Health Insurance in Franklin County, Virginia: Your 2026 Coverage Options
- For 2026, 6 carriers offer health insurance plans on the Marketplace Virginia (HealthCare.gov) in Franklin County.
- Virginia residents, including those in Franklin County, can choose from HMO, PPO, and EPO plan types on the marketplace.
- Virginia expanded Medicaid in 2019; adults with incomes up to 138% of the Federal Poverty Level (FPL) may qualify for coverage.
- Franklin County has a population of 55,130, with an uninsured rate of 6.8%, per U.S. Census Bureau ACS 2024 5-year estimates.
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What Are Your Health Insurance Options in Franklin County, Virginia?
Residents of Franklin County, Virginia, primarily access health insurance through the Affordable Care Act (ACA) marketplace, known locally as Marketplace Virginia, which utilizes the HealthCare.gov platform. This marketplace is designed to provide individuals and families with access to comprehensive health coverage, often with financial assistance.Understanding ACA Plan Categories
ACA plans are categorized into metal tiers—Bronze, Silver, Gold, and Platinum—based on how you and your plan share the costs of care.- Bronze plans: Offer lower monthly premiums but higher deductibles and out-of-pocket maximums. They cover about 60% of your medical costs, leaving you responsible for 40%.
- Silver plans: Provide a balance between premiums and out-of-pocket costs, covering about 70% of medical expenses. These are the only plans eligible for Cost-Sharing Reductions (CSRs), which lower your deductibles, copayments, and out-of-pocket maximums if you qualify based on income.
- Gold plans: Have higher monthly premiums but lower deductibles and out-of-pocket costs, covering approximately 80% of medical expenses.
- Platinum plans: Feature the highest premiums but the lowest out-of-pocket costs, covering about 90% of medical expenses. These are suitable for those who anticipate frequent medical care.
Financial Assistance: Subsidies and Medicaid
Many Franklin County residents qualify for financial help to reduce the cost of health insurance.- Premium Tax Credits (APTCs): These subsidies lower your monthly premium payments. Eligibility is based on household income, generally available to those earning between 100% and 400% of the Federal Poverty Level (FPL).
- Cost-Sharing Reductions (CSRs): These reduce your out-of-pocket costs like deductibles, copayments, and coinsurance. CSRs are only available with Silver plans and are for those with incomes up to 250% FPL.
- Virginia Medicaid (FAMIS Plus): As Virginia expanded Medicaid in 2019, adults with household incomes up to 138% FPL are eligible for comprehensive, low-cost or free health coverage.
| Household Size | 100% FPL (Approx.) | 138% FPL (Approx.) | 250% FPL (Approx.) | 400% FPL (Approx.) |
|---|---|---|---|---|
| 1 | $15,060 | $20,783 | $37,650 | $60,240 |
| 2 | $20,440 | $28,207 | $51,100 | $81,760 |
| 3 | $25,820 | $35,631 | $64,550 | $103,280 |
| 4 | $31,200 | $43,056 | $78,000 | $124,800 |
Approximate 2026 Federal Poverty Level (FPL) thresholds for various household sizes.
Health Insurance Carriers in Franklin County
For the 2026 plan year, residents of Franklin County have a strong selection of health insurance carriers offering plans through Marketplace Virginia. Franklin County is part of Virginia Rating Area 4, which covers Chesapeake, Franklin, Hampton, Isle of Wight, James City, Newport News, Norfolk, Northampton, Poquoson, Portsmouth, Southampton, Suffolk, Surry, Virginia Beach, Williamsburg, and York counties. In 2026, 6 carriers offer marketplace plans in Rating Area 4. The confirmed local carriers providing marketplace plans in Franklin County for 2026 include:- CareFirst BlueChoice
- Cigna
- HealthKeepers
- Oscar Health
- Sentara Health Plans
- United Healthcare
Medicaid and CHIP Coverage in Virginia
Virginia expanded its Medicaid program in 2019, significantly increasing access to affordable health coverage for many residents, including those in Franklin County. This expansion means that adults with household incomes up to 138% of the Federal Poverty Level (FPL) may qualify for Virginia Medicaid, also known as FAMIS Plus. This program provides comprehensive health benefits with little to no out-of-pocket costs. Beyond adult expansion, Virginia offers robust programs for pregnant women and children:- FAMIS Moms (Medicaid for Pregnant Women): Pregnant women in Virginia with household incomes up to 200% FPL are eligible for full Medicaid coverage. This includes comprehensive prenatal care, labor and delivery services, and 12 months of postpartum care, an extension adopted by Virginia under the American Rescue Plan.
- FAMIS (Children's Health Insurance Program): Uninsured children in households with incomes up to 200% FPL can receive low-cost health coverage through FAMIS. For children in families with incomes between 200% and 400% FPL, FAMIS Select offers additional low-cost coverage options.
Choosing the Right Health Plan in Franklin County
Selecting a health insurance plan requires evaluating your healthcare needs, budget, and eligibility for financial assistance. Consider the following steps when making your decision in Franklin County:- Estimate Your Income: Your household income for 2026 will determine your eligibility for premium tax credits, cost-sharing reductions, or Virginia Medicaid. Be as accurate as possible when estimating.
- Understand Plan Types: Decide whether an HMO, PPO, or EPO plan best suits your needs regarding network flexibility and referral requirements. Remember, PPOs are available on-exchange in Virginia.
- Compare Metal Tiers:
- If you qualify for Cost-Sharing Reductions (incomes up to 250% FPL), a Silver plan often provides the best value, offering enhanced benefits beyond standard Silver coverage.
- If you anticipate high medical costs, a Gold or Platinum plan may offer lower out-of-pocket expenses despite higher premiums.
- If you prefer lower monthly premiums and don't expect frequent medical care, a Bronze plan could be a cost-effective choice, but be prepared for higher out-of-pocket costs if you do need care.
- Check Provider Networks: Confirm that your preferred doctors, specialists, and facilities, such as Carilion Franklin Memorial Hospital, are in-network for any plan you consider.
Frequently Asked Questions
What types of health insurance plans are available in Franklin County, Virginia?
In Franklin County, Virginia, you can choose from HMO, PPO, and EPO plan types on the HealthCare.gov marketplace. PPO plans are available on-exchange in Virginia, offering more flexibility in choosing providers outside a specific network.
How many health insurance carriers offer plans in Franklin County for 2026?
For the 2026 plan year, 6 carriers offer marketplace health insurance plans in Franklin County, Virginia's Rating Area 4. These include CareFirst BlueChoice, Cigna, HealthKeepers, Oscar Health, Sentara Health Plans, and United Healthcare.
What are the income limits for Medicaid in Virginia?
Virginia expanded Medicaid in 2019, meaning adults with household incomes up to 138% of the Federal Poverty Level (FPL) may qualify for comprehensive coverage through Virginia Medicaid or FAMIS Plus. Pregnant women (FAMIS Moms) and children (FAMIS) can qualify with incomes up to 200% FPL.
Is Carilion Franklin Memorial Hospital covered by marketplace plans?
Carilion Franklin Memorial Hospital in Rocky Mount is an acute care facility serving Franklin County. Most major marketplace health plans in Rating Area 4, including those from carriers like Cigna and HealthKeepers, will have network agreements with local hospitals. It's crucial to verify your specific plan's network to ensure your preferred providers, including Carilion Franklin Memorial Hospital, are covered.