Health Insurance Options in Smithfield, Virginia for 2026
- In 2026, 6 carriers offer marketplace plans in Smithfield's Rating Area 4.
- Virginia Medicaid (FAMIS Plus) covers adults with household incomes up to 138% of the Federal Poverty Level.
- Smithfield residents can choose from HMO, PPO, and EPO plans on HealthCare.gov, with potential subsidies.
- Isle of Wight County, home to Smithfield, has no acute care hospitals, requiring residents to seek care in neighboring counties.
- The median household income in Smithfield is $113,158, per U.S. Census Bureau ACS 2024 5-year estimates.
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What Health Insurance Plans Are Available in Smithfield, Virginia?
Residents of Smithfield can choose from a variety of health insurance plans through HealthCare.gov, Virginia's platform for ACA marketplace enrollment. These plans are categorized into metal tiers: Bronze, Silver, Gold, and Platinum, each offering different levels of cost-sharing. Catastrophic plans are also available for individuals under 30 or those with a hardship exemption. In Virginia, marketplace shoppers have access to multiple plan types, including Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Exclusive Provider Organizations (EPOs). This means you are not restricted to HMO or EPO plans, and can find PPO options from several carriers in Smithfield's Rating Area 4. Financial assistance, including Premium Tax Credits (APTCs) and Cost-Sharing Reductions (CSRs), is available to help make these plans more affordable. APTCs lower your monthly premiums, while CSRs reduce out-of-pocket costs like deductibles, copayments, and coinsurance for those who enroll in Silver-tier plans and meet specific income criteria.Understanding Metal Tiers
| Metal Tier | Approximate Cost Sharing | Best For |
|---|---|---|
| Bronze | Insurer pays ~60%, you pay ~40% | Lower premiums, high deductible. Good for healthy individuals who want protection from catastrophic costs. |
| Silver | Insurer pays ~70%, you pay ~30% (can increase with CSRs) | Moderate premiums, moderate deductible. Good for individuals and families who qualify for Cost-Sharing Reductions. |
| Gold | Insurer pays ~80%, you pay ~20% | Higher premiums, lower deductible. Good for those who expect to use medical services frequently. |
| Platinum | Insurer pays ~90%, you pay ~10% | Highest premiums, lowest deductible. Best for those with significant ongoing medical needs. |
| Catastrophic | Very high deductible, low premium | Limited to individuals under 30 or with hardship exemption. Covers essential health benefits. |
Virginia Medicaid and FAMIS Programs in Smithfield
Virginia has expanded its Medicaid program, known as Virginia Medicaid Expansion or FAMIS Plus, providing critical health coverage to a wider range of residents in Smithfield and across the state. Adults with household incomes up to 138% of the Federal Poverty Level (FPL) are eligible for comprehensive Medicaid benefits. This expansion ensures that individuals and families who might otherwise struggle to afford coverage can access necessary medical care without facing a "coverage gap." Beyond adults, Virginia offers robust programs for children and pregnant women:- FAMIS Moms: Virginia Medicaid covers pregnant women with income up to 200% FPL. This includes comprehensive prenatal care, labor and delivery services, and an extended 12 months of postpartum care, a benefit adopted by Virginia under the American Rescue Plan.
- FAMIS (Family Access to Medical Insurance Security): This program provides health coverage for uninsured children in households with incomes up to 200% FPL.
- FAMIS Select: For children whose household incomes fall between 200% and 400% FPL, FAMIS Select offers low-cost health coverage options.
Federal Poverty Level (FPL) Guidelines for 2026 (Example)
Eligibility for subsidies and Medicaid is based on your household income relative to the Federal Poverty Level. Below are approximate FPL thresholds for 2026 for a single individual and a family of four (these numbers are illustrative and subject to official updates annually):
| Household Size | 100% FPL | 138% FPL (Medicaid Expansion) | 200% FPL (FAMIS/FAMIS Moms) | 400% FPL (Max Subsidy Eligibility) |
|---|---|---|---|---|
| 1 Person | ~$15,060 | ~$20,783 | ~$30,120 | ~$60,240 |
| 4 People | ~$31,200 | ~$43,056 | ~$62,400 | ~$124,800 |
Note: These FPL figures are illustrative estimates for 2026. Official figures are released annually by the Department of Health and Human Services.
Health Insurance Carriers in Smithfield
For the 2026 plan year, Smithfield residents have a choice of health insurance plans from 6 different carriers participating in the HealthCare.gov marketplace for Rating Area 4. This rating area is quite extensive, covering a total of 17 counties and cities in Virginia. The confirmed local carriers offering plans in Rating Area 4, which covers Chesapeake, Franklin, Franklin, Hampton, Isle of Wight, James City, Newport News, Norfolk, Northampton, Poquoson, Portsmouth, Southampton, Suffolk, Surry, Virginia Beach, Williamsburg, York counties, include:- CareFirst BlueChoice
- Cigna
- HealthKeepers
- Oscar Health
- Sentara Health Plans
- United Healthcare
Healthcare Access in Smithfield and Isle of Wight County
Smithfield, a city with a population of 8,834, is located within Isle of Wight County. Per U.S. Census Bureau ACS 2024 5-year estimates, Smithfield has a median household income of $113,158 and an uninsured rate of 5.3%. Isle of Wight County itself, with a population of 39,974, reports a median household income of $95,241 and an uninsured rate of 4.7%. A key consideration for residents in this area is the availability of acute care. Isle of Wight County has no acute care hospitals within its boundaries, meaning residents needing emergency or inpatient hospital services typically travel to neighboring counties for care. This makes understanding your plan's network and out-of-area coverage particularly important when choosing a health insurance policy in Rating Area 4.How to Enroll in Health Coverage in Smithfield
Enrolling in a health insurance plan in Smithfield typically occurs during the annual Open Enrollment Period, which usually runs from November 1st to January 15th for coverage starting the following year. During this time, you can apply for new coverage, renew your existing plan, or switch to a different plan. Outside of Open Enrollment, you may qualify for a Special Enrollment Period (SEP) if you experience a Qualifying Life Event (QLE). Common QLEs include:- Losing existing health coverage (e.g., due to job loss, turning 26 and coming off a parent's plan, COBRA ending)
- Changes in household size (e.g., marriage, divorce, birth or adoption of a child)
- Moving to a new area that offers different health plans
- Changes in income that affect your eligibility for subsidies or Medicaid
Frequently Asked Questions
Can I get a PPO health insurance plan on HealthCare.gov in Smithfield, Virginia?
Yes, PPO plans are available on-exchange through HealthCare.gov in Virginia, including in Smithfield. Marketplace shoppers can choose from PPO, HMO, and EPO plan structures offered by various carriers in Rating Area 4.
What is the income limit for Virginia Medicaid (FAMIS Plus) in Smithfield?
In Virginia, adults may qualify for Medicaid (known as FAMIS Plus) if their household income is at or below 138% of the Federal Poverty Level. For pregnant women, Virginia Medicaid (FAMIS Moms) covers those with incomes up to 200% FPL.
How many health insurance carriers offer marketplace plans in Smithfield, VA for 2026?
For the 2026 plan year, 6 different health insurance carriers offer plans on HealthCare.gov in Smithfield, Virginia's Rating Area 4. These include CareFirst BlueChoice, Cigna, HealthKeepers, Oscar Health, Sentara Health Plans, and United Healthcare.
Does Isle of Wight County have an acute care hospital?
No, Isle of Wight County, where Smithfield is located, does not have any acute care hospitals within its boundaries. Residents needing acute medical care typically travel to neighboring counties for hospital services.