Sentara Health Plans in King and Queen County, Virginia

Sentara Health Plans is one of 6 carriers offering marketplace health insurance in King and Queen County for 2026.
Virginia residents can choose from HMO, PPO, and EPO plan types on Marketplace Virginia (HealthCare.gov).
Individuals and families earning between 100% and 400% FPL are eligible for significant premium subsidies.
Virginia Medicaid (FAMIS Plus) covers adults up to 138% FPL; pregnant women are covered up to 200% FPL.

Navigating health insurance options in King and Queen County, Virginia, includes considering plans from Sentara Health Plans. As a prominent carrier in the region, Sentara Health Plans offers various health coverage options through Marketplace Virginia, the state's health insurance exchange that utilizes the federal platform, HealthCare.gov. This guide will help you understand the types of Sentara plans available, how they fit into the broader marketplace options, and how financial assistance can make coverage more affordable for residents of King and Queen County.

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What Sentara Health Plans are Available in King and Queen County?

For the 2026 plan year, Sentara Health Plans is one of 6 confirmed carriers providing marketplace health insurance options to residents in King and Queen County. These plans are available through Marketplace Virginia (HealthCare.gov), where individuals and families can compare coverage and costs. Sentara Health Plans typically offers a range of plan metallic tiers, including Bronze, Silver, Gold, and sometimes Platinum, designed to meet different budget and healthcare needs. Virginia's health insurance marketplace allows for a variety of plan structures, including Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and Exclusive Provider Organization (EPO) plans. This means King and Queen County residents have flexibility in choosing a plan that balances network access, referral requirements, and cost. While specific plan offerings from Sentara Health Plans may vary by tier and year, the availability of multiple plan types ensures that consumers can find a structure that suits their preferences.

Understanding Your Health Insurance Options in King and Queen County

King and Queen County is part of Virginia Rating Area 8, which covers Accomack, Albemarle, Amelia, Amherst, Appomattox, Bland, Brunswick, Buckingham, Campbell, Caroline, Charlotte, Charlottesville, Cumberland, Danville, Emporia, Essex, Fluvanna, Giles, Gloucester, Greene, Greensville, Halifax, Henry, King William, King and Queen, Lancaster, Louisa, Lunenburg, Lynchburg, Martinsville, Mathews, Mecklenburg, Middlesex, Nelson, Northumberland, Nottoway, Patrick, Pittsylvania, Prince Edward, Prince George, Sussex, Westmoreland, Winchester counties. This wide rating area ensures a competitive market with multiple carriers. In 2026, 6 carriers offer marketplace plans in Rating Area 8, including Sentara Health Plans. The choice of plan can significantly impact your out-of-pocket costs and access to doctors and hospitals. Residents of King and Queen County, with a population of 6,695 and a median age of 49.3 years, face unique healthcare access considerations, as the county has no acute care hospitals within its boundaries. Residents needing acute care typically travel to neighboring counties for services. The county's uninsured rate stands at 5.8%, per U.S. Census Bureau ACS 2024 5-year estimates.

Financial Assistance and Subsidies

The Affordable Care Act (ACA) provides significant financial assistance to make health insurance more affordable. This assistance comes in two main forms:

Premium Tax Credits (Subsidies): These credits reduce your monthly premium payment. Eligibility is based on income, generally for individuals and families earning between 100% and 400% of the Federal Poverty Level (FPL). In Virginia, a family of four earning up to approximately $120,000 might qualify for assistance.
Cost-Sharing Reductions (CSRs): These reduce your out-of-pocket costs, such as deductibles, copayments, and coinsurance. CSRs are only available on Silver-tier plans and are typically for those with incomes up to 250% FPL.

Virginia expanded Medicaid in 2019 (Virginia Medicaid Expansion / FAMIS Plus). Adults with household incomes up to 138% of the FPL may qualify for comprehensive Medicaid coverage, which typically has no premiums and very low out-of-pocket costs. Pregnant women in Virginia (FAMIS Moms) can qualify for Medicaid with incomes up to 200% FPL, receiving prenatal, delivery, and 12 months of postpartum care. Children are covered under FAMIS up to 200% FPL, with FAMIS Select offering low-cost coverage for children between 200% and 400% FPL. You can apply for these programs through commonhelp.virginia.gov.

Health Insurance Carriers in King and Queen County

In 2026, 6 carriers offer marketplace plans in Rating Area 8, which includes King and Queen County. This ensures a competitive market with diverse options beyond just Sentara Health Plans. When choosing a plan, consider the network of doctors and hospitals, the specific benefits offered, and the overall costs (premiums, deductibles, and out-of-pocket maximums). The confirmed carriers for King and Queen County's Rating Area 8 for the 2026 plan year are:

CareFirst BlueChoice
Cigna
HealthKeepers
Oscar Health
Sentara Health Plans
United Healthcare

Each of these carriers offers various plans across the metallic tiers (Bronze, Silver, Gold) and different plan types (HMO, PPO, EPO). It is recommended to compare plans from all available carriers to find the best fit for your healthcare needs and budget.

How to Enroll in a Health Plan in King and Queen County

Enrolling in a health insurance plan, whether from Sentara Health Plans or another carrier, typically occurs during the annual Open Enrollment Period. This period usually runs from November 1st to January 15th each year, with coverage starting on January 1st for plans selected by December 15th. If you miss Open Enrollment, you may still be able to enroll if you qualify for a Special Enrollment Period (SEP). SEPs are triggered by specific qualifying life events, such as:

Losing existing health coverage (e.g., due to job loss, COBRA expiration)
Getting married or divorced
Having a baby, adopting a child, or placing a child for adoption or foster care
Moving to a new area that offers different health plan options
Changes in income that affect eligibility for subsidies or Medicaid

If you believe you qualify for an SEP, it's crucial to act quickly, as most SEPs require you to enroll within 60 days of the qualifying event. A licensed health insurance producer can help you determine your eligibility for an SEP and guide you through the enrollment process, at no cost to you.

Frequently Asked Questions

Are Sentara Health Plans available on HealthCare.gov in King and Queen County?

Yes, Sentara Health Plans is one of 6 carriers offering health insurance plans through Marketplace Virginia (HealthCare.gov) in King and Queen County for the 2026 plan year. Residents can compare Sentara plans with options from other carriers during open enrollment or a special enrollment period.

What types of health plans does Sentara offer in King and Queen County?

In King and Queen County, Sentara Health Plans, along with other carriers, offers a range of plan types including Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and Exclusive Provider Organization (EPO) plans. The specific availability of plan types from Sentara Health Plans may vary, but all three structures are generally available on the Virginia marketplace.

Can I get financial assistance for a Sentara Health Plan in Virginia?

Yes, individuals and families in King and Queen County with incomes between 100% and 400% of the Federal Poverty Level (FPL) may qualify for premium tax credits to lower their monthly health insurance costs. Those with incomes up to 250% FPL may also qualify for cost-sharing reductions to reduce out-of-pocket expenses on Silver plans.

What is the deadline to enroll in a Sentara Health Plan for 2026 coverage?

The primary enrollment period is during the annual Open Enrollment, which typically runs from November 1st to January 15th each year for coverage starting the following January 1st. Outside of Open Enrollment, you can only enroll if you qualify for a Special Enrollment Period due to a qualifying life event like marriage, birth, or loss of other coverage.