Private Health Insurance in Virginia
Private health insurance in Virginia is coverage you buy directly, outside the ACA Marketplace, priced on your age, zip code and health instead of your income. With Virginia Marketplace premiums rising 15.8% to 16.9% on average for 2027, more people who earn too much for a tax credit are pricing a private plan first. It is not the right fit for everyone, and the sections below explain how it works in Virginia and when the Marketplace is the better call.
Who buys their own coverage in Virginia
Virginia's own exchange reported 370,086 plan selections to CMS for 2026 open enrollment, about 5 percent fewer than the 388,856 counted for 2025. The bigger shift was in who gets help: about 78 percent of 2026 enrollees received an advance premium tax credit, compared with about 86 percent the year before, so roughly 22 percent of buyers now pay the full premium themselves. That full-price group is large in a state where, by Census estimates for 2024, about 46.6 percent of households have incomes of $100,000 or more and usually earn too much to get any credit.
How Virginia regulates private plans
Virginia lets fixed indemnity coverage work only as a supplement. Under 14VAC5-141-120, a hospital or other fixed indemnity policy pays set dollar amounts written into the policy, never tied to the bill, and its face must say it is not a substitute for major medical coverage. Va. Code § 38.2-6301 places health care sharing ministries whose members share one religion outside the insurance code. A 2019 bill for agricultural organization plans was vetoed, but a 2022 law, § 59.1-589 and following, lets a nonprofit association run a self-funded benefits consortium for employer members. Other association plans follow § 38.2-3521.1.
Protecting yourself when you buy in Virginia
For an individual accident and sickness policy, Va. Code § 38.2-3502 gives you 10 days after it arrives to send it back, and the coverage is then void from the start with the premium refunded; insurers may allow longer. The State Corporation Commission's Search for Insurance Agent/Company tool shows whether an agent or insurer holds a Virginia license. Complaints go to the Bureau of Insurance at 1-877-310-6560 or its online form. The Bureau's guide to alternative coverage warns that the federal government will not call to sell coverage and that copycat websites imitate the state Marketplace.
The Virginia Marketplace you would be comparing against
Virginia buyers shop on Virginia's Insurance Marketplace, the state-run exchange and the only place to apply for federal premium tax credits and the new state help called Virginia Premium Savings. Starting with 2027 plans, Virginia Premium Savings lowers premiums for households earning 138 to 250 percent of the federal poverty level, is applied after any federal credit, and is paid from a fixed state appropriation, so funding may not reach everyone who qualifies. Virginia also runs a state reinsurance program, administered by the Bureau of Insurance and approved through 2027, that helps hold down individual-market premiums. The enhanced federal credits ended after 2025, and excess advance credits must now be repaid in full at tax time, so self-employed tradespeople should keep their income estimate current. Leaving a small employer gives you 12 months of state continuation, short-term plans are held to three months at a time and six months in any year, and open enrollment runs to January 29, 2027.
Other Virginia rules to know
- Leaving a small employer: 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, small-group plans about 10.7%. See the Virginia 2027 rate page.
Why people leave the Marketplace for a private plan
Marketplace premiums are rising again for 2027, and above 400 percent of the poverty level ($63,840 for one person, $132,000 for a family of four) there is no tax credit at all. Underestimate your income and you repay the credit in April. Many Marketplace plans are local HMOs or EPOs, out-of-pocket maximums reach $12,000 per person in 2027, and you can only enroll once a year without a qualifying event.
What a private plan does differently
A private, medically underwritten plan is priced on health, not income, so a strong year never raises the premium and there is nothing to pay back at tax time. If approved, it can start the first of any month, and many plans use national PPO networks that work when you travel.
The honest trade-offs
You apply and answer health questions, and approval is not guaranteed. Underwritten plans can decline an application or exclude a pre-existing condition, and benefits and limits differ from plan to plan. Private plans are not ACA Marketplace plans. If you have a significant health condition, the Marketplace is the guaranteed option, and I will tell you so.
For 2027 the Marketplace credit stops at 400 percent of the poverty level: $63,840 for one person, $86,560 for two and $132,000 for a family of four. The out-of-pocket maximum for 2027 Marketplace plans is $12,000 for one person and $24,000 for a family. The full guide covers the rest.
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Virginia questions
Where do Virginia residents enroll in 2027 coverage?
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.
What continuation rights does Virginia give after leaving a small employer?
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.
How much are Virginia premiums rising for 2027?
Individual-market premiums are set to rise 15.8% to 16.9% on average, and small-group plans about 10.7%.
What is private health insurance?
Coverage you buy directly from an insurer outside the ACA Marketplace. Medically underwritten private plans are priced on age, zip code and health rather than income, and they can start the first of any month if you are approved.
Is private health insurance cheaper than the Marketplace?
Often for healthy people above the subsidy line, who pay full price on the Marketplace. Below the line, a Marketplace plan with a tax credit may be cheaper. The only way to know is to price both.
Can a private plan turn me down?
Yes. Underwritten plans can decline an application or exclude a pre-existing condition. The Marketplace has to accept everyone during open enrollment or a special enrollment period.
Sources: www.cms.gov, law.lis.virginia.gov, law.lis.virginia.gov, law.lis.virginia.gov, www.scc.virginia.gov. Facts checked October 2026. See all Virginia health insurance rules.
Private plans in other states
Written by Frank Caballero, licensed health insurance agent in Virginia and 30 other states, NPN 21032307.