Small Business Health Insurance in Virginia
Virginia employers with up to 50 employees can offer health benefits three ways: a fully insured small-group plan, an individual coverage HRA that reimburses each employee's own plan, or a QSEHRA for businesses under 50 full-time employees. Which one fits depends on your budget, how many people you cover and how the Virginia small-group market is priced for 2027.
Private health insurance in Virginia
Most people 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
The Virginia small-group market for 2027
Virginia law, Code section 38.2-3431, defines a small employer as one with an average of 1 to 50 employees in the prior year. In their 2027 filings, small-group insurers requested increases averaging 11.7 percent before the Bureau of Insurance's review, and they expect enrollment to stay flat. The Bureau reports that small-group loss ratios rose from 84 percent in 2024 to 87 percent in 2025. The market has also shrunk: after 16 insurers from 2018 to 2022 and one newcomer in 2023, six insurer entities left the small-group market in 2025.
Virginia options and rules for small employers
Because Virginia taxable income starts from federal adjusted gross income, ICHRA and QSEHRA reimbursements that are tax-free federally stay tax-free on the state return too. Virginia's 2027 ban on tobacco rating applies across ACA markets, which simplifies quotes for employers with smokers on staff. A real estate association plan is allowed in state law, with a 25,000-member minimum, but federal regulators said in 2023 that federal small-group and individual rules still govern it. For firms under 20 workers, state continuation gives departing employees 12 months, and the employer must send notice within 14 days.
Virginia at a glance for owners and employees
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.
Group plan or HRA
A small-group plan gives everyone the same coverage and usually requires a minimum share of employees to enroll and a minimum employer contribution. An ICHRA lets you set a monthly allowance by employee class and lets each person pick their own individual plan; it works for any size business. A QSEHRA is simpler and capped by annual limits, for employers under 50 full-time employees. Employees offered an affordable ICHRA lose access to the Marketplace tax credit, so set the allowance with that in mind.
Covering the owner
An owner-only business cannot buy a small-group plan in most states; it needs at least one eligible employee who is not an owner or an owner's spouse. Until then the owner buys individual coverage. Once you have employees, you can usually join the group plan or the ICHRA as well.
Tax treatment
Employer contributions to group premiums and HRA reimbursements are generally deductible to the business and tax-free to employees. General information, not tax advice — confirm with your CPA based on your specific entity structure.
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%.
How many employees do I need for a small-group health plan?
Usually at least one eligible employee who is not an owner or an owner's spouse. Insurers also set participation and contribution minimums.
What is the difference between an ICHRA and a QSEHRA?
Both reimburse employees for their own individual plans. An ICHRA works for any size employer with no cap and lets you vary amounts by employee class; a QSEHRA is for employers under 50 full-time employees and has annual limits.
Sources: law.lis.virginia.gov, www.scc.virginia.gov, law.lis.virginia.gov, law.lis.virginia.gov. Facts checked October 2026. See all Virginia health insurance rules.
Small business in other states
Written by Frank Caballero, licensed health insurance agent in Virginia and 30 other states, NPN 21032307.