Health Insurance in Roanoke, Virginia
- In 2026, 6 carriers offer ACA marketplace health plans in Roanoke, Virginia's Rating Area 5.
- Virginia expanded Medicaid in 2019, covering adults with incomes up to 138% of the Federal Poverty Level.
- Roanoke residents can choose from HMO, PPO, and EPO plans on Marketplace Virginia / HealthCare.gov.
- Pregnant women and children in Virginia may qualify for coverage through FAMIS Moms or FAMIS with incomes up to 200% FPL.
- Roanoke County, with a population of 98,355, is served by Carilion Medical Center, a major acute care hospital.
Finding the right health insurance in Roanoke, Virginia, involves understanding your options on the state marketplace, eligibility for Virginia Medicaid, and the local carriers serving Rating Area 5. For 2026, residents of Roanoke can choose from health plans offered by 6 different carriers, including CareFirst BlueChoice, Cigna, and United Healthcare, through Marketplace Virginia or HealthCare.gov. Virginia's expanded Medicaid program also provides comprehensive coverage for adults with incomes up to 138% of the Federal Poverty Level, while programs like FAMIS Moms and FAMIS support pregnant women and children up to 200% FPL. This guide details your health insurance choices, potential subsidies, and local healthcare resources available in Roanoke.
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What Are My Health Insurance Options in Roanoke, Virginia?
Residents of Roanoke have several pathways to securing health insurance coverage, primarily through the Affordable Care Act (ACA) marketplace, Virginia's expanded Medicaid program, or the Family Access to Medical Insurance Security (FAMIS) programs for children and pregnant women.
ACA Marketplace Plans
Marketplace Virginia, which uses the federal HealthCare.gov platform, is where individuals and families can shop for private health insurance plans. In Virginia, you can choose from various plan types, including Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and Exclusive Provider Organization (EPO) plans. PPO plans ARE available on-exchange in Virginia, offering more flexibility in provider choice compared to HMOs or EPOs, though they may come with higher premiums.
All plans offered through Marketplace Virginia cover essential health benefits, including doctor visits, prescription drugs, emergency services, maternity care, and mental health services. Financial assistance in the form of Advance Premium Tax Credits (APTCs) and Cost-Sharing Reductions (CSRs) is available to eligible individuals and families to make coverage more affordable.
Virginia Medicaid and FAMIS Programs
Virginia expanded its Medicaid program in 2019, now known as Virginia Medicaid Expansion or FAMIS Plus. This means adults with household incomes up to 138% of the Federal Poverty Level (FPL) may qualify for comprehensive, low-cost or no-cost health coverage. Unlike states that have not expanded Medicaid, Roanoke residents within this income bracket will not fall into a coverage gap.
Additionally, Virginia offers robust programs for children and pregnant women:
- FAMIS Moms: Covers pregnant women with incomes up to 200% FPL, providing prenatal care, labor and delivery, and 12 months of postpartum care. Applications can be submitted through commonhelp.virginia.gov.
- FAMIS (Family Access to Medical Insurance Security): Provides uninsured children in households with incomes up to 200% FPL with low-cost coverage.
- FAMIS Select: For children with household incomes between 200% and 400% FPL, offering another low-cost health insurance option.
Understanding Health Insurance Costs and Financial Help in Roanoke
The cost of health insurance in Roanoke depends on several factors, including your age, household size, chosen plan type, and income. Many Roanoke residents qualify for financial assistance through the ACA marketplace, significantly reducing their monthly premiums and out-of-pocket costs.
Federal Poverty Level (FPL) and Subsidies
Your household income, relative to the Federal Poverty Level, determines your eligibility for subsidies:
- Advance Premium Tax Credits (APTCs): These credits lower your monthly premium payments. Eligibility extends to individuals and families with incomes between 100% and 400% FPL, and even higher for those spending more than 8.5% of their income on health insurance premiums.
- Cost-Sharing Reductions (CSRs): Available for those with incomes up to 250% FPL, CSRs reduce your deductibles, copayments, and out-of-pocket maximums. To receive CSRs, you must enroll in a Silver-tier plan.
Here’s a general overview of FPL thresholds and potential benefits (using approximate 2024 FPL figures for illustration):
| Household Income (as % FPL) | Coverage Options | Key Benefits |
|---|---|---|
| Up to 138% FPL | Virginia Medicaid (FAMIS Plus) | Comprehensive, low-cost or no-cost health coverage. |
| 138% to 250% FPL | Marketplace Virginia (APTCs & CSRs) | Significant premium tax credits; reduced deductibles, copays, and out-of-pocket maximums on Silver plans. |
| 250% to 400% FPL | Marketplace Virginia (APTCs) | Premium tax credits to lower monthly costs; standard deductibles and copays based on plan tier. |
| Over 400% FPL | Marketplace Virginia (No APTCs/CSRs) | Access to marketplace plans at full price; may still find competitive rates. |
Health Insurance Carriers Serving Roanoke's Rating Area 5
In 2026, 6 carriers offer marketplace plans in Rating Area 5, which covers Roanoke and 18 other counties including Alleghany, Bath, Bedford, Botetourt, Carroll, Covington, Craig, Floyd, Galax, Grayson, Highland, Montgomery, Pulaski, Radford, Roanoke, Salem, Smyth, and Wythe. This competitive landscape provides a variety of options for residents seeking coverage.
The confirmed carriers offering plans in Rating Area 5 for the 2026 plan year are:
- CareFirst BlueChoice
- Cigna
- HealthKeepers
- Oscar Health
- Sentara Health Plans
- United Healthcare
When comparing plans, consider factors like the provider network, prescription drug coverage, and out-of-pocket costs to find the best fit for your healthcare needs and budget.
Local Healthcare Facilities in Roanoke County
Roanoke, Virginia, is the principal city within Roanoke County, which is part of Rating Area 5. This rating area covers 19 counties in total, serving a population of 98,355 in Roanoke with an uninsured rate of 9.8%, per U.S. Census Bureau ACS 2024 5-year estimates. The region's healthcare needs are primarily met by facilities such as Carilion Medical Center, located directly in Roanoke. Carilion Medical Center is a major acute care hospital providing a wide range of medical services to the community.
Understanding which health insurance plans include Carilion Medical Center and other local providers in their network is crucial when making your selection. This ensures you have access to preferred doctors and specialists without incurring out-of-network costs.
How to Enroll in Health Coverage in Roanoke
Enrolling in health insurance in Roanoke typically follows a clear path based on your income and household situation:
- If your household income is up to 138% FPL: You likely qualify for Virginia Medicaid (FAMIS Plus). Apply directly through commonhelp.virginia.gov.
- If your household income is between 138% and 400% FPL (or higher, if premiums are high): You are likely eligible for significant premium tax credits and potentially Cost-Sharing Reductions on Marketplace Virginia / HealthCare.gov. You should explore plans during Open Enrollment or if you qualify for a Special Enrollment Period due to a life event.
- For pregnant women (up to 200% FPL) and children (up to 200% FPL): Apply for FAMIS Moms or FAMIS through commonhelp.virginia.gov. Children between 200% and 400% FPL can explore FAMIS Select.
Navigating the various plan options, subsidy calculations, and enrollment processes can be complex. A licensed health insurance producer can provide free, unbiased assistance, helping you compare plans, verify provider networks, and complete your application to ensure you get the best coverage for your needs in Roanoke.