Virginia launched its own health insurance marketplace this year, hoping to offer more affordable and accessible coverage options to its residents. However, the new system has faced some technical glitches and confusion among consumers, especially those who were previously enrolled in the federal marketplace. Despite these issues, the state has reported a higher number of enrollees than last year, indicating a strong demand for health insurance amid the ongoing pandemic.
What is the Virginia health insurance marketplace?
The Virginia health insurance marketplace is a state-run platform that allows individuals and small businesses to compare and purchase health insurance plans that meet the standards of the Affordable Care Act (ACA). The marketplace also provides financial assistance to eligible consumers who need help paying for their premiums or out-of-pocket costs.
The marketplace was created by a law passed by the Virginia General Assembly in 2020, which authorized the state to take over the administration of the ACA from the federal government. The state received approval from the U.S. Department of Health and Human Services in May 2021 to operate its own marketplace, starting from the open enrollment period for 2022 coverage, which began on November 1 and will end on January 15.
The state contracted with GetInsured, a private company that provides technology and customer service for several other state marketplaces, to build and operate the Virginia marketplace website and call center. The state also partnered with Cover Virginia, a nonprofit organization that helps consumers enroll in Medicaid and other public health programs, to provide outreach and education to potential marketplace customers.
What are the benefits of the Virginia health insurance marketplace?
According to the state, the main benefits of having its own health insurance marketplace are:
- Lower premiums: The state estimates that the average premium for a benchmark plan (the second-lowest-cost silver plan) in the marketplace is 9.6% lower in 2022 than it was in 2021, when Virginia used the federal marketplace. This is partly because the state was able to negotiate lower rates with insurers and apply for a federal waiver that allows it to use some of the savings to fund a reinsurance program, which reduces the risk and cost of covering high-cost enrollees.
- More choices: The state reports that there are 19 insurers offering plans in the marketplace in 2022, compared to 11 in 2021. This means that consumers have more options to choose from, depending on their location, income, health needs, and preferences. The state also says that 95% of Virginians have access to at least three insurers in their area, and 82% have access to at least five insurers.
- More assistance: The state claims that it has invested more resources in providing assistance to consumers who need help navigating the marketplace, applying for financial aid, or resolving issues with their coverage. The state has hired more than 200 customer service representatives, who are available by phone, email, chat, or in person at various locations across the state. The state has also expanded its network of certified application counselors, navigators, and brokers, who can offer free and unbiased advice and enrollment support to consumers.
What are the challenges of the Virginia health insurance marketplace?
Despite the benefits, the Virginia health insurance marketplace has also faced some challenges in its first year of operation. Some of the main challenges are:
- Technical glitches: The marketplace website and call center have experienced some technical problems, such as slow loading times, error messages, and system outages, that have frustrated some consumers and prevented them from completing their applications or renewing their plans. The state and GetInsured have acknowledged these issues and said they are working to fix them as soon as possible. The state has also extended the deadline for consumers to enroll or renew their plans for January 1 coverage from December 15 to December 23, to give them more time to overcome the technical difficulties.
- Consumer confusion: The transition from the federal to the state marketplace has also caused some confusion among consumers, especially those who were previously enrolled in the federal marketplace and had to re-enroll in the state marketplace to keep their coverage and financial assistance. Some consumers have reported receiving conflicting or unclear information from the state, the federal government, or their insurers about their enrollment status, eligibility, or plan details. Some consumers have also complained that they were automatically enrolled in different plans than they had before, without their consent or knowledge. The state and its partners have tried to address these issues by sending multiple notices and reminders to consumers, updating the website and call center scripts, and offering assistance to consumers who have questions or concerns.
- COVID-19 impact: The ongoing COVID-19 pandemic has also posed some challenges for the marketplace, as it has increased the demand for health insurance, but also the uncertainty and complexity of the health care system. The pandemic has also affected the availability and affordability of some health care services, such as testing, treatment, and vaccination, which may vary depending on the plan, provider, and location. The state and the federal government have taken some steps to mitigate the impact of the pandemic on the marketplace, such as extending the open enrollment period, increasing the financial assistance available, and requiring insurers to cover COVID-19 related services without cost-sharing.
How many people have enrolled in the Virginia health insurance marketplace?
According to the latest data from the state, as of December 23, 2023, more than 390,000 Virginians have enrolled in health insurance plans through the marketplace, surpassing the total number of enrollees in 2021, which was about 270,000. The state expects the enrollment number to increase further, as consumers have until January 15 to sign up for coverage that starts on February 1.
The state also reports that more than 80% of the enrollees qualify for some form of financial assistance, such as premium tax credits or cost-sharing reductions, which lower their monthly payments or out-of-pocket costs. The state says that the average monthly premium for enrollees who receive financial assistance is $89, compared to $612 for those who do not.
The state attributes the higher enrollment to several factors, such as the lower premiums, the more choices, the more assistance, and the enhanced outreach and marketing efforts. The state also cites the impact of the American Rescue Plan Act, which was passed by Congress in March 2021 and increased the amount and availability of financial assistance for marketplace consumers.
The state hopes that the higher enrollment will improve the health and well-being of Virginians, especially those who were previously uninsured or underinsured, and reduce the disparities and inequities in access to health care that have been exacerbated by the pandemic.
