Virginia is nicknamed as “Old Dominion” and the state is named after England’s Virgin Queen, Elizabeth 1. The state does not lies in the top when it comes to the health rankings and is not considered among the healthier states and there is great room for improvement as far as health of its citizens are concerned. The individual mandate that was earlier into effect after the Affordable Care Act is no more into effect from the start of the year 2019 but still residents are advised to shop for the best individual and family plans that well cater to their comprehensive healthcare needs. Residents of Virginia who are without access to employer-sponsored health insurance coverage can shop or enroll for diverse healthcare plans through private marketplace or through the federal marketplace exchange. The Old Dominion state uses the federally run exchange thus residents can enroll through HealthCare.gov. However, the state is one of the seven federally run exchange, which conducts its own plan management therefore state is quite active in having a close look upon all the plans sold through the exchange. For the 2020 health insurance coverage, the open enrollment period has ended and only residents with qualifying events can still enroll or make changes in their coverage.
Highlights & Updates On Virginal Health Insurance Marketplace
- Virginia uses the federally run exchange so residents of the state enroll through HealthCare.gov.
- The next open enrollment period for health plans effective in 2021 will begin from November 1, 2020, as open enrollment for 2020 health plans has ended.
- A state-run exchange is expected to be created by 2023 in Virginia, as legislation has been introduced in the state’s senate.
- Oscar health insurance carrier has joined the Virginia’s exchange to offer health plans in the Richmond area for 2020.
- Five insurance carriers in Virginia have filed for health insurance rate decrease for 2020 plans.
- Enrollment in private exchange has dropped as of 2020.
- Currently nine insurance carriers are offering health plans for 2020 coverage.
- Short-term health plans are available in Virginia with plans available for the initial terms of up to 364 days.
Individuals & Family Health Insurance Plans
Individuals in Virginia who don’t have access to employer sponsored health insurance plans are responsible for obtaining right health insurance plan for themselves and their family members in order to keep themselves and their families prepared for the medical emergency. This Old Dominion state provides them the option of shopping for individual and family plans either through the federal exchange or through the participating private insurance companies. With the rising health care cost it becomes essential to have ideal health insurance plan that covers their needs and keep them financially protected. Thus all such individuals, who are not receiving health benefits from their current employers, or are either self-employed, unemployed, or a student have the following options in terms of Individuals and Family Health plans:
Heath Maintenance Organization Plan – Individuals with HMO plans are offered with a wide range of healthcare services rendered by a network of healthcare providers by paying a monthly or annual fee. The network of healthcare providers comprises of primary care physicians, clinical facilities and specialists who enter into contracts with the HMO. The in-network physicians and hospitals are paid an agreed-upon fee to provide healthcare services to the members of the plan. Beneficiaries of HMO plans have to choose a primary care physician, who manage their health and also provide referral for seeing a specialist. The premium amount of HMO plans are lower comparatively to other types of health insurance plans. However, HMO plans retain a high quality of healthcare from its network of doctors and hospitals. Individuals who receive healthcare benefits outside the plan’s network have to pay the entire medical cost from their pocket. Though, some out-of-network healthcare services such as emergency care and dialysis can be covered under the HMO plans. Members of the HMO plans are required to work and live in the plan’s network area so that they are eligible for the coverage. HMO plans not only come with low premiums but these plans also have no or low deductibles, though insured have to pay a co-payment for each clinical visit, test, or prescription.
Preferred Provider Organization Plan – Preferred Provider organization is a managed care organization comprising of medical professionals like doctors, specialty physicians, and other healthcare professionals along with hospitals and clinics. The healthcare professionals and hospitals enter into a contract with the insurance carrier to offer medical services to members of the plan at an agreed-upon reduced rate and in return the insurers pay the PPO a fee to access the network of providers. Members of the PPO plans are free to use the healthcare services of any provider within their network. Though, members can access out-of-network care but it will costs them more. PPO plan members have to pay a co-payment per visit and they also need to meet a deductible before insurance covers or pays the claim. PPO plans have higher premiums because these plans are expensive to administer and manage. PPO plan networks are large, as healthcare providers are spread across cities and states and moreover these plans come with more flexibility compared to alternative plans. PPO plans are termed as more comprehensive individual and family plans in terms of coverage because several healthcare services included in PPO plans are either excluded in other plans or additional premium is charged for them.
Point-of-Service Plan – POS plans come with the combine features of both HMO and PPO plans and its benefits depend whether the members of the plan uses in-network or out-of-network health care providers. This managed-care health insurance plan requires policyholders to choose an in-network primary care doctor and obtain referral before seeing a specialist just like an HMO plan. A POS plan also provides coverage for out-of-network services but the policyholders are required to pay more just like a PPO plan. POS plans do not have deductibles for in-network services and even the co-payment amount in the POS plan is less if in-network medical services are availed. Besides, this plan also offer nationwide coverage that proves to be extremely beneficial for policyholders who have to frequently travel. A major disadvantage of POS plan is that the out-of-network deductibles seen to be high for POS plans. POS plan can be 50% cheaper than PPOs plan, though most of the policyholders find this plan confusing and challenging and they are unable to understand its costs. So individuals must carefully read the plan documents carefully and compare the available choices before deciding the best option for them.
Fee-for-Service Plan – Fee-for-service or Indemnity plans allow individuals to completely manage their healthcare and visit any doctor or hospital of their choice and they also do not need to obtain any referral for it. A set portion of their healthcare charges are paid by the insurance company. Members of this plan have the option to receive most of the healthcare from a single doctor but they are not compel to choose a primary care physician. In this plan members are required to pay up-front for the received healthcare services and later on submit a claim to the insurance company for reimbursement. They are also required to pay an annual deductible before start receiving claims from the insurance company. Once the insured meet the deductible amount, the insurance company starts paying the policyholder’s claim at a set percentage of the usual, customary and reasonable (UCR) rate. The UCR rate is the amount charged by the healthcare providers of the insured area, which they generally charge for any given medical service.
High-Deduction-Health Plan with HSA – A high deductible is a type of health insurance plan that comes with lower monthly premiums and a higher deductible. It is considered as an affordable health insurance plan but the deductibles are pretty high compared to a traditional healthcare plan. However, once the policyholders reach their annual deductible amount then they are 100% covered for the remaining part of the year. As per the IRS rules, a minimum deductible for an HDHP is $1,400 for an individual and $2,800 for a family plan in 2020. In addition to this, the plan’s out-of-pocket maximum must not be higher than $6,900 in 2020 for an individual plan or $13,800 for a family plan in 2020. Individuals who do not anticipate much medical expenses in the coming year can choose HDHP and minimize their premiums amount. Though, individuals need to be sure to afford the out-of-pocket expenses in case if required so. A qualified High Deductible Health Plan is often paired with an health Savings Account that allow individuals to save for health care expenses. The amount saved on the premium of HDHP plan can be deposited in HSA to offset out-of-pocket expenses not covered in this plan.
Short-term Health Insurance Plan in Virginia
A short-term health insurance plan is considered as an ideal option for individuals, who do not have employer-sponsored coverage or those who missed open enrollment dates or who don’t qualify for Medicaid. Individuals looking to shop for short-term plans should remember that this plan does cover some essential health benefits like prescription drugs, maternity care, mental health services and prescription drugs. Virginia’s regulations clarify that various state rules do not apply to short-term plans, if these plans are nonrenewable and are of duration of not more than six months. However, short-term plans issued out-of-state associations, which currently include all short-term plans available in the state can be renewed for up to 36 months. As per the state regulations the short-term plans issued by an in-state insurance carrier to be guaranteed renewable for a period of up to 36 months. Therefore, individuals looking for short-term plans should first evaluate their healthcare needs before purchasing it.
Dental Insurance Plan in Virginia
Individuals in Virginia have the option of flexible and cost-effective dental plans that will certainly secure them a healthy smile. Is is vital for the individuals to have dental insurance plans, which will allow them take proper care of their teeth. Right from regular check-ups, cleanings, x-rays to dental care services that are essential to promote general dental health, dental insurance plans cater to complete oral healthcare needs. Some of the dental plans even provide coverage for oral surgery, dental implants and orthodontia.
Dental insurance plans in Virginia are categorized as:
Dental PPO Plans – Dental Preferred Provider organization plans in Virginia allow individuals the flexibility to choose any dentist of their choice to receive dental care. Individuals have the option to choose an out-of-network dentist to receive dental care but probably the benefits might be reduced. Most of the dental plans available in Virginia are PPO plans, however individuals need to choose the right PPO plan after carefully analyzing deductibles, annual maximums and waiting periods. A dental plan with lower premium can actually cost ore if it has a low annual maximum and high deductible.
Dental Health Maintenance Organization – DHMO plans maintain a dental network of dentist from which the policyholders are required to choose a primary dentist for receiving any type of dental care. In case if individuals visit an out-of-network dentist for receiving dental care then they have to pay the entire service cost from out-of-pocket. Dental Health Maintenance Organization plans do not have deductibles, waiting period or annual maximums and insured just have to pay a fixed copay for treatments.
Dental Discount Plans – Dental discount plans are not really insurance but it proves beneficial for individuals who wish to reduce the cost of their dental care services. In this members are not required to pay a premium rather they pay a monthly or annual fee to get plan benefits. Members upon visiting an in-network dentist receive discounts for certain dental services and there is no need to file any claim for obtaining a discount on the dental service.
Vision Insurance in Virginia
Individuals in Virginia should purchase a standalone vision insurance plan that offers comprehensive vision care for them and their families without burning a hole in their pocket. Most of the vision insurance plans available here don’t meet the state’s insurance definition and are usually termed as the benefits plans. Low-cost vision plans in Virginia function like simple discount plans whereas more comprehensive plans cover a larger vision care expenses. Vision care plans in exchange of premium pays for the insured basic vision care needs like regular check-ups, lens, frames and even for certain types of contact lens. Most of the vision insurance plans do not have deductibles though insured need to pay a co-payment for many eye-care services.
Insurance Carriers in Virginia
Currently, there are nine health insurance companies offer ACA-compliant health plans in Virginia, compared to seven insurance companies available last year. These companies include:
- Cigna Health
- Group Hospitalization and Medical Services Inc.
- HealthKeepers Inc.
- Kaiser Foundation Health Plan of the Mid-Atlantic States Inc.
- Optima Health Plan
- Oscar Health
- Piedmont Community HealthCare HMO Inc.
- Virginia Premier