Key Takeaways
- Virginia expanded Medicaid under the ACA in 2019, covering adults up to 138% FPL
- Virginia operates a state-federal partnership health insurance marketplace
- FAMIS (Family Access to Medical Insurance Security) is Virginia's CHIP program
- Virginia has a Life, Accident and Sickness Insurance Guaranty Association
- The Bureau of Insurance regulates all insurance activities in Virginia
Virginia State Health Programs
Virginia provides various programs to ensure residents have access to health insurance coverage.
Virginia Medicaid
Virginia's Medicaid program covers low-income individuals:
Eligibility Categories
| Category | Income Limit |
|---|---|
| Children | Up to 143% FPL |
| Pregnant Women | Up to 148% FPL |
| Parents/Caretakers | Up to 138% FPL |
| Adults (Expansion) | Up to 138% FPL |
| Aged/Disabled | Various limits |
Medicaid Expansion
Virginia expanded Medicaid in January 2019:
- Covers adults ages 19-64
- Income up to 138% of Federal Poverty Level
- Comprehensive benefits package
- Significantly increased coverage access
Exam Tip: Virginia IS a Medicaid expansion state (since 2019). Adults up to 138% FPL qualify for coverage.
Virginia Health Insurance Marketplace
Virginia operates a state-federal partnership marketplace:
Marketplace Features
| Feature | Description |
|---|---|
| Platform | HealthCare.gov (federal platform) |
| Plan Management | Virginia handles plan oversight |
| Open Enrollment | November 1 - January 15 |
| Premium Tax Credits | Based on income |
| Plan Tiers | Bronze, Silver, Gold, Platinum |
Partnership Model
- Virginia manages plan certification
- Federal government handles enrollment
- State provides consumer assistance
FAMIS (Virginia CHIP)
FAMIS (Family Access to Medical Insurance Security) is Virginia's CHIP program:
FAMIS Eligibility
| Factor | Requirement |
|---|---|
| Age | Under 19 years old |
| Income | Above Medicaid, up to 200% FPL |
| Residency | Virginia resident |
| Citizenship | U.S. citizen or qualified immigrant |
FAMIS Benefits
- Comprehensive health coverage
- Dental services
- Vision services
- Mental health services
- Low-cost premiums
FAMIS Plus
Covers pregnant women up to 200% FPL with:
- Prenatal care
- Delivery services
- Postpartum care
Virginia Life, Accident and Sickness Insurance Guaranty Association
Protects policyholders when insurers become insolvent:
Coverage Limits
| Coverage Type | Maximum Limit |
|---|---|
| Life Insurance Death Benefit | $300,000 |
| Cash Surrender Value | $100,000 |
| Health Insurance | $500,000 |
| Annuity Present Value | $250,000 |
| Disability Income | $300,000 |
Important Rules
| Rule | Description |
|---|---|
| Advertising | Cannot use as selling point |
| Eligibility | VA residents with covered policies |
| Funding | Assessments on member insurers |
| Coverage | Policies from licensed VA insurers |
What Is NOT Covered
- Policies from unlicensed insurers
- Self-funded employer plans
- Variable product investment portions
- Government programs
Exam Tip: Producers CANNOT use Guaranty Association coverage as a selling point. This is a frequently tested rule.
Did Virginia expand Medicaid under the Affordable Care Act?
What type of health insurance marketplace does Virginia operate?
What is the name of Virginia's CHIP program?
What is the maximum life insurance death benefit coverage under Virginia's Guaranty Association?
Can Virginia producers use the Guaranty Association as a selling point?
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