Health Insurance for Registered Nurses in Virginia
Most registered nurses in Virginia are paid in ways that leave them shopping for their own coverage, whether they work around Northern Virginia or anywhere else in the state. Most of the ones I work with choose a private plan priced on their health, not their income, that can start any month if approved. Virginia Marketplace premiums are rising 15.8% to 16.9% on average for 2027, so the private option is worth pricing first.
Private health insurance in Virginia
Most registered nurses I help in Virginia end up on a private plan, not a Marketplace plan. Private, medically underwritten health insurance is priced on your age, zip code and health instead of your income, so a strong year never raises your premium and there is no tax credit to pay back in April.
Why people leave the Marketplace
- Premiums keep climbing. Virginia Marketplace premiums are rising 15.8% to 16.9% on average for 2027.
- The subsidy cliff. Above 400 percent of the poverty level ($63,840 for one person, $132,000 for a family of four) you pay full price.
- Surprise tax bills. Underestimate your income and you repay the tax credit in April.
- Narrow networks. Many plans are local HMOs or EPOs that need referrals and cover little outside the area.
- High out-of-pocket costs. 2027 out-of-pocket maximums reach $12,000 per person and $24,000 per family.
- One window a year. Outside open enrollment you need a qualifying life event to enroll or switch.
What a private plan does differently
- Start any month. If approved, coverage can begin the first of next month, with no wait for open enrollment.
- Networks that travel. Many private plans use national PPO networks, which can give you in-network doctors outside Virginia too. Networks vary by plan.
- Can cost less than full-price Marketplace plans for some healthy applicants above the subsidy line.
- Accident coverage the Marketplace does not offer. A private plan can be paired with accident coverage, a separate policy. What it includes varies by plan.
- Approval is based on health. You answer health questions, and acceptance is not guaranteed.
With a significant health condition, or income low enough for a large tax credit, a Marketplace plan can be the better fit, and I will tell you if it is. Either way you see both side by side.
Private plans are not ACA Marketplace plans. Benefits, exclusions and pre-existing condition rules differ by plan and by state, so review the plan details before you enroll.
Get a private plan quoteLearn more: coverage not based on income · how underwriting works · private vs Obamacare · PPO plans for individuals · switching from the Marketplace
Virginia health insurance in 2027
Virginia's finalized 2027 increase averages about 16 to 17 percent for the individual market, depending on the tracker, with small-group plans up about 10.7 percent.
- Marketplace rates: up 15.8% to 16.9% on average for 2027 (final).
- Benchmark silver plan, age 40: $549 a month in 2027, up from $455 in 2026.
- The subsidy cliff in Virginia: earning $1 over $63,840 costs a single 60-year-old about $7,466 more a year for that plan, and $1 over $86,560 costs a 60-year-old couple about $19,135.
- Where to enroll: Virginia's Insurance Marketplace, the state's own exchange, which sets its own 2027 enrollment dates.
More: Virginia 2027 rate changes · 2027 subsidy cliff by state. General information, not tax advice.
How registered nurses work in Virginia
Among Virginia RNs paid a wage or salary, only 65 percent have access to employer health insurance, according to the 2025 state survey. About 15 percent hold a single part-time job and 4 percent are paid by contract or per diem, the groups least likely to get benefits. Union membership in Virginia was about 5.2 percent in 2024, so few nurses have a negotiated benefit plan. Northern Virginia nurses can also pick up shifts in Maryland, since both states belong to the Nurse Licensure Compact, and those extra jobs rarely come with coverage.
Virginia licensing for registered nurses
To earn a Virginia RN license from the Board of Nursing, part of the Department of Health Professions, a graduate of an approved program must pass the NCLEX and submit fingerprints for a state and FBI criminal background check. Renewal comes due every other year in the birth month and requires one of nine continued competency options, such as 30 contact hours, or 15 contact hours plus 640 hours of active practice. Virginia is rated restricted for nurse practitioners, though NPs can qualify for autonomous practice after the equivalent of three years of full-time clinical experience.
The Virginia market for registered nurses
Virginia's registered nurse workforce reached about 113,310 in 2025, up 49 percent from 2015, according to the state Healthcare Workforce Data Center. BLS, which counts only payroll jobs at Virginia employers, reported about 77,490 RNs in May 2025. Nearly three in four Virginia RNs work in Central Virginia, Northern Virginia or Hampton Roads, and just 9 percent work in non-metro areas. Southside, Southwest and Eastern Virginia together hold only about 8 percent of RN work locations, a thin share for a large stretch of the state.
Virginia coverage rules that apply to you
- Leaving a job: Virginia requires insured group plans that are not subject to federal COBRA, which generally means employers with fewer than 20 employees, to offer 12 months of continuation after at least three months of coverage, at the group rate plus an administrative fee of up to 2 percent.
- Short-term plans: Virginia law caps short-term plans at an initial term of three months and no more than six months of coverage in any 12-month period, a state limit that applies regardless of how federal rules are enforced.
- Where to enroll: Virginia runs its own exchange, Virginia's Insurance Marketplace, and open enrollment for 2027 coverage runs November 1, 2026 to January 29, 2027, with a December 15 deadline for coverage that starts January 1. Private, medically underwritten plans can start the first of any month if approved.
- 2027 rates: individual plans 15.8% to 16.9% on average. See the Virginia 2027 rate page.
PRN, part-time and between jobs
Staff nurses usually have a hospital plan, but PRN and part-time nurses often get no benefits at all, and nurses changing systems can face a waiting period. Those are the moments an RN buys coverage on their own.
What the Marketplace gets wrong for nurses
Marketplace premiums are rising again for 2027, and a nurse picking up extra shifts can land above the 400 percent income line and owe the tax credit back in April. Many Marketplace plans are narrow networks that may not include the hospital you work at. A private, medically underwritten plan is priced on health instead of income, so overtime never changes the premium, and if approved, it can start the first of any month.
When the Marketplace still fits
A nurse with a significant health condition, or a single-income household well under the subsidy line, may do better on the Marketplace because acceptance is guaranteed and the credit can be large. I compare both before you choose.
When the Marketplace still makes sense
The Marketplace fits registered nurses with a significant health condition, because acceptance is guaranteed, and households whose 2027 income stays under 400 percent of the poverty level ($63,840 for one person, $132,000 for a family of four), where a tax credit lowers the price. Above that line it costs full price. The full guide for registered nurses goes deeper.
Quote for a registered nurse in Virginia
Private plans priced first, with the Marketplace alongside when it fits. No fee.
Questions from Virginia registered nurses
What license do registered nurses need in Virginia?
To earn a Virginia RN license from the Board of Nursing, part of the Department of Health Professions, a graduate of an approved program must pass the NCLEX and submit fingerprints for a state and FBI criminal background check. Renewal comes due every other year in the birth month and requires one of nine continued competency options, such as 30 contact hours, or 15 contact hours plus 640 hours of active practice. Virginia is rated restricted for nurse practitioners, though NPs can qualify for autonomous practice after the equivalent of three years of full-time clinical experience.
How much are Virginia health insurance premiums rising for 2027?
Individual-market premiums in Virginia are set to rise 15.8% to 16.9% on average for 2027. Households above 400 percent of the poverty level get no tax credit and pay the full increase.
What happens to my coverage if I leave a job in Virginia?
Virginia requires insured group plans that are not subject to federal COBRA, which generally means employers with fewer than 20 employees, to offer 12 months of continuation after at least three months of coverage, at the group rate plus an administrative fee of up to 2 percent. Losing employer coverage also opens a 60-day Marketplace special enrollment period, and if approved, a private plan can start the first of any month.
Do PRN nurses get health insurance?
Often not. Many hospitals offer benefits only to nurses scheduled above a set number of hours, so PRN nurses usually buy their own private or Marketplace plan.
Can extra shifts affect a nurse's Marketplace tax credit?
Yes. The credit is based on household income for the year, so overtime and extra shifts can reduce it or require repaying part of it at tax time. A private plan's premium does not depend on income.
Sources: www.dhp.virginia.gov, www.bls.gov, law.lis.virginia.gov, law.lis.virginia.gov. Facts checked October 2026. See all Virginia health insurance rules.
Registered Nurses in other states
Written by Frank Caballero, licensed health insurance agent in Virginia and 30 other states, NPN 21032307.