Land of the Pentagon, colonial Williamsburg, and Virginia Beach, Virginia is a high-traffic government region, tourist attraction, and historical countryside all at once. Home to the first settlement, various battle sites, and residences of many former U.S. presidents, there is obviously much history in Virginia. Famous for the slogan “Virginia is for Lovers”, the state holds a variety of geographical and architectural wonders, and acts as the gateway to the South.

Residents of Virginia have access to several great insurance companies: Aetna, Anthem Blue Cross Blue Shield, Coventry, Humana, UniCare and UnitedHealth Care. Availability of these companies varies based on your area. East Coast Health Insurance has knowledgeable agents licensed in Virginia who are happy to speak with you at any time, and can be reached at 888.803.5917. To locate the insurers in your region, enter your zip code in the quote engine below.

 


 

Health Status

The overall health of Virginians has stayed relatively consistent over the past ten years, though there has been some fluctuation in certain areas. As would be expected in the tobacco capital of the world, the population of smokers is fairly high at 1.1 million adults, despite a decrease over the past decade. The number of overweight and obese adults has increased, as well as the diabetic adult population. Excessive drinking has also become more prevalent among adults, increasing from 13.6 to 15.3 in just the past year.

The air quality is low, due to many factories, government facilities, and other sources of pollution, which also causes the health of the state to decline. To the west, the more mountainous areas have access to cleaner air and healthier living. Some positives in Virginia are the low percentage of children living at poverty level and low violent crime. Improvements to the condition of many Virginia residents could be made by taking advantage of services either through health insurance or public health programs (see below). By getting a health plan (or using your current one to the fullest extent) you have access to not only medical services, but preventive and wellness care to help you live better – preferably before you become ill.

 

Health Insurance Plans

 

Aetna

  • PPO plans in Virginia are available as either Value or Individual PPO, with additional benefit options including dental care and unlimited primary care visits. With both plans, there are many deductibles to choose from in order to fit your budget, though the Value plans have the lowest monthly premiums. Preventive care is covered at 100% with in-network providers, which includes vaccinations, annual physicals, well-child care, cancer screenings and more. After your deductible has been met, you will receive hospital care, physician services, and other care for a chosen level of coinsurance (40% for Value, 20% for Individual PPO).
  • PPO High Deductible (HSA Compatible) plans are, as described, part of the Aetna PPO network with a choice of several high deductibles, and qualified for opening a health savings account. These plans give you a wide selection of benefits for no cost after deductible, and the flexibility to manage health care costs with an HSA. You can also receive care with non-network providers for a higher cost, but no referral is needed. These plans also come with a dental benefit option, and preventive care covered at 100% once your plan starts.
  • Preventive & Hospital Care plans are also compatible with HSAs, therefore giving those who do not require much health care services the option of using tax-advantaged funds as well. Preventive care is covered in full as soon as your plan begins, and limited hospital services are covered after you have met the deductible. These plans are ideal for individuals who want to stay healthy, want a safety net in case of emergency, and like to have control over their medical expenses.

 

Anthem Blue Cross Blue Shield of Virginia

  • Premier plans give members access to the Anthem Virginia Preferred Network of providers, as well as the option of non-network care. These PPOs offer Anthem’s highest level of coverage, including maternity, unlimited doctor’s office visits for a $30 copay, and preventive care at no cost. Deductibles range from $500 to $10,000 for individuals, and either 80% or 100% coverage after your deductible has been met. Out-of-network care will  typically cost 30% coinsurance on most services, and prescription drugs are available for a $15 copay for both generic and brand names.
  • SmartSense plans provide a basic level of coverage for a lower premium, with deductible choices between $750 – $10,000. With the exception of the highest deductible, which pays for covered services in full, all other plans have 30% coinsurance on services after deductible. Generic and brand name prescription medications are available for a $15 copay, and preventive care is offered immediately at no cost within the PPO network. Covered services include professional and diagnostic services, inpatient and outpatient care, emergency room services and more.
  • CoreShare plans have higher cost sharing for covered services in exchange for a lower monthly premium. These plans have deductible options from $750 to $7,500, with 50% coinsurance for most services in-network. Preventive care is covered at 100% immediately, which includes cancer screenings, well-child care, immunizations, routine physicals and more. Prescription drugs on Anthem’s formulary are $15 copay or 50% coinsurance. Some benefits included once the deductible is met are chiropractic, mental health care, home health care, physical therapy, inpatient and outpatient hospital care.
  • Lumenos HSA Plus plans offer a broad range of coverage through the Anthem PPO network and the option of opening a health savings account. After your deductible is met, Lumenos HSA plans cover hospital care, physician visits, diagnostic services, emergency care and more for either 20% or 0% coinsurance. You can choose between $1,500 or $5,000 deductibles, and before it is reached you can receive any preventive services at no cost. These plans offer most every medical service under the sun, including add-on benefits such as maternity, dental, and life.

 

 CoventryOne

  • Copay plans in Virginia come in Value or Classic options, both of which offer a simplified approach to paying for health care. Value Copay 20/40 plans have deductible options of $2,000, $3,000 or $5,000, paying either a $20 copay on services like doctor’s office visits or 40% coinsurance after deductible on hospital care. Classic plans have a bigger range of deductibles to choose from (between $500 and $5,000) and provide predictable copays for physician’s visits ($30 PCP, $60 specialist) and emergency care. Preventive care is always covered at 100%.
  • PPO plans from Coventry in Virginia are classified under the A, B and C-type system, with a wide selection of deductibles to choose from. A plans have the most deductible options, between $500 – $5,000, and a $25 copay for doctor’s office visits and mammograms. When using in-network providers, preventive services are no cost to you, and available immediately. After your deductible is met, you pay either 20 or 30% coinsurance on most hospital and physician services. B and C plans have no deductible in-network, and a basic level of coverage on necessary services, including a $20 primary care doctor copay.
  • QHDHP plans are high deductible plans with 70, 80 or 100% coverage after deductible on a number of medical services, such as inpatient and outpatient hospital care, emergency services. Primary care doctor’s office visits are available before deductible for a $20 copay (specialists for $40), or no cost with higher deductibles. These plans also cover preventive care in full from the day your plan starts.

 

Humana One

  • Monogram plans are PPOs with low monthly premiums and a $7,500 in-network deductible. These plans offer 100% coverage on preventive care before deductible, and many other medical services after deductible.  Prescription coverage varies based on the tier of the medication, starting at $15 for generics. Preventive care in Virginia includes screenings for breast, cervical and prostate cancer, GYN exams, vaccinations, well-child care and more. Services covered after deductible include but are not limited to inpatient and outpatient hospital care, physician’s office visits, surgery, allergy testing and emergency care.
  • Autograph plans also utilize the Humana PPO network , some of which have the option of pairing with a health savings account. Autograph plans also come with additional benefits such as dental and prescription coverage. These plans come in either Share (20% coinsurance) or Total (0% coinsurance) options, with deductibles ranging from $2,000 to $6,000. Both types cover a variety of services, such as doctor’s office visits, surgeries, mental health care, lab work, skilled nursing and transplants. Routine physicals, mammograms, immunizations and other preventive care is covered in full.
  • Portrait plans have higher premiums with 80/20 coinsurance coverage after the deductible has been met. These plans are available with prescription drug and/or dental benefits, and cover preventive care at 100% from the day your plan begins. Physician visits are $35 for primary care and $50 for specialists. Once you have met the deductible, most medical care including emergency room, surgery, inpatient stays and home health care will be covered at 80% by your plan.

 

UniCare

  • PPO plans are available from UniCare in deductibles of $500, $1,000, $1,500, $2,000, $3,000 and $5,000, and cover either 70% or 80% of medical costs after deductible, depending which plan you choose. The first four doctor’s office visits per plan member are available for a $30 copay with the deductible waived, and cost 20% coinsurance after deductible. Most medical care such as inpatient hospital stays, outpatient care, emergency and urgent care, lab work and X-rays are covered once you have reached your deductible amount.
  • Saver 2000 plans have a $2,000 annual deductible, with 70/30 coinsurance on most health care services after you meet your deductible. These plans have prescription drug coverage, in addition to two doctor’s office visits for a $30 copay for both in and out-of-network providers. Saver plans are also PPO plans, which gives you the options of seeking non-network care depending on your preference. Saver plans are ideal for those who do not need a large amount of of health care services, but want the basics.
  • Premier No Deductible plans have no yearly deductible (surprise!) and cover 80% of your medical care, including preventive care, surgery, lab work, inpatient and outpatient care and emergency care. Doctor’s office visits are covered at 100% after a $30 copay, and are unlimited to members of Premier plans. Prescription drugs are also covered at 100% after a $10 copay for generics or $25 brand name (retail pharmacy).

 

UnitedHealthOne

  • Copay plans are the most comprehensive plans available from UnitedHealthOne, and also possibly the easiest to use due to their fixed rates on common services. You have the option of either paying 30%, 20%, or 0% coinsurance after deductible, and a wide range of deductibles to work with to fit your budget. As soon as your plan starts, you can receive preventive care at no cost, and primary care services for a $35 copay. Prescription medications are also offered for a set copay, starting at $15 for generics. Copay plans are convenient and allow access to many services.
  • High Deductible plans have low monthly premiums and a comprehensive set of benefits, available in three variations: Plan 100, Plan 80 and Saver 80. Plan 100 covers 100% of your medical costs once you have met your deductible, including doctor’s office visits, lab work, emergency room care, surgery, and other inpatient and outpatient hospital care. The same services are covered at 80% in Plan 80 and Saver 80 plans. All three of these offer preventive care at no cost before meeting the deductible, so you can stay healthy as soon as your plan starts.
  • HSA plans have high deductibles and are compatible with a health savings account (HSA), which allows you more control over your health care. Depending on your preference and personal needs, you can use the funds from your HSA to pay for qualified medical expenses or save for retirement – with tax advantages. These plans come with a choice of 70% or 100% coverage after deductible on hospital care, doctor’s office visits, emergency care and more. You can use the PPO network or non-network providers as well with an HSA plan.

 

 

Public Health Options

Virginia residents have a variety of options when it comes to state-funded health care, in addition to various services to prevent disease and illness provided through public facilities for free. For those who qualify for Medical Assistance (Medicaid), coverage on health care services is available for little or no cost. The State Children’s Health Insurance Program (CHIP) in Virginia is called FAMIS, and gives medical assistance to children and families with low income. All medical assistance/Medicaid services are administered by the Virginia Department of Social Services. Other types of assistance programs are available to individuals with various medical needs, including pregnant women, HIV/AIDS, and those who seek prevention services. For a full list of services offered, visits the Virginia Department of Health site.

 

Health Insurance Laws

In the state of Virginia, the most essential health insurance laws to know are based around the rights of private health insurance companies. Pre-existing conditions are determined by insurers in Virginia by a broad scope of whether an individual has had symptoms for which they could have been able to seek medical advice or care (regardless of whether or not they received treatment). This allows health insurers to be selective, with the ability to deny individuals who they decide has a pre-existing condition a health plan. The insurance company may decide to offer them a plan, but under the condition they pay higher premiums.

Individuals with pre-existing conditions in Virginia can also receive an exclusion period of up to 12 months with their plan, which means the insurer will not pay for any care related to that condition for a certain length of time. Permanent exclusion periods, called elimination riders, are also permitted among insurance companies in the state. This will not go on for too much longer, however, due to the Affordable Care Act. As of 2014, all insurance companies must accept individuals with pre-existing conditions or high risk for a health plan. The ACA law also prohibits the use of elimination riders and exclusion periods.

For the time being, those who have been denied a health policy by the private market (or overcharged) are eligible for the Pre-Existing Condition Insurance Plan (PCIP). This is a plan that functions much like a private health plan, with a monthly premium to pay, and gives those with pre-existing conditions the chance to have access to medical care without discrimination. Virginia’s PCIP system is run by the U.S. Department of Health and Human Services. PCIPs are only available until the law takes effect in 2014, after which, those individuals will have to apply for a plan with a private company.

Another law of importance is guaranteed renewability, which is a part of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This law guarantees an insured individual the right to have their plan renewed again at the end of each term, as long as they have not violated the policy in any way. Guaranteed renewability also protects the insured by making it illegal for an insurance company to cancel someone’s plan on the grounds of illness. Additionally, HIPAA laws give rights to the insured by making the transfer of personal medical information consensual and confidential.