No one wants to spend the time to shop for health insurance. After all, you’d rather spend time enjoying the scenery and history of Virginia. We’re here to help your search for health insurance a little easier, so you can spend more time on the things you want to do.
Quick Look: The Best VA Health Insurance
- Best for Access to Specialists: Kaiser Permanente
- Best for Member Support: Aetna
- Best for Pharmacy Programs: Cigna
- Best for Quality Health Insurance: Anthem
- Best for Nationwide Coverage: CareFirst Blue Cross Blue Shield
The Best VA Health Insurance
You might feel overwhelmed as you search for the best health insurance in Virginia. Between plan types, deductibles and premiums, it’s difficult to know which option is best. Let us help you start your search with our top picks for the best insurance providers in Virginia.
1. Kaiser Permanente
Kaiser Permanente, or the Kaiser Foundation Health Plan, is an excellent option for anyone who needs health insurance in Virginia. The company won the 2019 J.D.
Power Health Plan Satisfaction Study Award, ranking among the best providers in overall satisfaction. Kaiser gives you plenty of plan options.
You can choose to have a lower-cost premium and higher deductible or pay a little more each month and get a lower deductible.
While Kaiser won the J.D. Power award for the greater Southern Atlantic area, Aetna Better Health of Virginia won the 2019 award in Virginia. Aetna ranks among the best for insurance providers in overall satisfaction and cost.
In addition, the company has an A+ rating with the Better Business Bureau (BBB). You can find a lot of great resources and transparent communication about coverage on the easy-to-use Aetna Better Health of Virginia website.
Cigna also has an A+ rating with the BBB. The company provides several mobile apps to help you stay connected to your health. Access your ID card, view claims history and find what’s covered by your plan with the myCigna Mobile App.
Coach by Cigna gives you access to health and fitness resources right in your pocket. The other apps provide a combination of member services and health resources so you can download the app that’s best for your lifestyle.
Anthem Health Plans of Virginia give you excellent access to a large provider network.
The company ranks highly for coverage and benefit options in the 2019 J.D. Power Health Satisfaction Survey.
The sleek, secure website allows you to make payments online and view important information about your plan.
5. CareFirst Blue Cross Blue Shield
CareFirst provides some health insurance plans in Virginia. Plans are available to residents of Northern Virginia with options for affordable premiums and great coverage.
A big benefit of CareFirst plans is the ability to get a video visit with a doctor. If you can’t make it to a healthcare facility, you can video chat with a doctor to get the care you need.
- Best For:Nationwide coveragesecurely through Blue Cross Blue Shield Health Insurance's website
What is Health Insurance?
Medical treatments and services are expensive. Even a simple annual checkup at the doctor could cost you a lot of money. You can use health insurance to help combat the cost of health care.
Health insurance is a type of insurance that helps you pay for medical services. You pay your insurance company a monthly fee, called a premium, to enroll in a health insurance plan. When you visit the doctor, your health insurance plan helps cover part of the cost.
For example, you catch a disease that leaves you in the hospital for several days. Your hospital and medical bills would likely be several thousand dollars. Without insurance, you have to pay the full amount of your expensive medical bills yourself. With health insurance, your insurance company helps you by paying a share of the cost.
Average Cost of Health Insurance in Virginia
The cost of health insurance in Virginia depends a lot on whether you have health insurance through a group plan or an individual plan.
A group plan is health insurance coverage you get from an employer. You may have health insurance benefits through your job or your spouse’s job. Group coverage is almost always less expensive than individual health insurance. Your employer pays the majority of your monthly premium. As an employee, you only cover a percentage.
In Virginia, employer health insurance coverage costs $6,635 annually. Employers pay on average $4,889 per year or about $407 per month. As an employee, you can expect to pay $1,746 annual or about $146 per month.
Individual health insurance plans often cost more than a group insurance plan. If you’re self-employed or your employer doesn’t offer health benefits, you may wonder how to get health insurance. One option is to visit the government-run Healthcare Marketplace or contacting insurance providers directly.
Costs for individual plans in Virginia average about $521 per month for middle-tier coverage. That’s a cost of $6,252 annually, which is $708 higher than the national average for similar plans.
Other Costs of Health Insurance
Your monthly premium isn’t the only money you’ll pay for health insurance. Although the specific costs vary by plan, health insurance comes with some expenses you may not be expecting.
- Deductible: A deductible is money you pay out of pocket before your health insurance pays. You might have a deductible of $4,000 and need a $4,500 medical treatment. You’ll need to cover the first $4,000 of the treatment before your insurance pays anything. Plans with higher monthly premiums generally have lower deductibles than more affordable health insurance plans.
- Coinsurance: This is your percentage share of the cost of medical treatments or services. Once you meet your deductible, you’ll pay a percentage of the cost of medical services. For example, a doctor’s visit might have 20% coinsurance. You’ll pay 20% and your insurance pays the remaining 80%.
- Copayment: A copay is similar to coinsurance, but you’ll pay a fixed price instead of a percentage. You may have a $20 copay as a fee to visit the doctor.
- Provider network: Most health insurance plans have a group of doctors that contract with the insurance company. Medical services are less expensive when you visit an in-network doctor. Depending on your plan, you may have to cover the full cost of services if you use an out-of-network doctor.
- Out-of-pocket maximum: The out-of-pocket maximum is the total amount of money you’ll pay for covered services. For example, your out-of-pocket max is $8,000. Once you reach that amount, through your deductible and often your coinsurance or copayments, you won’t have additional out-of-pocket expenses. Your premium payment doesn’t count toward the out-of-pocket maximum.
Types of Health Coverage
As you shop for health insurance, you may notice different types of plans are available. There are 2 main types of health coverage. Each type of coverage comes with advantages and disadvantages.
- Health maintenance organization (HMO): An HMO plan uses a provider network to help reduce the cost you’ll pay when you visit the doctor. When you sign up for an HMO, you’ll need to choose a primary care provider. This is the doctor or healthcare facility you’ll use for all of your medical needs. If you need to see a specialist, you’ll have to get a referral from your primary doctor. Going to an out-of-network doctor means you’ll cover the full cost out-of-pocket.
- Preferred provider organization (PPO): PPO plans use a provider network like HMO plans. With this plan, you’re not required to choose a primary care provider and can visit out-of-network doctors. If you choose to see an out-of-network provider, you can expect to pay a bit more out of pocket than you would at an in-network doctor.
What Does Health Insurance Cover?
Although each health insurance plan is different, most plans cover similar medical treatments and services. The Affordable Care Act requires insurance companies that offer Marketplace plans to cover certain services. This doesn’t mean your insurance has to cover the full cost of these services. You can still expect to pay your deductible and any coinsurance or copays for these services.
The 10 services are known as essential benefits and include:
- Ambulatory patient services: Also called outpatient care, you’ll probably use this coverage more than any other essential benefit. Outpatient care is any service or minor medical treatment you get without staying at the hospital. For example, a visit to the doctor to get medicine for the flu is an ambulatory patient service.
- Prescription drugs: Health insurance plans must cover at least one drug in each drug category. Your insurance plan may cover a certain brand of antibiotics, for example.
- Laboratory services: Your insurance has to provide coverage for diagnostic testing in addition to preventive screenings. Things like bloodwork fall into this category.
- Emergency services: Insurance companies can’t require preauthorization, charge you more or deny coverage for care administered in an emergency. Be sure to check what constitutes an emergency by contacting your insurance company.
- Preventive care: Your health insurance plan covers preventive, or wellness, care services. This includes regular checkups and health screenings for common diseases. This benefit also includes coverage for the care and treatment of chronic diseases.
- Pregnancy and newborn care: Your health insurance cannot charge you more if you’re pregnant when you sign up for the plan or because you’re a woman. After the birth of your child, your insurance must allow you to add your child to your insurance plan. You can also choose to change insurance plans after you have a child.
- Rehabilitative and habilitative services: These are the services, treatments and medical devices you need to regain or develop mental and physical skills. This could include physical therapy or a wheelchair after an accident.
- Hospitalization: Insurance must include surgery and overnight hospital stays in your coverage. Be aware, however, that your insurance company doesn’t have to cover the full amount of your stay.
- Mental health and substance use disorders: Although your plan may limit the number of visits you can have per year, it must cover mental health and behavioral services. This includes seeing a psychiatrist or going through a substance abuse program.
- Pediatric services: Pediatric services refer to medical coverage for children. In addition to medical treatment and services for kids, your insurance must provide dental and vision benefits for children.
What Does Health Insurance Not Cover?
Your health insurance can choose not to cover medical treatments or services outside the 10 essential benefits. However, most insurance plans limit coverage exclusions to experimental treatments and cosmetic surgery.
Example of services most insurance won’t cover include:
- Adult dental
- Cosmetic surgery
- Weight loss treatment
- Alternative treatments like acupuncture
Get Health Insurance Coverage in VA
Always speak with a representative of an insurance company before you enroll in a plan. Ask questions about coverage, benefits and costs so you have an idea of what your insurance might cost. Start your search today by comparing rates from different insurance providers in Virginia.
Does Virginia has Medicaid health insurance?
Yes, Virginia has Medicaid health insurance for which you may qualify if you are a low-income resident.
Does health insurance cover dental work?
Health insurance in Virginia makes some allowances for dental care, but you generally need a dedicated dental insurance policy.