Virginia residents have access to comprehensive health insurance coverage through the Affordable Care Act (ACA), and understanding what benefits are available can save you thousands of dollars each year. Whether you are shopping for individual coverage, looking for family plans, or trying to figure out if you qualify for financial assistance, this guide walks you through everything you need to know about Virginia ACA benefits and coverage for 2026. You can also check your eligibility for multiple programs in just a few minutes.
For a broader look at all assistance programs available in the state, visit our Virginia Benefits Overview.
Virginia's Insurance Marketplace: How It Works
Virginia operates its own state-based health insurance marketplace called Virginia's Insurance Marketplace (VIM). Launched in the fall of 2023, this platform replaced HealthCare.gov as the place where Virginia residents shop for ACA coverage. The marketplace is the only place where you can access premium subsidies and cost-sharing reductions to lower the cost of health insurance.
For the 2026 plan year, eight insurance carriers are offering plans through the Virginia marketplace. You can browse, compare, and enroll at marketplace.virginia.gov.
Who Can Enroll?
To purchase coverage through Virginia's Insurance Marketplace, you must:
- Live in Virginia
- Be lawfully present in the United States
- Not be currently incarcerated
- Not be enrolled in Medicare
Essential Health Benefits in Virginia
All ACA marketplace plans in Virginia are required to cover ten categories of essential health benefits (EHBs). Starting in 2025, Virginia updated its essential health benefits benchmark plan to include additional coverage for certain prosthetic devices and formula and enteral nutrition products for inherited metabolic disorders.
The ten essential health benefit categories include:
- Ambulatory patient services (outpatient care you receive without being admitted to a hospital)
- Emergency services (emergency room visits)
- Hospitalization (inpatient care when you are admitted to a hospital)
- Maternity and newborn care (care before and after your baby is born)
- Mental health and substance use disorder services (including behavioral health treatment and counseling)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help recover from injuries, disabilities, or chronic conditions)
- Laboratory services (blood tests, screenings, and other lab work)
- Preventive and wellness services and chronic disease management (annual checkups, vaccinations, and screenings at no additional cost)
- Pediatric services (including dental and vision care for children)
All marketplace plans must also cover these additional protections under the ACA:
- No annual or lifetime dollar limits on essential health benefits
- No denial of coverage for pre-existing conditions
- Coverage for young adults on a parent's plan until age 26
- Free preventive care services (such as flu shots, cancer screenings, and wellness visits)
Plan Levels (Metal Tiers)
Virginia marketplace plans come in four metal tiers. Each tier covers the same essential health benefits, but they differ in how costs are shared between you and the insurance company.
| Metal Tier | Insurer Pays | You Pay | Best For |
|---|---|---|---|
| Bronze | 60% | 40% | Lower monthly premiums, higher out-of-pocket costs |
| Silver | 70% | 30% | Moderate premiums, access to cost-sharing reductions |
| Gold | 80% | 20% | Higher premiums, lower costs when you need care |
| Platinum | 90% | 10% | Highest premiums, lowest costs at the point of care |
Silver plans are especially valuable for lower-income households because they are the only tier eligible for cost-sharing reductions (CSRs), which lower your deductibles, copays, and out-of-pocket maximums.
Premium Subsidies and Financial Assistance
The ACA provides advance premium tax credits (APTC) to help lower your monthly insurance premiums. These subsidies are available to individuals and families who meet income requirements and enroll through Virginia's Insurance Marketplace.
Important 2026 change: The enhanced subsidies that were in place since 2021 under the American Rescue Plan expired at the end of 2025. For 2026, subsidies are reverting to their original ACA levels, meaning they are available only to households earning between 100% and 400% of the federal poverty level (FPL). Some enrollees may see higher premiums as a result.
2026 ACA Subsidy Income Limits for Virginia
The following table shows the income ranges for premium subsidy eligibility based on the 2025 federal poverty guidelines (used for 2026 marketplace plans):
| Household Size | 138% FPL (Medicaid Ceiling) | 400% FPL (Subsidy Cap) |
|---|---|---|
| 1 | $20,783 | $60,240 |
| 2 | $28,207 | $81,760 |
| 3 | $35,631 | $103,280 |
| 4 | $43,056 | $124,800 |
| 5 | $50,480 | $146,320 |
| 6 | $57,904 | $167,840 |
- If your income falls below 138% FPL, you likely qualify for Virginia Medicaid (Cardinal Care) instead of marketplace subsidies.
- If your income is between 138% and 400% FPL, you may qualify for premium tax credits through the marketplace.
- If your income is above 400% FPL, you can still purchase a marketplace plan but will not receive premium subsidies.
Cost-Sharing Reductions (CSRs)
If your household income is at or below 250% FPL and you select a Silver plan, you may qualify for cost-sharing reductions that lower your deductible, copayments, and maximum out-of-pocket costs. CSRs are applied automatically when you choose a Silver plan and meet the income requirements.
| Income Level | Actuarial Value of Silver Plan |
|---|---|
| 100% to 150% FPL | 94% (plan pays 94% of costs) |
| 150% to 200% FPL | 87% (plan pays 87% of costs) |
| 200% to 250% FPL | 73% (plan pays 73% of costs) |
| Above 250% FPL | 70% (standard Silver plan) |
How to Enroll in Virginia ACA Coverage: Step by Step
Step 1: Gather Your Documents
Before you begin, have the following ready for each person you want to cover:
- Social Security numbers
- Immigration documents (if applicable)
- Employer and income information (pay stubs, W-2s, or tax returns)
- Information about any current health coverage
- Policy numbers for any current insurance plans
Step 2: Check Your Eligibility
Use our free benefits screener to see what programs you may qualify for, including ACA subsidies, Medicaid, and other assistance programs. You can also use the marketplace's cost calculator at marketplace.virginia.gov.
Step 3: Create an Account
Visit Virginia's Insurance Marketplace and create an account. You will need to provide basic personal information, verify your identity, and complete your application.
Step 4: Compare Plans
Browse available plans by metal tier, monthly premium, deductible, and provider network. Pay attention to:
- Monthly premium after subsidies
- Annual deductible
- Out-of-pocket maximum
- Whether your doctors and prescriptions are covered
Step 5: Enroll
Select your plan and complete enrollment. If you are enrolling during open enrollment (November 1, 2025 through January 30, 2026), your coverage can start as early as January 1, 2026.
Step 6: Pay Your First Premium
Your coverage does not begin until you pay your first monthly premium. Contact your insurance company directly to make your first payment.
Open Enrollment and Special Enrollment Periods
Open Enrollment for 2026
The open enrollment period for 2026 Virginia marketplace plans runs from November 1, 2025 through January 30, 2026.
- Enroll by December 31, 2025 for coverage starting January 1, 2026
- Enroll between January 1 and January 30, 2026 for coverage starting February 1, 2026
Special Enrollment Periods
Outside of open enrollment, you can enroll or change plans if you experience a qualifying life event, such as:
- Losing other health coverage (job loss, aging off a parent's plan)
- Getting married or divorced
- Having or adopting a child
- Moving to a new area
- Changes in household income that affect eligibility
- Losing Medicaid or CHIP coverage
You generally have 60 days from the qualifying event to enroll in a new plan.
Virginia Medicaid and FAMIS: Alternative Coverage Options
If your income is too low for marketplace subsidies, you may qualify for Virginia Medicaid (Cardinal Care) or FAMIS (the state's Children's Health Insurance Program).
Virginia Medicaid (Cardinal Care)
Virginia expanded Medicaid in January 2019, covering adults aged 19 to 64 with incomes up to 138% FPL. Over 595,000 Virginians are enrolled through the expansion.
| Category | Income Limit |
|---|---|
| Adults (19 to 64) | 138% FPL |
| Children (Medicaid) | 148% FPL |
| Children (FAMIS) | 205% FPL |
| Pregnant women (Medicaid) | 148% FPL |
| Pregnant women (FAMIS MOMS) | 205% FPL |
Apply through CommonHelp or call Cover Virginia at 1-855-242-8282.
FAMIS (Children's Coverage)
FAMIS covers children under 19 in families earning up to 205% FPL. The program offers medical, dental, vision, behavioral health, and prescription coverage with no premiums, copays, or deductibles.
Virginia's Easy Enrollment Program
Virginia offers a unique easy enrollment program that connects you to health coverage through the tax filing process. When you file your Virginia state tax return, you can check a box authorizing the state to share your information with Virginia Medicaid and the marketplace to determine your eligibility for coverage and financial help. This is a simple way to find out if you qualify without completing a separate application.
Additional Benefits You May Qualify For
Beyond ACA coverage, Virginia residents may be eligible for other assistance programs that can reduce household expenses. Use our free screener tool to check your eligibility for:
- SNAP (food assistance) for households up to 200% FPL
- LIHEAP (energy assistance) for households up to 150% FPL
- WIC (nutrition for pregnant women and young children) up to 185% FPL
- Child Care Subsidy for working families
- Lifeline (phone and internet discount)
Frequently Asked Questions
What does Virginia ACA coverage include?
All Virginia marketplace plans cover the ten essential health benefits required by the ACA, including doctor visits, hospital care, prescriptions, mental health services, maternity care, preventive care, and more. Preventive services like annual checkups and vaccinations are covered at no additional cost.
How much does ACA health insurance cost in Virginia?
Costs vary based on your age, location, plan tier, and income. For 2025 plans, the average monthly premium after subsidies was about $135 for subsidy-eligible enrollees. Use our screener or the Virginia marketplace cost calculator to estimate your costs.
Can I get free health insurance in Virginia?
If your income is at or below 138% FPL, you may qualify for Virginia Medicaid (Cardinal Care), which provides free or very low-cost coverage. Some marketplace enrollees with very low incomes also pay $0 in monthly premiums after subsidies are applied.
What if I miss open enrollment?
If you miss the open enrollment period, you may still enroll if you experience a qualifying life event such as losing other coverage, getting married, having a baby, or moving. You typically have 60 days from the event to sign up.
Is Virginia a Medicaid expansion state?
Yes. Virginia expanded Medicaid in January 2019, covering adults with incomes up to 138% of the federal poverty level. This means there is no coverage gap for low-income adults in Virginia.
How do I apply for Virginia ACA coverage?
Visit Virginia's Insurance Marketplace online, call 888-687-1501, or work with a licensed insurance agent, Navigator, or certified application counselor. You can also check your eligibility first using our free screening tool.
What changed about ACA subsidies in 2026?
The enhanced premium subsidies from the American Rescue Plan, which were in effect from 2021 through 2025, expired at the end of 2025. For 2026, subsidies are capped at households earning up to 400% FPL, and some enrollees may see higher premiums. Virginia's reinsurance program continues to help moderate rate increases.
Get Started Today
Finding the right health coverage in Virginia does not have to be complicated. Start by checking your eligibility for ACA subsidies, Medicaid, and other programs in just a few minutes. Virginia's Insurance Marketplace and programs like Cardinal Care and FAMIS ensure that affordable coverage options are available for residents at every income level.
For questions about enrollment, contact Virginia's Insurance Marketplace at 888-687-1501 or Cover Virginia at 1-855-242-8282.
