Why do I need health insurance?
Accidents and illnesses can happen at any time. We can’t always predict when we will need health care. Without insurance, you are responsible for the total cost of your medical bills — which can be thousands of dollars. Medical debt is the number one reason people file for bankruptcy. The best way to protect your health and your finances is to have health insurance.
What is the Marketplace?
Virginia’s Insurance Marketplace (VIM) is a platform for Virginians to shop, compare, and enroll in a health insurance plan. All Marketplace plans are high-quality plans that cover essential health benefits. Many households are also eligible for financial help to lower the cost of health care.
What is open enrollment?
Open enrollment is the time of year that anyone can enroll in new coverage or make changes to their current health plan. Outside of the open enrollment period, you typically have to experience a “qualifying life event” to enroll or change your coverage. Some examples of qualifying life events are losing your health insurance or Medicaid, moving to a new address, or getting married.
Are there eligibility requirements to enroll in a health plan?
Yes, but different health insurance programs have different eligibility requirements. One thing is always true: to enroll in a health insurance plan in Virginia, you must be a Virginia resident or about to move to Virginia.
A navigator can help you review your eligibility and check which types of health insurance you can enroll in. And if you can’t enroll in health insurance, they can help connect you with other ways to access care when you need it.
How can I learn more about my health plan?
To review what is included in your plan, see your insurer’s summary of benefits. You can download the summary online or request a paper copy in the mail.
The summary of benefits includes information about your health plan and how much it covers for different medical services. It should also tell you where to find in-network providers and a list of covered medications.
A navigator can also help answer questions about your plan.
How does health insurance work?
When you enroll in a health insurance policy, you become part of a group that health insurance companies call a “risk pool.” All the members pay a premium to help cover the cost of medical expenses for their pool.
In return for your premium, the insurance company agrees to share the cost of your covered medical services. Those services are listed in your policy.
What is Medicaid?
Medicaid and FAMIS are free/low-cost health insurance plans offered by the government to people who meet specific income or health criteria.
Medicaid is a federal and state program that helps people with limited income and resources cover their medical costs. It also covers benefits for older adults that are normally not covered by Medicare, like nursing care.
FAMIS is a program that covers some children and pregnant Virginians who have modest income but do not meet Medicaid’s stricter income guidelines.
I’m not eligible for insurance… where can I go when I need health care?
If your income is below a certain amount and you do not have health insurance or Medicaid, you can receive free health services at a free clinic. Even if you are not eligible for a free clinic, you might qualify for free or low-cost services at a community health center. Community health centers use a “sliding scale” to adjust the cost of services based on your income. Click here to find clinics near you.
What is a Managed Care Organization?
If you have Medicaid, your Managed Care Organization (MCO) is the health plan that contracts with providers to manage your Medicaid coverage. Your MCO can answer questions about your coverage and care, provide case management, and coordinate transportation to appointments.
What do navigators do?
Navigators are a free, unbiased source of information about health coverage. A navigator can help you check your eligibility for different types of health coverage and complete an application. They can also answer questions about your coverage and help you use your coverage to access health care. If you are having issues with your health insurance plan or lose health coverage, a navigator can review your options with you.