SCC Bureau of Insurance Offers Tips for Shopping for Health Insurance

If you're in the market for health insurance, it's important to compare prices, benefits and restrictions and make sure you find a product that meets your individual needs.

With open enrollment just around the corner (November 1), many Virginians will shop for health care coverage through Virginia's Insurance Marketplace. Through this online, state-based exchange, consumers can shop for, compare and enroll in federal Affordable Care Act (ACA) plans that offer comprehensive insurance coverage from licensed and regulated insurance companies.

Whether you are thinking about changing plans or purchasing a new health insurance policy, the SCC Bureau of Insurance (Bureau) encourages Virginians to review their coverage needs, thoroughly explore and understand all their options, and avoid pitfalls when purchasing coverage.

"Not all health plans are created alike. Some are not insurance or may not come with the same benefits and protections as ACA-compliant plans," said Virginia Insurance Commissioner Scott A. White. He encourages Virginians to fully understand the coverage, costs, provider networks, protections and restrictions before they sign up for any health plan. "Understand enrollment periods, what ACA-compliant plans must cover and where to turn for legitimate information. If you have questions, the Bureau of Insurance can help."

Consumer protection laws govern some types of health coverage, such as plans purchased through an employer or ACA-compliant plans purchased on or off Virginia's Insurance Marketplace. Other types of plans such as health care sharing ministries and discount plans, and plans issued through out-of-state associations might be less expensive than health insurance plans subject to the ACA, but they typically are not subject to Virginia insurance laws and may not offer the same benefits or protections as ACA-compliant plans.

Short-term, limited-duration health insurance plans and limited benefit plans are not available through the health insurance marketplace, but they are regulated health insurance plans. While they may, in some cases, be less expensive than plans offered through Virginia's Insurance Marketplace, they often cover less than ACA-compliant marketplace plans; may not provide coverage for the entire year; may deny eligibility for coverage or exclude services because of pre-existing conditions and may apply dollar limits on the amount they will pay. In addition, if this type of coverage terminates mid-year, the policyholder generally would not be eligible for a special enrollment period on Virginia's Insurance Marketplace and would need to wait until the next annual open enrollment period to purchase Marketplace coverage.

The Bureau encourages consumers to carefully consider what health care services you and your family will need before you sign up for any health insurance plan. Ask yourself:

• Does the plan cover the services my family needs or are there limits to the benefits available under the plan?
• Are doctors and medications my family needs covered by the plan? 
• What are the monthly premiums and other costs of using health services such as co-pays, co-insurance and deductibles? 

Keep the following in mind:

• In Virginia, Virginia's Insurance Marketplace is the official website to enroll in ACA plans. Enroll by December 31, 2025, for coverage to begin January 1, 2026.
• Although you don't have to use Virginia's Insurance Marketplace to enroll in an ACA plan, you must enroll through Virginia's Insurance Marketplace to receive financial assistance.
• Ask for details of any health plan in writing, including cost and coverage, and make sure you understand what you are purchasing.
• Look for a disclosure indicating whether the health plan complies with the ACA.
• Any policy that excludes coverage for pre-existing conditions is not an ACA plan.
• The open enrollment period for buying a 2026 ACA plan (on or off Virginia's Insurance Marketplace) begins November 1, 2025, and ends January 30, 2026. Anyone who contacts you to sell individual health insurance plans through an "enrollment period" outside of that is not selling an ACA-compliant policy.
• Do not provide personal information or send money in response to unsolicited calls, emails or texts.
• To verify that an insurance agent, agency or company is licensed in Virginia, visit the consumer section of the Bureau's website.
• Be wary of telemarketers from the "national enrollment center," "national healthcare center," or other official-sounding name. The Marketplace will not call to sell you health insurance.

For more information, visit the Virginia Bureau of Insurance website or call toll-free at 1-877-310-6560. Use the Health Coverage Plan Comparison Tool to compare plans. To learn more about Virginia's Insurance Marketplace, visit Marketplace.Virginia.gov.

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Contact: Katha Treanor, 804-371-9141

Source URLs:

https://www.marketplace.virginia.gov/

https://www.scc.virginia.gov/boi/consumerinquiry/

https://www.scc.virginia.gov/consumers/insurance/

https://www.scc.virginia.gov/media/sccvirginiagov-home/consumer-home/insurance/life-amp-health/tips-guides-amp-publications/healthcomparisontool.pdf