Health Insurance in Southampton County, Virginia for 2026

In 2026, 6 health insurance carriers offer marketplace plans in Virginia's Rating Area 4, which includes Southampton County.
Virginia's Medicaid program (FAMIS Plus) covers adults with incomes up to 138% of the Federal Poverty Level.
Marketplace Virginia offers a variety of plan types, including HMO, PPO, and EPO options, with PPO plans available on-exchange.
Southampton County has a population of 17,964 and an uninsured rate of 4.9%, per U.S. Census Bureau ACS 2024 5-year estimates.

Navigating health insurance options in Southampton County, Virginia, for 2026 involves understanding both marketplace plans and state-specific assistance programs. Residents can find subsidized coverage through Marketplace Virginia (HealthCare.gov) if their income falls between 100% and 400% of the Federal Poverty Level (FPL). For those with lower incomes, Virginia's expanded Medicaid program, known as FAMIS Plus, provides comprehensive coverage for adults up to 138% FPL. The local market in Rating Area 4 provides options from multiple carriers, ensuring a competitive selection for individuals and families seeking health coverage.

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Understanding Your Health Insurance Options in Southampton County

For residents of Southampton County, securing affordable health insurance primarily involves exploring options available through Marketplace Virginia, the state's health insurance exchange that utilizes the HealthCare.gov platform. During the annual Open Enrollment Period, or if you qualify for a Special Enrollment Period, you can choose from a range of plans designed to meet different needs and budgets. Virginia is a state where PPO plans are available on-exchange, alongside HMO and EPO options. This means consumers in Southampton County can choose a plan structure that best fits their preferences for provider networks and referrals. Plans are categorized into metal tiers:

Bronze plans: Typically have the lowest monthly premiums but the highest out-of-pocket costs when you need care. They cover 60% of costs on average.
Silver plans: Offer a balance of monthly premiums and out-of-pocket costs, covering 70% of costs on average. These plans are unique because if your income is below 250% FPL, you may qualify for Cost-Sharing Reductions (CSRs), which lower your deductibles, copayments, and out-of-pocket maximums.
Gold plans: Feature higher monthly premiums but lower out-of-pocket costs when you receive medical care, covering 80% of costs on average.
Platinum plans: Have the highest monthly premiums but the lowest out-of-pocket costs, covering 90% of costs on average.

Financial assistance, in the form of Advance Premium Tax Credits (APTCs), is available to reduce monthly premiums for individuals and families earning between 100% and 400% of the Federal Poverty Level. These credits can significantly lower the cost of coverage, making health insurance more accessible. Southampton County, part of Virginia's 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, has a population of 17,964 and a median income of $70,795. With an uninsured rate of 4.9%, lower than the state average, residents still face the challenge of accessing local acute care, as the county does not have any acute care hospitals within its boundaries. This means residents often travel to neighboring counties for hospital services.

Virginia Medicaid and FAMIS Programs for Low-Income Residents

Virginia expanded its Medicaid program in 2019, extending eligibility to adults with incomes up to 138% of the Federal Poverty Level. This program, known as Virginia Medicaid Expansion or FAMIS Plus, provides comprehensive health coverage with no monthly premiums for eligible individuals. If your income falls below this threshold, you may qualify for Medicaid, which offers extensive benefits including doctor visits, hospital care, prescription drugs, and mental health services. Beyond general adult Medicaid, Virginia also offers specialized programs:

FAMIS Moms: This program provides health coverage for pregnant women with household incomes up to 200% of the Federal Poverty Level. It covers prenatal care, labor and delivery, and 12 months of postpartum care, ensuring comprehensive support throughout pregnancy and beyond.
FAMIS (Family Access to Medical Insurance Security): Uninsured children in households with incomes up to 200% FPL are eligible for FAMIS, which provides low-cost health insurance.
FAMIS Select: For children in households with incomes between 200% and 400% FPL, FAMIS Select offers additional low-cost coverage options.

Applications for Virginia Medicaid and FAMIS programs can be submitted online through commonhelp.virginia.gov at any time of the year.

Health Insurance Carriers in Southampton County

In 2026, 6 carriers offer marketplace plans in Rating Area 4, which includes Southampton County. These carriers provide a range of options across the different metal tiers (Bronze, Silver, Gold, Platinum) and plan types (HMO, PPO, EPO). The confirmed carriers for this rating area are:

CareFirst BlueChoice
Cigna
HealthKeepers
Oscar Health
Sentara Health Plans
United Healthcare

When selecting a plan, it is essential to compare not only premiums but also deductibles, copayments, out-of-pocket maximums, and the specific network of doctors and hospitals. Given that Southampton County does not have acute care hospitals, verifying that nearby facilities in neighboring counties are in-network for your chosen plan is particularly important.

Making an Informed Decision About Your Health Coverage

Choosing the right health insurance plan for your needs in Southampton County involves evaluating your income, health status, and preference for provider networks.

If your income is below 138% FPL: You likely qualify for Virginia Medicaid (FAMIS Plus). This provides comprehensive, low-cost coverage. Apply through commonhelp.virginia.gov.
If your income is between 100% and 400% FPL: You are eligible for Advance Premium Tax Credits (APTCs) to lower your monthly premiums on Marketplace Virginia. Consider Silver plans, especially if your income is below 250% FPL, as you may also qualify for Cost-Sharing Reductions (CSRs) that reduce your out-of-pocket costs.
If your income is above 400% FPL: You can purchase plans through Marketplace Virginia at full price. Focus on finding a plan that balances monthly premiums with your expected medical costs and preferred provider network.
Consider plan types: With HMO, PPO, and EPO plans available, think about whether you need the flexibility of a PPO or prefer the potentially lower costs of an HMO/EPO. Always check if your preferred doctors and any necessary out-of-county hospitals are in the plan's network.

A licensed health insurance producer can provide personalized guidance, helping you compare plans, understand subsidies, and enroll in coverage that best suits your family's needs and budget, all at no cost to you.

Frequently Asked Questions

How do I apply for health insurance in Southampton County, Virginia?

Residents of Southampton County, Virginia, can apply for health insurance through Marketplace Virginia, which uses the HealthCare.gov platform. You can enroll during the annual Open Enrollment Period or if you qualify for a Special Enrollment Period due to a qualifying life event like losing other coverage, getting married, or having a baby. You can also apply for Virginia Medicaid (FAMIS Plus) at any time if your income is below 138% of the Federal Poverty Level.

What types of health plans are available on Marketplace Virginia?

Marketplace Virginia offers a variety of 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, giving consumers more flexibility in choosing providers. These plans are categorized into metal tiers (Bronze, Silver, Gold, Platinum) based on how costs are split between you and the plan.

Can I qualify for Medicaid in Southampton County, Virginia?

Yes, Virginia expanded Medicaid in 2019 (known as Virginia Medicaid Expansion or FAMIS Plus). Adults in Southampton County with incomes up to 138% of the Federal Poverty Level (FPL) may qualify for comprehensive, low-cost health coverage. Pregnant women may qualify for Virginia Medicaid (FAMIS Moms) with incomes up to 200% FPL, and children through FAMIS up to 200% FPL. Applications can be submitted through commonhelp.virginia.gov.

Are there hospitals located within Southampton County?

Southampton County currently does not have any acute care hospitals within its boundaries. Residents needing hospital services or emergency care typically travel to neighboring counties for treatment. When choosing a health plan, it is important to consider the network of providers and facilities in nearby areas to ensure convenient access to care.