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Getting Health Coverage in Virginia

Author: Deepak Madala

You have options for getting health coverage in Virginia, and free help is available. Many Virginians can get free or low-cost health coverage through programs like Medicaid and Virginia’s Insurance Marketplace. This guide explains the main programs and how to find the right one for you.

What if I need help right away? 

If you need help now, contact Enroll Virginia. Enroll Virginia is a free service with trained helpers called navigators. They can help you find and sign up for coverage. They work in your community and speak many languages.

Call 888-392-5132 or visit enrollva.org.

What if I am about to lose my coverage?

If you think you are about to lose your health insurance, do not wait. Many enrollment deadlines are very strict. For example, if you lose your job, you have 60 days to sign up for a new Marketplace plan. If you miss that window, you could be uninsured for months.

You can apply for Medicaid year-round. It’s still a good idea to move fast when you lose health coverage, to avoid gaps in your coverage. An Enroll Virginia navigator can help you with the application. 

What are my health coverage options? 

The right health coverage for you depends on your age, your income, your family situation, and other factors. Here are the main programs available in Virginia.

Virginia's Insurance Marketplace

The ACA Marketplace lets you shop for private health insurance. You may be eligible for financial help (tax credits) to lower the cost of your monthly premiums. Some people also qualify for lower deductibles and other out-of-pocket costs.

Who can use the Marketplace:

  • People who don't qualify for Medicaid
  • People who don't get insurance through their job
  • People who have a qualifying immigration status

Enroll Virginia navigators can help you apply for a Marketplace plan for free.

Important note for 2026: Federal changes may impact rates for Virginians enrolling in 2026 coverage. Contact Enroll Virginia for up-to-date information about costs and financial help.

Medicaid

Medicaid is free or low-cost health coverage from the government. You may qualify if you are a low-income adult or senior, a child, pregnant, or a person with a disability.

Who can get Medicaid:

  • Low-income adults
  • Children
  • Pregnant people
  • People with disabilities
  • Seniors, including individuals who need long-term care

To find out if you qualify, check the income guidelines for adults 19–64 or children and families.

What Medicaid covers:

  • Doctor visits
  • Hospital care
  • Prescriptions
  • Dental care
  • Vision care
  • Behavioral health care
  • Transportation to appointments

Virginia partners with health plans called Managed Care Organizations (MCOs) to provide Medicaid benefits. Your MCO may offer additional benefits. Check with your MCO or visit virginiamanagedcare.com to learn more.

Virginia also provides coverage for children and pregnant people through FAMIS. FAMIS has income requirements, but they are less strict than Medicaid. Families with modest incomes who don't qualify for Medicaid may still qualify for FAMIS. You can apply for FAMIS the same way you apply for Medicaid. 

How to apply:

Medicare

Medicare and Medicaid are two different programs. Medicare is a federal health insurance program for:

  • People 65 and older
  • People with disabilities who have been on Social Security Disability or SSI for 2 years or more
  • People with end stage renal disease or ALS (Lou Gehrig’s disease)
  • People who meet work history and immigration status requirements

When you sign up for Medicare, you can choose how you get your Medicare benefits. There are two common ways to get Medicare: Original Medicare and Medicare Advantage (also known as “Part C”).

Original Medicare

Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). People with Original Medicare can use any doctor or hospital that takes Medicare, anywhere in the U.S. Many people who have Original Medicare also buy supplemental coverage called “Medigap plans.” This is a plan you buy from a private insurer to help pay for costs your Medicare doesn’t cover.

Medicare Advantage

Medicare Advantage is an alternative to Original Medicare. Private companies provide Medicare Advantage plans that cover the same benefits as Original Medicare. Many of these plans include extra benefits that Original Medicare does not cover. The extra benefits can include drugs, vision, dental, hearing, and more.

If you have a Medicare Advantage plan, you can only use doctors in the plan network. These plans also often require pre-approval for drugs and services. Original Medicare does not have these limits on provider choice, or the pre-approval requirements. A VICAP counselor can help you review your options and decide which one is best for you. 

Medicare Part D

Medicare members on Original Medicare and Medicare Advantage plans who need drug coverage can enroll in Medicare Part D. Part D benefits are provided by private companies.

If you can’t afford Medicare, you may be able to get help from the Virginia Medicaid program to pay some of your Medicare costs. Your income and resources determine the amount of help you can get. 

Medicare is complicated. The federal government publishes a free Medicare guide every year. It explains the different parts of Medicare and how you can apply. You don’t have to figure out the details alone. There are free programs that can answer your questions about Medicare and other health coverage options.

Get free help with Medicare: 

Employer coverage

If your employer offers health insurance, talk to your HR department to learn about your options.

Special information

If you're not a U.S. citizen: 

  • You might still be able to get health coverage.
  • Children can often get coverage even if their parents can't.
  • You can ask for an interpreter when you apply. You can also ask for information in your language.
  • When you apply for Medicaid, some of your personal information may be shared with other government agencies. Read Data Privacy for Immigrants FAQ to learn more.
  • You might be able to get health care at a free clinic or community health center even if you don’t have health coverage. Depending on your income, you could qualify for free services or you might have to pay a fee. 

If you don't have a home: 

  • You can still apply for Medicaid and other health programs. Not having an address won't stop you from getting coverage.
  • You may be able to get health care at a free clinic.

If you're getting out of jail or prison:

  • You can apply for Medicaid when you’re incarcerated. When you’re released, you can call the Cover Virginia Incarcerated Unit to start your Medicaid.
  • You can apply for Marketplace insurance when you're released.

Get help applying

Enroll Virginia offers free, in-person help in your language and in your community. Their trained and certified navigators can answer your questions and help you enroll in Medicaid, FAMIS, or a Marketplace plan.

Enroll Virginia does not help with Medicare or employer coverage. For Medicare help: Contact VICAP through your local senior center.

Getting ready to apply

What documents do I need?

Gather all the documents you think you will need before you start. It will make the process faster.

This can include:

  • Proof of income, like a recent pay stub or last year's tax return
  • The names and dates of birth of everyone in your household
  • Social Security numbers and immigration documents for anyone applying
  • Information about any health insurance you currently have

You only need to provide information for the people who are applying for benefits. For example, if you are a parent applying for your child's Medicaid, only your child's information is required.

How do I choose a Marketplace plan?

Before you pick a plan, check a few things. Make sure your doctors are in the plan's network. Make sure your medications are covered. Compare costs like monthly premiums, deductibles, and copays. The Marketplace has a free online tool to help you compare plans.

What else should I keep track of?

If you apply online, save your username and password somewhere safe. You may need to log back in during the year to update your information or submit documents.

What if I don't qualify for any health program?

Even if you do not qualify for Medicaid, Medicare, or a Marketplace plan, you can still get health care. Free clinics and community health centers provide care to people who do not have insurance.

The Virginia Department of Health (VDH) offers some free health services for uninsured Virginians. VDH has an online tool to find free vaccine providers for children and adults. 

Enroll Virginia navigators can help you find a free clinic or community health center near you. Visit enrollva.org/clinics or call 888-392-5132.

After applying

Marketplace plans: What do I do after I enroll?

Your coverage will not start until you pay your first month's premium. About a week after enrolling, call your insurance company. Ask them to confirm your plan name and start date. Ask about your premium amount and how to pay it. Ask when your insurance card will arrive.

Check your eligibility notice from the Marketplace. If it asks you to send in documents, do it right away. If you don't, you could lose your financial help.

Medicaid: What do I do after I'm approved?

You will need to choose a Managed Care Organization, called an MCO. A Cardinal Care card will come in the mail. You can use it while you wait for your MCO card to arrive. Choosing an MCO can be confusing. An Enroll Virginia navigator can help you pick the right one.

Do I need to report changes?

Yes. Tell your program right away if your income, family size, immigration status, or contact information changes. Do not wait until the end of the year. Changes can affect your coverage or your financial help.

What if something seems wrong?

Don't wait. Call your plan or Enroll Virginia at 888-392-5132 to follow up.

If you are having a problem with your insurance company, you can also file a complaint with the Virginia Bureau of Insurance.