Individual / Private health insurance plans provide individuals and families with the flexibility to choose a plan that best fits their specific needs, budget, and preferred network of healthcare providers.

These plans are typically available to self-employed individuals, those who don’t have access to employer-sponsored coverage, or individuals who prefer to have their own independent coverage.

Types of Private Health Insurance Plans in Virginia

• Affordable Care Act (ACA), also known as “Obamacare,” requires all health insurance plans to provide Minimum Essential Coverage. The ACA also offers subsidies to eligible families with a household income below 300% of the Federal Poverty Level. It is the current law governing health insurance in the United States.
• Short-Term Plans provide temporary coverage for a few months (duration varies by state). While offering less comprehensive coverage than long-term plans, they act as a safety net for those without insurance or ineligible for special enrollment periods due to qualifying life events. Virginia legislature allows consumers to buy short-term plans with initial durations up to three months.
• Health Sharing Plans, which are typically non-profit and often affiliated with religious organizations, provide healthcare benefits that differ from Minimum Essential Coverage (MEC) and may impose waiting periods for pre-existing conditions. It’s important to note that Health Sharing Plans are not legally classified as insurance.

Private Health Insurance Networks in Virginia

• HMO (Health Maintenance Organization): HMO plans require you to choose a primary care doctor who coordinates your care. HMO plans typically have lower premiums than other types of plans.

• PPO (Preferred Provider Organization): PPO plans allow you to see any doctor in the plan’s network, but you will pay more to see a doctor outside of the network. PPO plans typically have higher premiums than HMO plans.

• POS (Point of Service Plans): POS plans are a hybrid of HMO and PPO plans. You can choose a primary care doctor, but you can also see a doctor outside of the network for a higher copay. POS plans typically have premiums in between HMO and PPO plans.

• EPO (Exclusive Provider Organizations): EPO plans also offer a network of doctors and specialists, but coverage for out-of-network providers may vary based on your plan. While some EPOs may require a primary care physician, others may not. Unlike HMOs, EPOs generally do not mandate referrals for specialist visits.