Virginia's Obamacare exchange opens Wednesday

Wednesday starts a new way for Virginians to get Obamacare coverage, with the launch of Virginia's Insurance Marketplace.

As of Nov. 1, the start of the open enrollment period when Americans can start looking for Affordable Care Act health insurance coverage for 2024, Virginians will do so through the state-regulated health benefit exchange.

Virginia set up this health insurance marketplace, replacing the federal government's healthcare.gov, in order to enroll more residents in affordable coverage and tailor the insurance shopping experience to Virginians. The State Corporation Commission oversees the marketplace. Insurers project 2024 enrollment in ACA plans at a bit more than 680,000 Virginians, a Richmond Times-Dispatch analysis of their rate filings shows.

The marketplace is for Virginians who don't have access to affordable health coverage at work, including people who are self-employed or unemployed. If you can get Medicare or Medicaid you don't need coverage through the state marketplace.

Getting coverage is important, the SCC said.

"It allows you to get the care you need while also protecting you from life-altering medical expenses. Accidents can happen to anyone at any age, even if you're healthy," it said.

"Health insurance also may not be as expensive as you think," the commission added. "The Marketplace offers affordable coverage options, and financial assistance is available to Virginians who qualify."

You can get started online here https://www.marketplace.virginia.gov/new-customers or by calling the SCC consumer assistance center here 888-687-1501.

You can find someone to meet you face to face for help with what can seem the complicated question of the best kind of coverage here https://enroll.marketplace.virginia.gov/hix/entity/locateassister/searchentities

If you recently lost Medicaid coverage or have gone through another big change like marriage or pregnancy and need coverage for the remainder of 2023, you should go to where Virginians had been directed for ACA coverage until now: the federal government's healthcare.gov. For next year though, you need to use the state marketplace.

The marketplace is for Virginians who don't have access to affordable health coverage at work, including people who are self-employed or unemployed. If you can get Medicare or Medicaid you don't need coverage through the state marketplace.

Low income Virginians can get Medicaid: youth under 19 and pregnant women in households at 148% of the federal poverty level or less can qualify (for one child living with a single parent, the cutoff is $29,186 a year. For adults up to 65, the Medicaid cutoff is 138% of the poverty line, or$20,121 for a person living alone. For the aged, blind or disabled the cutoff is $972 a month for someone living on his or her own.

But for people with larger incomes there are subsidies that hold down the monthly cost of ACA insurance.

There are five basic types of coverage: bronze plans are designed to pay 60% of a typical Virginian's health care costs, with the individual picking up the rest; silver plans are designed to cover 70% of costs; gold plans 80% and platinum plans 90%. Virginians under 30 can get catastrophic coverage, with low premiums but high out of pocket costs.

Generally, insurance experts say people who expect to see the doctor a lot or if they need regular prescriptions a gold or platinum plan, which have higher premiums but cover more costs, may be the best option.

For others, a silver or bronze of catastrophic plan may make more sense. People with silver plans can qualify for cost sharing help with out of pocket expenses, if their household income is no more than 250% of the federal poverty level.

ACA policies in Virginia must cover essential benefits.

These include: emergency care; care in a hospital; outpatient care; pregnancy, maternity, and newborn care; mental health and substance abuse services; prescription drugs; rehabilitation services and devices; laboratory work; preventive care; chronic disease management and pediatric services including children's dental and vision care.

When applying, you'll need a photo ID, your Social Security number, your most recent tax return; pay stubs from the last four weeks and if you are not a citizen immigration documents.

Using the exchange will get you coverage from a regulated insurance company – the SCC makes sure its rates aren't unfairly high or so low that the company can't actually pay claims. You pay your premiums to the insurer, not the state marketplace, and you have to pay premiums on time to maintain coverage.