Self-employed health insurance in Virginia: how the state's system works for you (2026)
Self-employed Virginians buy coverage through Virginia's Insurance Marketplace, the state's own exchange, not HealthCare.gov. Depending on income and health, the options are a marketplace plan with federal premium help, Medicaid in a low-income year, a marketplace plan at full price, or a bridge such as continuing a former employer's plan. Virginia's reinsurance program sits underneath all of it, holding sticker prices lower than they would otherwise be.
Here is how each of those works in Virginia, what happened to 2026 rates, and what is coming in 2027.
Where a self-employed Virginian starts from
When you work for yourself, the whole premium is yours, and so is the job of estimating the income that decides what help you get. Virginia has built several things around that problem. It moved off the federal platform and opened its own marketplace in fall 2023. It expanded Medicaid in 2019, so a lean year does not have to mean going without coverage. And since 2023 it has run a reinsurance program designed to push down the premiums everyone sees.
The market is smaller than it was a year ago. Eight insurance companies offer plans on Virginia's Insurance Marketplace for 2026, down from ten in 2025. Which of them serve your area depends on where you live, so the useful comparison is the one the marketplace produces for your own address.
Option one: a marketplace plan with federal premium help
Moving to a state-run exchange did not change the federal money. Premium tax credits work the same way on Virginia's Insurance Marketplace as they do on HealthCare.gov: your household size and projected income set the amount, and you can take it in advance each month or claim it when you file.
What changes is the address and the calendar. You apply at the state site, marketplace.virginia.gov, and for 2026 coverage the open enrollment window stayed open until January 30, 2026, about two weeks later than the federal deadline. The state also lists a network of more than 4,300 certified assisters and licensed agents who help people enroll.
For a self-employed household, the hard part is the same as anywhere. Advance credits are trued up at tax time against what you actually earned, and since the enhanced federal credits lapsed after 2025, there is once again an income level where help ends abruptly. If your income swings, read how the subsidy cliff catches uneven earners before you settle on an estimate.
Option two: Medicaid when income runs low
Virginia adopted the Medicaid expansion, effective 2019. Adults can qualify with income up to 138% of the federal poverty level. For someone launching a business or riding out a slow stretch, that is a real safety net, and it is one that self-employed people in non-expansion states do not have.
Medicaid has its own rules for counting self-employment income, so ask how yours will be treated rather than guessing. If your income is anywhere near that line, check Medicaid eligibility before you assume you need to buy a plan, and report changes when your business picks up.
Not sure whether you fall into Medicaid, federal help or full price? A two-minute check sorts out which Virginia options fit your household. It asks no health questions and there is no obligation.
Check my Virginia optionsOption three: full price, with reinsurance behind it
Once your income clears the federal subsidy range, every marketplace plan is still open to you. You just pay the whole premium yourself. You still get the marketplace protections: no health questions, no refusal because of a condition, and a standard set of covered benefits.
Virginia has done something specific to take the edge off that full price. The Commonwealth Health Reinsurance Program, operating under a federally approved Section 1332 waiver since the 2023 plan year, reimburses insurers for a share of their highest-cost claims. Because insurers carry less of that risk, they can file lower rates. The law behind the program aims for up to a 20% premium reduction. Virginia's actuaries projected rates about 15.6% lower in the first year, and the State Corporation Commission has reported reductions of roughly 15% to 17% since. It is supported mainly by federal pass-through funding, with state funding behind it.
A lower sticker price helps most the people who pay the sticker price, which is exactly the self-employed household that earns too much for a credit.
Option four: bridges while you get settled
Continuing an employer's plan. If you only just left a job, larger employers fall under federal COBRA. Virginia law adds its own continuation requirement for group insurance at small employers, those with fewer than 20 employees, that federal COBRA does not reach. The details, including how long you can stay on and how fast you must act, depend on your situation, so ask the former employer or insurer directly and do not let the election deadline pass. Our guide to coverage options between jobs lays out the other paths worth pricing against it.
Short-term plans. Virginia is one of the stricter states on short-term medical coverage, with tight limits on both the initial term and the total time you can keep a plan. That makes it a narrow bridge here, useful for a short gap and not much more. Confirm the current limits before buying one.
Underwritten coverage. Plans sold outside the marketplace can ask health questions and price or decline based on the answers, and what they cover follows different rules. If you are weighing one, start with a plain explanation of medical underwriting.
The 2026 numbers in Virginia
Virginia's 2026 marketplace premiums rose by an average of 21.6% before subsidies, according to the State Corporation Commission's Bureau of Insurance. It was described as the largest one-year increase since the early years of the ACA. Increases varied a good deal from one insurer to the next.
Even after that increase, the benchmark plan, meaning the second-lowest-cost silver plan used to size federal help, averaged $455 a month for a 40-year-old in Virginia in 2026.
Statewide averages give you a sense of scale, not a quote. Age, location, household size and income all change the figure you would see, and 2027 rates are filed and approved separately.
What else is specific to Virginia
State premium help is coming. Virginia is adding its own state-funded premium help, called Virginia Premium Savings, on top of federal credits, starting with the 2027 plan year. It is aimed at households with income between 138% and 250% of the federal poverty level, so check whether you fall in that range when 2027 enrollment opens. Virginia's open enrollment for 2027 coverage runs November 1, 2026 through January 29, 2027.
Your deduction carries through. Virginia's income tax starts from federal adjusted gross income. The federal self-employed health insurance deduction is taken before you reach that figure, so it lowers your Virginia taxable income as well.
No coverage mandate. Virginia does not require residents to carry insurance, and there is no state penalty for going without.
A sane way to decide in Virginia
Work out which income band you are likely to land in for the year, then match it to the option built for that band.
| Your likely income | Where to look first | Watch for |
|---|---|---|
| At or below 138% of poverty | Medicaid, under Virginia's expansion | Ask how your business income will be counted before you buy a plan |
| Inside the federal subsidy range | Virginia's Insurance Marketplace with a premium tax credit | Estimate carefully, since advance credits are repaid at tax time if you earn more than planned |
| Above the subsidy range | Full-price marketplace plans, which reinsurance keeps lower than they would otherwise be | 2026 rates rose 21.6% on average, and state help starting in 2027 may change the picture |
| Just left a job, income unclear | COBRA or Virginia continuation while you get settled | Election deadlines are short, and you pay the full group premium |
- Use the state site, not HealthCare.gov. Virginians enroll through marketplace.virginia.gov.
- Compare against your own address. With eight companies statewide, your local list may be short.
- List your doctors and prescriptions before you look at premiums, then rule out plans that leave them out.
- Revisit in the fall. The 2027 state subsidy and new rates both arrive then, and last year's choice may not hold.
A licensed advisor can walk through these options with your actual numbers, without health questions up front.
See where your household fits in Virginia. Tell us a little about your income and who needs coverage, and get a clear view of your options before open enrollment.
Start the two-minute checkCommon questions
Is Virginia's Insurance Marketplace the same as HealthCare.gov?
No. Since fall 2023, Virginians shop and enroll through Virginia's Insurance Marketplace, a state-run exchange operated by a division of the State Corporation Commission. Federal premium tax credits still apply there. You simply apply through the state's site instead of HealthCare.gov.
When is open enrollment in Virginia?
For 2026 coverage, it ran from November 1, 2025 through January 30, 2026, about two weeks past the January 15 deadline HealthCare.gov states used. Dates are set each year, so confirm the current window on the state marketplace before you plan around it.
What is the Virginia health insurance reinsurance program?
It is the Commonwealth Health Reinsurance Program, in place since the 2023 plan year under a federal waiver. It pays insurers back for part of their most expensive claims, which lets them file lower rates. Virginia's own first-year projection, accepted by federal officials, put premiums about 15.6% lower than they would otherwise be.
Does the self-employed health insurance deduction lower my Virginia income tax?
Generally yes. Virginia's income tax starts from your federal adjusted gross income, and the federal self-employed health insurance deduction is taken before that figure, so it carries into your Virginia return without a separate state step. Your tax preparer can confirm how it applies to you.