Virginia Health Insurance Exchange Guide

May 14, 2013

This guide provides an overview of the Virginia Health Insurance Exchange including the history of the Exchange, how the Exchange will operate, and Exchange information for Virginia residents and small businesses.

Beginning in 2014, as part of the Affordable Care Act (ACA), health insurance coverage for individuals and small businesses will become available through new state health insurance exchanges (also called health insurance marketplaces). Virginia Health Insurance Exchange, VA Health Insurance Exchange

Most importantly, the key tax credits (e.g. the small business healthcare tax credits) and tax subsidies (e.g. individual health insurance tax subsidies) will only be available for coverage purchased through a state health insurance exchanges. 

All states have three options for setting up a state health insurance exchange for 2014:

  1. Build a State-Based Exchange

  2. Enter into a State-Federal Partnership Exchange

  3. Default to a Federally-Facilitated Exchange

Virginia will default to a federally-facilitated health insurance exchange, while maintaining involvement with plan management functions. The Virginia Health Insurance Exchange will open October 1, 2013, with coverage beginning January 1, 2014.

Virginia Health Insurance Exchange - History

Originally, Virginia officials explored operating a state-based health insurance exchange. In April 2011, Virginia Governor McDonnell signed HB 2434 into law declaring the state’s intent to establish a state-based health insurance exchange. The legislation was based on recommendations by the Virginia Health Reform Initiative Advisory Council. However in November 2011, Governor McDonnell opposed passing additional legislation needed for the establishment of a state-based exchange until after the Supreme Court ruled on the ACA in June 2012. After ACA was upheld, numerous bills to establish a state-based health insurance exchange were introduced in the 2012 Virginia Legislature however none were brought to voting. 

In March 2013, Virginia received approval from the Center for Consumer Information and Insurance Oversight (CCIIO) to perform plan management activities of the Virginia Health Insurance Exchange. The federal government will oversee and manage all other Exchange functions.

Virginia Health Insurance Exchange - What is it?

The Virginia Health Insurance Exchange will be operated through a federally-run Health Insurance Exchange (also called the "Health Insurance Marketplace"). According to healthcare.gov, starting in October 2013 Virginia residents will be able to access information about insurance plans available through the Exchange. The SHOP Exchange will be available to small businesses in Virginia for businesses with 100 or fewer employees. Coverage starts January 1, 2014.

According to an estimate by healthcare.gov, 844,752 or 12% of Virginia's non-elderly residents are uninsured, of whom 775,334 (92%) may qualify for either tax credits to purchase coverage in the Exchange or for Medicaid if Virginia participates in Medicaid expansion. Through the Exchange, Virginia residents can shop for and compare insurance plans, access insurance premium tax credits, and be screened for eligibility in public assistance programs such as Medicaid and CHIP. 

Click here for information on the federally-run Health Insurance Exchange.

Virginia Health Insurance Exchange - What Plans will be Available?

All plans offered through the Virginia Health Insurance Exchange will meet the ACA definition of a Qualified Health Plan (QHP). The plans will be offered by level of coverage for essential health benefits (EHB), to allow consumers to compare plans on an "apples to apples" basis. The four "metal" levels are: Bronze (plan pays 60%), Silver (plan pays 70%), Gold (plan pays 80%) and Platinum (plan pays 90%). More information on the types of plans that will be available, and the carriers offering plans in Virginia, is expected by late summer 2013.

Virginia Health Insurance Exchange - Role of Insurance Professionals & Navigators

The Virginia Health Insurance Exchange will follow federal guidelines for insurance professionals selling policies through the Exchange, and for Navigators assisting consumers and small businesses.

Insurance professionals will be able to register with the Virginia Health Insurance Exchange and receive any commissions directly from the carriers (using their Exchange ID number and NPN). For more information see: Role of Agents in Health Insurance Marketplaces.

The Virginia Health Insurance Exchange Navigator program will assist consumers in making choices about their health care options and accessing their new health care coverage, including access to premium tax credits for some consumers. The federal government will run the Navigator program in Virginia.

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