Health Insurance in Carroll County, Virginia
- In 2026, 6 health insurance carriers offer marketplace plans in Virginia Rating Area 5, which includes Carroll County.
- Virginia expanded Medicaid in 2019, covering adults with household incomes up to 138% of the Federal Poverty Level.
- Marketplace Virginia (HealthCare.gov) offers HMO, PPO, and EPO plan types, providing a range of network options.
- Carroll County's uninsured rate is 9.0%, lower than the state average, according to U.S. Census Bureau ACS 2024 5-year estimates.
- Residents of Carroll County must travel to neighboring counties for acute care as there are no acute care hospitals within the county.
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What Health Insurance Options Are Available in Carroll County, Virginia?
Residents of Carroll County, Virginia, have several pathways to obtaining health insurance, primarily through Marketplace Virginia (HealthCare.gov) or Virginia's Medicaid and CHIP programs.Marketplace Virginia (HealthCare.gov)
Marketplace Virginia is the state's health insurance exchange, operating on the federal HealthCare.gov platform. Through this marketplace, individuals and families can:- Compare Plans: Review a variety of plans offered by multiple private insurance companies.
- Apply for Financial Assistance: Many Carroll County residents qualify for subsidies that can significantly reduce their monthly premiums (Advance Premium Tax Credits) and out-of-pocket costs (Cost-Sharing Reductions). Eligibility for these subsidies is based on your household income relative to the Federal Poverty Level (FPL).
- Choose Plan Types: Unlike some states, Virginia offers a choice of Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and Exclusive Provider Organization (EPO) plans on-exchange. This provides flexibility in selecting a plan that matches your preferred doctor network and coverage needs.
Virginia Medicaid (FAMIS Plus and FAMIS Moms)
Virginia expanded its Medicaid program in 2019, making coverage available to more residents.- Adults: If your household income is at or below 138% of the Federal Poverty Level, you may qualify for Virginia Medicaid (known as FAMIS Plus). This program provides comprehensive health coverage with no monthly premiums and minimal out-of-pocket costs.
- Pregnant Women: Virginia Medicaid (FAMIS Moms) covers pregnant women with incomes up to 200% FPL. This includes comprehensive prenatal care, labor and delivery services, and 12 months of postpartum care.
- Children: The Family Access to Medical Insurance Security (FAMIS) program covers uninsured children in households up to 200% FPL. For children between 200% and 400% FPL, FAMIS Select offers low-cost coverage.
Understanding Your Costs and Subsidies in Carroll County
The cost of health insurance in Carroll County can vary widely depending on your income, age, family size, and the type of plan you choose. Many individuals and families qualify for financial assistance, which is crucial for making coverage affordable.Federal Poverty Level (FPL) and Subsidies
Your eligibility for subsidies is tied to your household income relative to the Federal Poverty Level. Here's a general overview for 2026:- Below 138% FPL: You likely qualify for Virginia Medicaid (FAMIS Plus). For a single individual, this is approximately $20,782 annually.
- 100% - 400% FPL: You may qualify for significant Advance Premium Tax Credits (APTCs) to lower your monthly premiums. For a single individual, this range is approximately $15,000 to $60,000 annually.
- 150% - 250% FPL: In addition to APTCs, you may also qualify for Cost-Sharing Reductions (CSRs) if you choose a Silver-tier plan. CSRs reduce your deductibles, copayments, and out-of-pocket maximums, making healthcare much more affordable.
Even if your income is above 400% FPL, you may still qualify for premium tax credits that cap your premium contribution at 8.5% of your household income, making marketplace plans more accessible.
Plan Metal Tiers and What They Cover
Marketplace plans are categorized into metal tiers: Bronze, Silver, Gold, and Platinum. These tiers indicate how you and your plan share costs, not the quality of care.| Metal Tier | Plan Pays (Approx.) | Your Share (Approx.) | Best For |
|---|---|---|---|
| Bronze | 60% | 40% | Low monthly premiums, higher out-of-pocket costs. Good for those who rarely visit the doctor. |
| Silver | 70% | 30% | Moderate premiums and out-of-pocket costs. Best value if you qualify for Cost-Sharing Reductions. |
| Gold | 80% | 20% | Higher monthly premiums, lower out-of-pocket costs. Good for those with regular medical needs. |
Consider your expected healthcare usage and financial situation when choosing a metal tier. A licensed agent can help you understand which tier offers the best value for your specific circumstances in Carroll County.
Health Insurance Carriers in Carroll County
For the 2026 plan year, residents of Carroll County have access to plans from multiple reputable health insurance carriers through Marketplace Virginia. In 2026, 6 carriers offer marketplace plans in Virginia Rating Area 5. These carriers provide a range of options, including HMO, PPO, and EPO plans, to meet diverse healthcare needs. The confirmed local carriers offering plans in Rating Area 5, which covers Alleghany, Bath, Bedford, Botetourt, Carroll, Covington, Craig, Floyd, Galax, Grayson, Highland, Montgomery, Pulaski, Radford, Roanoke, Roanoke, Salem, Smyth, Wythe counties, include:- CareFirst BlueChoice
- Cigna
- HealthKeepers
- Oscar Health
- Sentara Health Plans
- United Healthcare
Carroll County, with a population of 29,157 and an uninsured rate of 9.0% per U.S. Census Bureau ACS 2024 5-year estimates, is part of Virginia Rating Area 5. This rating area is served by 6 confirmed carriers offering marketplace plans, ensuring competitive options for residents, despite the county having no acute care hospitals within its boundaries.
Hospitals and Healthcare Access in Carroll County
Access to healthcare facilities is a key consideration when choosing a health insurance plan. Carroll County currently has no acute care hospitals within its geographical boundaries. This means that residents needing emergency services or inpatient hospital care will typically need to travel to a neighboring county. When selecting a health plan, it is important to verify which hospitals and healthcare systems in adjacent counties are included in your chosen plan's network. While Carroll County itself does not have acute care facilities, the surrounding region in Rating Area 5 offers various options. You should consider the proximity of network hospitals and specialists when making your decision to ensure convenient access to necessary medical services.How to Choose the Right Health Plan in Carroll County
Choosing the ideal health insurance plan involves evaluating your specific needs, financial situation, and healthcare preferences. Here's a guide to help Carroll County residents make an informed decision:- Assess Your Income and Eligibility for Assistance:
- If your income is below 138% FPL (e.g., ~$20,782 for an individual), apply for Virginia Medicaid (FAMIS Plus) through commonhelp.virginia.gov.
- If your income is between 100% and 400% FPL, you will likely qualify for significant premium tax credits. Explore Silver plans if your income is between 150% and 250% FPL to maximize Cost-Sharing Reductions.
- Consider Your Healthcare Needs:
- Low Usage: If you are generally healthy and rarely visit the doctor, a Bronze plan with a lower premium but higher deductible might be suitable.
- Moderate Usage: Silver plans offer a balance of premiums and out-of-pocket costs, often enhanced by CSRs for eligible individuals.
- High Usage: If you have chronic conditions, require regular prescriptions, or anticipate frequent doctor visits, a Gold plan with higher premiums but lower out-of-pocket costs may save you money in the long run.
- Review Carrier Networks:
- Since Carroll County has no acute care hospitals, confirm that your preferred doctors and the hospitals in neighboring counties are in the network of any plan you consider.
- Compare HMO, PPO, and EPO options to understand referral requirements and out-of-network coverage. PPO plans offer the most flexibility for out-of-network care, though usually at a higher cost.
- Utilize Free Expert Assistance:
- A licensed health insurance producer can provide personalized, unbiased guidance. They can help you navigate the Marketplace Virginia options, understand subsidy eligibility, compare plan benefits, and enroll in the plan that best fits your needs—all at no cost to you.
Frequently Asked Questions
Can I get PPO health insurance plans in Carroll County, Virginia?
Yes, PPO plans are available on Marketplace Virginia (HealthCare.gov) for residents of Carroll County. In addition to PPOs, you can also choose from HMO and EPO plan structures, giving you a range of options for provider networks and flexibility.
What is the income limit for Virginia Medicaid in Carroll County?
Virginia expanded Medicaid in 2019. Adults in Carroll County may qualify for Virginia Medicaid (also known as FAMIS Plus) if their household income is at or below 138% of the Federal Poverty Level (FPL). For a single individual, this threshold is approximately $20,782 per year in 2026.
Are there subsidies available for health insurance in Carroll County?
Yes, many residents of Carroll County qualify for premium tax credits (APTC) and cost-sharing reductions (CSR) when purchasing plans through Marketplace Virginia (HealthCare.gov). Eligibility depends on your household income relative to the Federal Poverty Level. Subsidies can significantly lower your monthly premiums and out-of-pocket costs.
How do I apply for health insurance in Carroll County, Virginia?
You can apply for health insurance through Marketplace Virginia, which operates via HealthCare.gov. This is where you can compare plans, check your eligibility for subsidies, and enroll. If your income qualifies, you can also apply for Virginia Medicaid (FAMIS Plus) through commonhelp.virginia.gov. A licensed health insurance producer can provide free assistance with the application process and plan selection.