If you live in Virginia and need health insurance, the 2026 coverage year brings some important changes worth understanding before you apply. Virginia operates its own state-based marketplace called Virginia's Insurance Marketplace, and eligibility for subsidized coverage depends on your income, household size, and whether you have access to other coverage. This guide breaks down exactly who qualifies, what the income limits are, and how to get enrolled.
Check whether you qualify right now with our free benefits screener or browse the full Virginia Benefits Overview for other programs you may be missing.
What Is the ACA Marketplace in Virginia?
The Affordable Care Act (ACA) created health insurance marketplaces where individuals and families can shop for private health plans. Virginia runs its own marketplace, called Virginia's Insurance Marketplace (VIM), which launched its state-based platform in the fall of 2023. Before that, Virginians enrolled through HealthCare.gov.
The marketplace is the only place to access government subsidies that lower your monthly premium costs. It is overseen by the State Corporation Commission and offers plans from multiple private insurers. For 2026, eight insurance carriers offer plans through Virginia's marketplace.
Who Qualifies for Virginia's Marketplace Plans?
To enroll in a health plan through Virginia's Insurance Marketplace, you must meet all of the following:
- Live in Virginia as your primary state of residence
- Be a U.S. citizen, national, or lawfully present immigrant for the entire coverage period
- Not be incarcerated (except when pending disposition of charges)
- Not be enrolled in Medicare
- Not have access to affordable employer-sponsored coverage (if your employer offers coverage, a separate affordability test applies)
- Not be eligible for Medicaid or CHIP (Virginia's Medicaid program, Cardinal Care, covers adults with incomes up to 138% of the federal poverty level)
If your income falls below 138% FPL, you will likely be directed to Medicaid instead of the Marketplace. Virginia expanded Medicaid in January 2019, which means most low-income adults are covered through Cardinal Care rather than the Marketplace.
2026 Virginia ACA Income Limits
ACA subsidy eligibility for 2026 coverage is based on the 2025 federal poverty level (FPL) guidelines. Households with incomes between 100% and 400% FPL may qualify for premium tax credits (advance premium tax credits, or APTC) to lower their monthly premiums.
Important change for 2026: The enhanced premium tax credits that were in place from 2021 through 2025 (under the American Rescue Plan and Inflation Reduction Act) expired on December 31, 2025. For 2026 coverage, the standard ACA subsidy rules apply, which generally cap eligibility at 400% FPL. This means some households that received subsidies in 2025 may see higher costs or lose subsidy eligibility in 2026.
ACA Marketplace Subsidy Eligibility by Household Size (2026)
Eligibility for 2026 is based on 2025 poverty guidelines. The table below shows the approximate income range that qualifies for premium tax credits through Virginia's marketplace:
| Household Size | 100% FPL (Medicaid floor) | 138% FPL (Medicaid ceiling) | 400% FPL (Subsidy ceiling) |
|---|---|---|---|
| 1 person | $15,650/year | ~$21,597/year | $62,600/year |
| 2 people | $21,150/year | ~$29,187/year | $84,600/year |
| 3 people | $26,650/year | ~$36,777/year | $106,600/year |
| 4 people | $32,150/year | ~$44,367/year | $128,600/year |
| 5 people | $37,650/year | ~$51,957/year | $150,600/year |
| Each additional | +$5,500/year | +$7,590/year | +$22,000/year |
How to read this table:
- If your income falls below 138% FPL, you likely qualify for Cardinal Care (Virginia Medicaid) rather than a Marketplace plan.
- If your income is between 138% and 400% FPL, you are in the prime zone for ACA premium tax credits.
- If your income is above 400% FPL, you can still buy Marketplace coverage but likely without a subsidy in 2026.
Note: Income thresholds are updated annually and based on your projected income for the coverage year, not last year's tax return. Always verify current numbers at marketplace.virginia.gov or through the free screener.
Cost-Sharing Reductions (CSR)
In addition to premium tax credits, households earning between 100% and 250% FPL may qualify for cost-sharing reductions if they enroll in a Silver plan. These reductions lower your deductible, copays, and out-of-pocket maximum, not just your monthly premium. This makes Silver plans a strong value for households in the lower half of the income range.
Virginia Medicaid (Cardinal Care) vs. Marketplace
Virginia is a Medicaid expansion state, which has a direct effect on who uses the Marketplace. If your income is below about $21,600/year for a single person (138% FPL), you are likely eligible for Cardinal Care rather than a subsidized Marketplace plan.
| Program | Income Range | Monthly Cost | Application |
|---|---|---|---|
| Cardinal Care (Medicaid) | Up to 138% FPL | Free or very low cost | commonhelp.virginia.gov |
| FAMIS (CHIP for children) | Up to 205% FPL for kids | No premiums or copays | commonhelp.virginia.gov |
| ACA Marketplace with subsidy | 138% to 400% FPL | Varies by plan and income | marketplace.virginia.gov |
| ACA Marketplace no subsidy | Above 400% FPL | Full premium cost | marketplace.virginia.gov |
The Marketplace application will automatically check your Medicaid eligibility. If you qualify for Cardinal Care, you will be redirected there rather than to a private plan.
Types of Marketplace Plans Available in 2026
Virginia's marketplace offers plans in five metal tier categories. The tiers reflect how costs are shared between you and the insurer:
- Bronze: Insurer pays about 60% of covered costs; you pay about 40%. Lowest monthly premiums, highest out-of-pocket costs when you use care.
- Silver: Insurer pays about 70% of covered costs. Midrange premiums. The only tier where cost-sharing reductions apply.
- Gold: Insurer pays about 80% of covered costs. Higher premiums but lower out-of-pocket costs.
- Platinum: Insurer pays about 90% of covered costs. Highest premiums, lowest out-of-pocket costs.
- Catastrophic: Available to adults under 30 or those who qualify for a hardship exemption. Very high deductibles with low premiums.
All plans cover the 10 essential health benefits required by the ACA, including emergency care, hospitalization, prescription drugs, preventive care, mental health services, maternity care, and more.
Enrollment Periods for 2026 Coverage
Open Enrollment (Now Closed for 2026)
The open enrollment period for 2026 coverage ran from November 1, 2025 through January 30, 2026. This window is now closed. If you did not enroll during open enrollment, you generally cannot sign up for a 2026 Marketplace plan unless you qualify for a Special Enrollment Period.
Special Enrollment Periods (SEP)
Outside of open enrollment, you can still enroll if you experience a qualifying life event (QLE). You typically have 60 days before or after the event to apply. Common qualifying events include:
- Losing health coverage (job loss, losing eligibility for Medicaid, aging off a parent's plan)
- Getting married or divorced
- Having a baby, adopting a child, or placing a child for foster care
- Moving to a new coverage area
- Changes in immigration status
- Pregnancy (Virginia specifically recognizes pregnancy as a qualifying life event)
If you recently experienced any of these, visit marketplace.virginia.gov or call 888-687-1501 to see if you are eligible for a SEP.
Step-by-Step: How to Apply for ACA Coverage in Virginia
Step 1: Gather your documents
Before you start, collect the following for each adult in your household:
- Social Security numbers
- Birthdate and immigration status documents (if applicable)
- Most recent tax return or pay stubs to estimate annual income
- Employer insurance information (if your employer offers coverage)
- Current health insurance information (if any)
Step 2: Go to Virginia's marketplace
Visit marketplace.virginia.gov and create an account or log in. Virginia's platform is separate from HealthCare.gov, so if you applied there before 2024, you will need to create a new account.
Step 3: Complete the application
Enter your household information, income estimate for 2026, and details about any current coverage. The application takes around 15 to 30 minutes. It will check your eligibility for both Medicaid and Marketplace subsidies at the same time.
Step 4: Review your eligibility results
After submitting your application, you will see whether you qualify for Cardinal Care (Medicaid), premium tax credits, cost-sharing reductions, or all three. You can also use our free benefits screener to get a quick estimate before applying.
Step 5: Compare and choose a plan
Browse the available plans by tier, premium cost, deductible, and provider network. Make sure your preferred doctors and prescriptions are covered before selecting a plan.
Step 6: Confirm enrollment and pay your first premium
After selecting a plan, you must pay your first premium for coverage to begin. If you chose a plan through an SEP, coverage typically starts the first of the following month.
Need help? Other ways to apply:
- Phone: Call Virginia's Insurance Marketplace at 888-687-1501
- Navigator or broker: Free, certified application helpers are available statewide. Find one at marketplace.virginia.gov
- Easy Enrollment: Virginia's tax return includes an option to authorize sharing your information with the Marketplace to determine eligibility automatically
What Changed for 2026
Two major shifts affect Virginia residents seeking Marketplace coverage in 2026:
-
Enhanced premium tax credits expired. From 2021 through 2025, expanded credits under the American Rescue Plan and Inflation Reduction Act made coverage more affordable across all income levels and removed the 400% FPL subsidy cliff. Those enhancements expired December 31, 2025. The standard ACA rules now apply for 2026, meaning fewer households may qualify for subsidies, and those who do may receive lower amounts.
-
Two fewer carriers. Virginia's marketplace had 10 insurers for 2025 coverage. For 2026, that number dropped to 8. Check plan availability in your specific area at marketplace.virginia.gov, as carrier availability varies by county.
Frequently Asked Questions
Q: Can I still sign up for 2026 ACA coverage in Virginia?
Open enrollment ended January 30, 2026. If you missed it, you can only enroll now if you qualify for a Special Enrollment Period due to a qualifying life event like job loss, marriage, or having a baby. Contact Virginia's Insurance Marketplace at 888-687-1501 to check.
Q: What if my income is too low for a Marketplace subsidy?
In Virginia, adults with incomes below 138% FPL (roughly $21,597/year for a single person based on 2025 guidelines) qualify for Cardinal Care, Virginia's Medicaid program. This provides free or very low cost comprehensive coverage. Apply at commonhelp.virginia.gov or call Cover Virginia at 1-855-242-8282.
Q: I have a job offer with health insurance. Can I still use the Marketplace?
Only if your employer's plan is considered unaffordable or fails minimum coverage standards. The ACA defines "affordable" employer coverage as costing no more than about 9% of your household income for the lowest-cost employee-only plan in 2026. If your employer's offer passes that test, you are generally not eligible for Marketplace subsidies. Use the Employer Health Plan Affordability Calculator at healthinsurance.org for an estimate.
Q: Does pregnancy qualify me for a Special Enrollment Period in Virginia?
Yes. Virginia specifically recognizes pregnancy as a qualifying life event that triggers a Special Enrollment Period, allowing you to enroll in a Marketplace plan outside of open enrollment.
Q: What does a Marketplace plan actually cover?
All plans sold on Virginia's marketplace must cover the ACA's 10 essential health benefits: doctor visits, emergency care, hospitalization, pregnancy and newborn care, mental health and substance use treatment, prescription drugs, rehabilitation services, lab tests, preventive care, and pediatric dental and vision. Adult dental and vision are not required benefits and vary by plan.
Q: How do I know if I qualify for cost-sharing reductions?
CSRs are available to households earning between 100% and 250% FPL who enroll in a Silver plan. The Marketplace application will determine your eligibility automatically. The reduction shows up as a lower deductible and out-of-pocket maximum, not as cash.
Q: What is the difference between CardinalCare and the Marketplace?
Cardinal Care is Virginia's Medicaid program, funded jointly by state and federal governments. It is free or nearly free for eligible low-income adults. The Marketplace offers private insurance plans, which may come with subsidies to lower the cost. Your income determines which program you are directed to. The Marketplace application checks both simultaneously.
Q: Can I get help applying?
Yes. Free Navigators and certified application counselors are available throughout Virginia to help you understand your options and complete the application at no charge. You can also call 888-687-1501. Alternatively, a licensed insurance broker can help you compare plans without charging you a fee.
Other Virginia Benefits to Check
Health coverage is one piece of the puzzle. Depending on your income and household situation, you may also qualify for:
- SNAP (food assistance): Virginia uses a 200% FPL gross income limit
- LIHEAP (heating and cooling assistance): Available for households at or below 150% FPL
- WIC: For pregnant women, new mothers, and children under 5 at or below 185% FPL
- Cardinal Care (Medicaid): For adults up to 138% FPL, children up to 148% FPL, and FAMIS (CHIP) for children up to 205% FPL
Use the free screener to check all programs at once based on your income and household size, or visit the full Virginia Benefits Overview for a complete breakdown of what is available in your state.
Key Virginia Resources
| Resource | Contact |
|---|---|
| Virginia's Insurance Marketplace | marketplace.virginia.gov or 888-687-1501 |
| Cardinal Care (Medicaid) | coverva.dmas.virginia.gov or 1-855-242-8282 |
| CommonHelp (benefits portal) | commonhelp.virginia.gov or 1-855-635-4370 |
| Virginia 211 (local help referrals) | Dial 2-1-1 or 211virginia.org |
Health insurance is not just about monthly premiums. The right coverage protects you from catastrophic medical bills and gives you access to preventive care that keeps you healthier long-term. If you are unsure where you stand, start with the free screener and take two minutes to find out what you may qualify for in Virginia.
