Sentara Health Insurance Plans in Hampton, Virginia

Updated July 2026 · VirginiaPlanFinder.com — Licensed Health Insurance Producer (NPN #21249133)

Sentara Health Plans is one of 6 carriers offering marketplace plans in Rating Area 4, which includes Hampton, Virginia.
Virginia expanded Medicaid in 2019, covering adults with incomes up to 138% of the Federal Poverty Level.
Marketplace Virginia offers HMO, PPO, and EPO plan types, with PPO options available from several carriers in Hampton.
Hampton's uninsured rate is 7.0%, significantly lower than the national average, per U.S. Census Bureau ACS 2024 5-year estimates.

Navigating health insurance options in Hampton, Virginia, offers a range of choices, including plans from Sentara Health Plans. As a resident of Hampton, you can explore individual and family health insurance through Marketplace Virginia, also known as HealthCare.gov, to find coverage that fits your needs and budget. Sentara Health Plans is a prominent local provider, and understanding its offerings alongside other carriers is key to making an informed decision about your healthcare coverage. This guide will help you understand your options, including plan types, financial assistance, and local healthcare resources.

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What Are Your Health Insurance Options in Hampton, Virginia?

Hampton residents have several pathways to securing health insurance coverage. For many, the primary avenue is Marketplace Virginia, which operates on the federal HealthCare.gov platform. Through the marketplace, individuals and families can compare a variety of plans and may qualify for subsidies to reduce their monthly premiums and out-of-pocket costs. Additionally, Virginia offers robust Medicaid and Children's Health Insurance Program (CHIP) options for those who meet specific income guidelines. For those who do not qualify for subsidies or prefer off-exchange plans, direct enrollment with carriers is also an option, though these plans typically do not include financial assistance.

Marketplace Plans and Subsidies

Marketplace Virginia allows you to enroll in plans during the annual Open Enrollment Period or through a Special Enrollment Period if you experience a qualifying life event. Financial assistance, known as premium tax credits and cost-sharing reductions, is available based on household income and size. These subsidies can significantly lower the cost of coverage, making comprehensive health insurance more affordable. Virginia expanded Medicaid in 2019, meaning adults with incomes up to 138% of the Federal Poverty Level (FPL) may qualify for Virginia Medicaid or FAMIS Plus. For example, a single individual earning up to approximately $20,120 per year (based on 2024 FPLs, subject to annual adjustment) could be eligible. This expansion ensures that more low-income residents in Hampton have access to comprehensive healthcare services without premiums.

Understanding Plan Types Available in Hampton

When selecting a health insurance plan in Hampton, you'll encounter various plan types, each with different network structures and cost-sharing models. Fortunately, Virginia offers a broad range of choices on the marketplace:

Health Maintenance Organization (HMO) Plans: These plans typically require you to choose a primary care provider (PCP) within the network and get referrals for specialist visits. They often have lower premiums but less flexibility in choosing providers outside the network.
Preferred Provider Organization (PPO) Plans: PPO plans offer more flexibility. You usually don't need a referral to see a specialist, and you can see out-of-network providers, though at a higher cost. PPO plans ARE available on-exchange in Virginia, including options from HealthKeepers Plus PPO, Cigna HMO and PPO, and United Healthcare HMO and PPO.
Exclusive Provider Organization (EPO) Plans: EPO plans are similar to HMOs in that they cover services only from providers in the plan's network, except in emergencies. However, they typically do not require a PCP referral for specialist visits within the network.

Hampton residents should consider their preferred doctors, healthcare needs, and budget when choosing between these plan types.

Health Insurance Carriers in Hampton

In 2026, 6 carriers offer marketplace 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. Sentara Health Plans is one of these key providers, offering options to residents throughout the area. The confirmed local carriers for Hampton and Rating Area 4 are:

CareFirst BlueChoice
Cigna
HealthKeepers
Oscar Health
Sentara Health Plans
United Healthcare

When reviewing plans, it's important to compare not only premiums but also deductibles, copayments, coinsurance, and the specific provider networks each carrier offers. Sentara Health Plans, with its strong local presence including Sentara Careplex Hospital in Hampton, is a significant option for many residents.

Local Healthcare Resources in Hampton

Hampton, Virginia, with a population of 137,557 and an uninsured rate of 7.0% per U.S. Census Bureau ACS 2024 5-year estimates, is served by Sentara Careplex Hospital, an acute care facility located within Hampton County. This hospital is part of the larger Sentara Health System, providing comprehensive medical services to the community. Residents in Rating Area 4, which includes Hampton and 16 other counties, benefit from access to a robust network of healthcare providers and facilities. When choosing a health insurance plan, consider whether your preferred doctors and hospitals, such as Sentara Careplex Hospital, are included in the plan's network.

Making the Right Choice for Your Health Insurance in Hampton

Choosing the right health insurance plan in Hampton depends on your unique circumstances, including your income, health needs, and preferred providers.

If your household income is below 138% FPL: You likely qualify for Virginia Medicaid (FAMIS Plus) and should apply through commonhelp.virginia.gov.
If your household income is between 100% and 400% FPL: You are eligible for significant premium tax credits on Marketplace Virginia. Consider an Enhanced Silver plan, which offers lower deductibles and out-of-pocket maximums in addition to reduced premiums.
If your household income is above 400% FPL: You can still purchase plans through Marketplace Virginia or directly from carriers. While you won't qualify for subsidies, you'll benefit from the consumer protections of the Affordable Care Act.

A licensed health insurance producer can provide personalized guidance, helping you compare Sentara Health Plans and other options, understand your subsidy eligibility, and navigate the enrollment process at no cost to you.

Frequently Asked Questions

What types of health insurance plans does Sentara Health Plans offer in Hampton, VA?

In Hampton, Sentara Health Plans, along with other carriers, offers a variety of plan types through Marketplace Virginia, including Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and Exclusive Provider Organization (EPO) plans. These plans vary in their network restrictions and cost-sharing structures.

Can I get a PPO plan through Marketplace Virginia in Hampton?

Yes, unlike some other states, PPO plans ARE available on-exchange through Marketplace Virginia in Hampton. This means you can find PPO options from carriers like Sentara Health Plans, HealthKeepers, Cigna, and United Healthcare, and potentially use subsidies to lower your premiums.

How do I know if I qualify for Medicaid in Virginia?

Virginia expanded Medicaid in 2019. Adults in Hampton with an income up to 138% of the Federal Poverty Level (FPL) may qualify for Virginia Medicaid or FAMIS Plus. Pregnant women and children have higher income thresholds, up to 200% FPL for FAMIS Moms and FAMIS for children.

Where can I find a Sentara Health Plans agent in Hampton?

You can connect with a licensed health insurance producer through VirginiaPlanFinder.com. These agents are certified to help you compare Sentara Health Plans and other options available in Hampton, guide you through the enrollment process, and help you apply for subsidies, all at no cost to you.