Medicaid card which you can show your doctor at an appointment. If your doctor participates in Medicaid the State will pay the bill for the appointment minus any other health insurance you may have. The program pays for many medical services including in- and outpatient hospital care, laboratory services, nursing home care, home health care, transportation necessary to receive medical care (ambulance rides), and other services. In VA the Department of Medical Assistance Services (DMAS) administers the Medicaid program and the Department of Social Services (DZSS) is responsible for reviewing applications and determining eligibility. There are 3 levels of Medicaid benefits

  1. Full coverage – provides normal range of benefits including doctor, hospital, and pharmacy services for those not enrolled in Medicare
  2. Time-limited coverage – includes those who meet spend down eligibility or for women who receive 24 months of family planning services after their Medicaid coverage ends following a pregnancy.
  3. Medicare-related coverage – provides Medicaid payment of Medicare premiums and may also include payment of Medicare's deductible and coinsurance, up to Medicaid's maximum payments

In order to qualify for full Medicaid coverage, you must provide your Social Security number, declare Virginia residency, provide documentation of US citizenship or alien status, and meet the income and asset requirements. These income requirements are listed on in the VA Medicaid handbook (see link below) as a percentage of the federal poverty level, a number evaluated by the federal government annually. To discuss your personal financial situation and see if you qualify for any of the Medicaid programs call DMAS at (804) 786-7933.

Virginians who meet all Medicaid eligibility requirements except for the income ceiling may be placed on a "spend down." Those in this program are called the "medically needy," and may be eligible for Medicaid for a limited period of time. For more information on Virginia Medicaid, open this pdf: http://www.dmas.virginia.gov/downloads/pdfs/ab-VA_MedPrgAtGlance.pdf For even more information, click through the links on the program's website at http://www.dmas.virginia.gov/rcp-home.htm

Virginia Medicaid has 2 managed care programs established to provide health care services to enrollees: Medallion and Managed Care Organization. If you meet the criteria to be assigned to a managed care program, within 15-45 days after your Medicaid approval you will receive a letter from DMAS asking you to choose between these 2 program options. For more information on managed care, or to see if your situation would qualify you, please call DMAS.

For detailed information on all aspects of the Medicaid program and FAMIS see the Medicaid Handbook here http://www.dmas.virginia.gov/downloads/pdfs/rcp-medicaid_applicant_handbook_famis.pdf

Click here to find information on Virginia Medicare Advantage plans.

FAMIS and Other Health Care Programs in Virginia

Children and pregnant women whose income goes over the Medicaid income limit may qualify for the Family Access to medical Insurance Security (FAMIS) program, Virginia's version of the Children's Health Insurance Program. For detailed information on the FAMIS end of Medicaid in Virginia, click here http://www.dmas.virginia.gov/downloads/pdfs/rcp-eigibility_for_cildren_under_age_19_and_pregnant_women.pdf

Some other programs available to Virginians through Medicaid and FAMIS include:

  • Baby Care – provides low-income pregnant women with the support and services they need through intensive case management and coordination of care http://www.vahealth.org/babycare/
  • Smiles for Children – this program provides coverage for diagnostic, preventative, restorative/surgical dental procedures, as well as orthodontia services for Medicaid and FAMIS Plus children. http://www.dmas.virginia.gov/dental-home.htm
  • Family Planning Services Program – within the Medicaid program, women who received Medicaid-paid pregnancy-related services and whose income is less than or equal to 133% of the federal poverty level are eligible to receive family planning services for up to 24 months from the end of the pregnancy http://www.vahealth.org/familyplanning/
  • Emergency Services for Non-citizens – special rules apply for Medicaid to those who are non-citizens. If an individual meets the requirements for one o f the Medic are-related covered groups listed on pages 5 and 6 of the Medicaid Handbook they may be eligible for emergency services coverage and other services. Call DMAS for details.
  • Pharmacy Assistance Programs – for those who need help paying for their prescription medicines should call toll free (888) 477-2669 or see www.pparx.org. For a list of programs, see http://www.dmas.virginia.gov/rcp-prescription_assistance.htm
  • Virginia's Uninsured Medical Catastrophe Fund – http://www.dmas.virginia.gov/rcp-uninsured_medical_catastrophe.htm

For detailed information on all services available in Virginia for people with disabilities, long term illnesses, and the elderly through the Department of Medical Assistance Services look at the state's Road Map to Services at http://www.dmas.virginia.gov/downloads/pdfs/Road_Map_to_Va_services.pdf.

HIPAA Plans - Virginia's High Risk Pool Alternative

For information on HIPAA plans available in Virginia to those residents who are for medical reasons uninsurable on the private market, check out our HIPAA Insurance page.