Sentara Health Insurance Plans in Reston, Virginia
- Sentara Health Plans is one of 6 carriers offering health insurance plans on the Marketplace Virginia / HealthCare.gov in Reston for the 2026 plan year.
- Reston is part of Virginia Rating Area 1, which covers Fairfax County and 17 other counties.
- Virginia's marketplace offers Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and Exclusive Provider Organization (EPO) plans, with PPOs available on-exchange.
- Individuals and families with incomes between 100% and 400% FPL may qualify for significant premium tax credits to reduce monthly costs.
- Virginia expanded Medicaid in 2019, covering adults with incomes up to 138% FPL through Virginia Medicaid or FAMIS Plus.
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What Sentara Health Plans Are Available in Reston?
As a resident of Reston, you have access to Sentara Health Plans through the Marketplace Virginia / HealthCare.gov. In 2026, Sentara Health Plans is one of six carriers offering marketplace plans in Rating Area 1, which includes Reston and the broader Fairfax County area. Virginia's marketplace offers a comprehensive selection of plan structures, including Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and Exclusive Provider Organization (EPO) plans. Unlike some states, PPO plans are indeed available on-exchange in Virginia, providing more flexibility for those who prefer out-of-network options or do not wish to select a primary care physician. Plans are categorized into metal tiers: Bronze, Silver, Gold, and Platinum. Bronze plans typically have the lowest monthly premiums but the highest deductibles and out-of-pocket costs, making them suitable for those who use healthcare infrequently. Silver plans offer a balance of premiums and out-of-pocket costs, and are the only tier eligible for cost-sharing reductions, which can significantly lower deductibles and copays for eligible individuals. Gold and Platinum plans feature higher premiums but lower out-of-pocket costs, appealing to those who expect to use medical services more frequently.Understanding Your Eligibility for Financial Assistance
Many Reston residents qualify for financial assistance to make health insurance more affordable. The primary forms of assistance are premium tax credits and cost-sharing reductions, both available through the Marketplace Virginia / HealthCare.gov.Premium Tax Credits
If your household income falls between 100% and 400% of the Federal Poverty Level (FPL), you may be eligible for premium tax credits. These credits can be applied directly to your monthly premium, reducing your out-of-pocket cost for coverage. The exact amount of your subsidy depends on your household size, income, and the cost of the benchmark Silver plan in your area. For example, a single individual in Reston earning $45,000 (approximately 300% FPL) might see their monthly premium for a Silver plan significantly reduced.Cost-Sharing Reductions (CSRs)
For individuals and families with incomes up to 250% FPL, cost-sharing reductions (CSRs) are available exclusively with Silver plans. CSRs reduce your deductible, copayments, and out-of-pocket maximums, making healthcare services more affordable when you need them. This means that a Silver plan with CSRs can offer benefits similar to a Gold plan, but at a lower premium, representing significant value.Virginia Medicaid and FAMIS Programs
Virginia expanded its Medicaid program in 2019, known as Virginia Medicaid Expansion or FAMIS Plus. This program covers adults with incomes up to 138% of the Federal Poverty Level. If your income falls within this range, you may qualify for comprehensive, low-cost or no-cost health coverage. Additionally, Virginia offers specific programs for pregnant women and children:- 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 made through commonhelp.virginia.gov.
- FAMIS (Family Access to Medical Insurance Security): Covers uninsured children in households up to 200% FPL. For children between 200% and 400% FPL, FAMIS Select offers low-cost coverage options.
Health Insurance Carriers in Reston
Residents of Reston, Virginia, are part of Rating Area 1, which covers a broad region including Alexandria, Arlington, Clarke, Culpeper, Fairfax, Falls Church, Fauquier, Frederick, Fredericksburg, Loudoun, Madison, Manassas, Manassas Park, Orange, Prince William, Rappahannock, and Warren counties. In 2026, 6 carriers offer marketplace plans in Rating Area 1:- CareFirst BlueChoice
- Cigna
- HealthKeepers
- Oscar Health
- Sentara Health Plans
- United Healthcare
Local Healthcare Providers in Reston and Fairfax County
Reston, with a population of 64,414 and a median income of $148,710 per U.S. Census Bureau ACS 2024 5-year estimates, is a vibrant part of Fairfax County. Fairfax County, home to 1,147,837 residents, has an uninsured rate of 7.1%. Residents needing acute care have access to several hospitals within Fairfax County. These include Fort Belvoir Community Hospital in Fort Belvoir, Inova Fairfax Hospital in Falls Church, Inova Fair Oaks Hospital in Fairfax, and Inova Mount Vernon Hospital in Alexandria. Reston itself is served by Reston Hospital Center, providing local access to comprehensive medical services. When choosing a Sentara Health Plan or any other carrier, it's important to verify that your preferred doctors and hospitals are within the plan's network, especially for HMO and EPO plans.Making Your Health Insurance Decision in Reston
Choosing a health insurance plan involves evaluating your healthcare needs, budget, and eligibility for financial assistance. Here's a general guide for Reston residents:- If your income is below 138% FPL: You likely qualify for Virginia Medicaid (FAMIS Plus). This program offers comprehensive coverage with minimal or no costs.
- If your income is between 100% and 400% FPL: You are eligible for premium tax credits. Consider a Silver plan, especially if your income is below 250% FPL, to maximize cost-sharing reductions and lower your out-of-pocket expenses.
- If your income is above 400% FPL: While you won't qualify for subsidies, you can still enroll in a marketplace plan. Compare Bronze, Silver, Gold, and Platinum options based on your expected healthcare usage and preferred deductible levels.
Frequently Asked Questions
Are Sentara Health Plans available on the HealthCare.gov marketplace in Reston?
Yes, Sentara Health Plans is one of six carriers offering marketplace plans in Reston's Rating Area 1 for the 2026 plan year. You can compare their plans with others through Marketplace Virginia / HealthCare.gov.
What types of Sentara Health Plans are available in Reston, Virginia?
In Virginia, marketplace plans, including those from Sentara Health Plans, are available as Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and Exclusive Provider Organization (EPO) options. PPO plans are available on-exchange in Virginia.
Can I get financial assistance for Sentara Health Plans in Reston?
Yes, if your household income is between 100% and 400% of the Federal Poverty Level (FPL), you may qualify for premium tax credits to lower your monthly costs. Additional cost-sharing reductions are available for incomes up to 250% FPL, reducing deductibles and out-of-pocket maximums.
What is the uninsured rate in Reston?
The uninsured rate in Reston, Virginia, is 5.7%, according to U.S. Census Bureau ACS 2024 5-year estimates. This is lower than the Fairfax County uninsured rate of 7.1%.