Sentara Health Insurance Plans in Salem, Virginia

Q: What types of Sentara Health Plans are available in Salem, Virginia?

In Salem, Sentara Health Plans offers a range of health insurance options through the Marketplace Virginia, including Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans. These plans provide various levels of coverage and network access to suit different healthcare needs and budgets.

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

Sentara Health Plans is one of 6 carriers offering health insurance through Marketplace Virginia in Salem's Rating Area 5 for 2026.
Virginia expanded Medicaid in 2019, covering adults with incomes up to 138% of the Federal Poverty Level (FPL).
Marketplace Virginia shoppers in Salem can choose from HMO, PPO, and EPO plan structures, with PPO plans available on-exchange.
Salem, Virginia, has an uninsured rate of 4.3%, significantly lower than the national average, per U.S. Census Bureau ACS 2024 5-year estimates.

Navigating health insurance options in Salem, Virginia, involves understanding both your local choices and statewide programs. Sentara Health Plans is a prominent carrier offering coverage in Salem through Marketplace Virginia, alongside several other insurers. For 2026, residents of Salem and the surrounding Rating Area 5 have access to a variety of plans, including Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and Exclusive Provider Organization (EPO) structures. Eligibility for financial assistance, such as premium tax credits and cost-sharing reductions, depends on your household income and can significantly lower your monthly premiums and out-of-pocket costs.

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What Health Insurance Options Are Available in Salem?

Residents of Salem, Virginia, seeking health insurance have several avenues for coverage, primarily through Marketplace Virginia (which uses the HealthCare.gov platform), Virginia Medicaid, or employer-sponsored plans. For those purchasing coverage independently, the marketplace is the main source for plans that comply with the Affordable Care Act (ACA) and offer potential financial assistance. In 2026, Salem is part of Virginia Rating Area 5, which covers a broad region including Alleghany, Bath, Bedford, Botetourt, Carroll, Covington, Craig, Floyd, Galax, Grayson, Highland, Montgomery, Pulaski, Radford, Roanoke, Roanoke, Salem, Smyth, and Wythe counties. Within this rating area, 6 carriers offer marketplace plans, ensuring a competitive selection for consumers. These plans include a mix of HMO, PPO, and EPO options, with PPO plans notably available on-exchange in Virginia, providing more flexibility for those who prefer out-of-network coverage options (albeit often at a higher cost).

Understanding Plan Types: HMO, PPO, and EPO

Health Maintenance Organization (HMO) Plans: These plans typically require you to choose a primary care provider (PCP) within the network who then refers you to specialists. HMOs generally have lower premiums and out-of-pocket costs, but offer less flexibility if you want to see providers outside the network.
Preferred Provider Organization (PPO) Plans: PPO plans offer more flexibility than HMOs. You generally don't need a referral to see a specialist, and you can see out-of-network providers, though you'll pay more for those services. PPOs often have higher premiums but offer a wider choice of doctors and hospitals.
Exclusive Provider Organization (EPO) Plans: EPO plans are a hybrid. They allow you to see any specialist within the network without a referral, similar to a PPO. However, like an HMO, they typically do not cover out-of-network care except in emergencies.

Sentara Health Plans and Other Carriers in Salem

Sentara Health Plans is one of the key providers of health insurance in Salem, Virginia. As part of a larger integrated health system, Sentara offers plans designed to connect members with a network of doctors, specialists, and hospitals. Their plans through Marketplace Virginia provide comprehensive coverage for essential health benefits, including preventive care, prescription drugs, emergency services, and more. In 2026, 6 carriers offer marketplace plans in Rating Area 5, which includes Salem. These confirmed local carriers provide a range of choices for residents:

CareFirst BlueChoice
Cigna
HealthKeepers
Oscar Health
Sentara Health Plans
United Healthcare

When selecting a plan, it is crucial to compare not only premiums but also deductibles, copayments, coinsurance, and the plan's provider network to ensure your preferred doctors and any necessary medical facilities are covered. Salem County's Lewisgale Medical Center is an acute care hospital, and ensuring it is within your chosen plan's network is important for local residents.

Financial Assistance and Virginia Medicaid Eligibility

Many Salem residents qualify for financial help to make health insurance more affordable. The Affordable Care Act (ACA) provides subsidies in the form of premium tax credits and cost-sharing reductions (CSRs) for eligible individuals and families purchasing plans through Marketplace Virginia.

Premium Tax Credits (Subsidies)

Premium tax credits can lower your monthly health insurance premiums. Eligibility is based on your household income relative to the Federal Poverty Level (FPL). For 2026, individuals and families with incomes between 100% and 400% FPL may qualify for these credits. For example, a single individual earning up to approximately $60,240 could receive assistance.

Cost-Sharing Reductions (CSRs)

CSRs reduce your out-of-pocket costs, such as deductibles, copayments, and coinsurance. These are available to individuals and families with incomes up to 250% FPL who enroll in a Silver-tier plan. If you qualify for CSRs, choosing a Silver plan can provide significantly better coverage value than higher-tier plans.

Virginia Medicaid and FAMIS Plus

Virginia expanded Medicaid in 2019 (known as Virginia Medicaid Expansion or FAMIS Plus), making coverage available to adults with incomes up to 138% of the FPL. For a single individual, this means an income of approximately $20,780 per year. If your income falls within this range, you may qualify for comprehensive, low-cost or no-cost health coverage through Virginia Medicaid. Additionally, Virginia offers specific programs for vulnerable populations:

FAMIS Moms: Pregnant women with household incomes up to 200% FPL (approximately $30,120 for an individual) can qualify for Virginia Medicaid, which includes extensive prenatal care, labor and delivery, and 12 months of postpartum care. Applications can be submitted through commonhelp.virginia.gov.
FAMIS (Children's Health Insurance Program): Uninsured children in households up to 200% FPL are covered by FAMIS. For children between 200% and 400% FPL, FAMIS Select offers low-cost coverage.

Choosing the Right Plan in Salem

Selecting the best health insurance plan in Salem depends on your specific healthcare needs, financial situation, and preferences for provider networks. The 6 confirmed carriers in Rating Area 5, including Sentara Health Plans, offer a diverse range of options for 2026. Salem, Virginia, with a population of 25,618 and an uninsured rate of 4.3% (per U.S. Census Bureau ACS 2024 5-year estimates), benefits from a competitive and accessible health insurance market. Consider these factors when making your decision:

Your Budget: Compare premiums, deductibles, and out-of-pocket maximums. If you qualify for subsidies, factor those into your premium calculations.
Healthcare Needs: If you have chronic conditions or anticipate needing frequent medical care, a plan with lower deductibles and copayments may be more cost-effective, even if the premium is slightly higher.
Doctor and Hospital Preferences: Check if your preferred doctors and Lewisgale Medical Center are in-network for the plans you are considering. HMOs have more restrictive networks, while PPOs offer more flexibility.
Medication Needs: Review the plan's formulary (list of covered drugs) to ensure your prescriptions are covered and to understand their cost.

A licensed health insurance producer can help you navigate these choices, understand your eligibility for financial assistance, and enroll in a plan that meets your needs. This service is typically free to you.

Frequently Asked Questions

What types of Sentara Health Plans are available in Salem, Virginia?

Sentara Health Plans offers a range of health insurance options through the Marketplace Virginia, including Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans. These plans provide various levels of coverage and network access to suit different healthcare needs and budgets.

Can I get a subsidy for Sentara Health Plans in Salem?

Yes, if your household income falls between 100% and 400% of the Federal Poverty Level (FPL), you may qualify for premium tax credits and cost-sharing reductions (CSRs) to lower the cost of a Sentara Health Plan purchased through Marketplace Virginia. For 2026, a single individual earning up to approximately $60,240 could qualify for assistance.

Is Lewisgale Medical Center covered by Sentara Health Plans in Salem?

Sentara Health Plans generally include a network of local providers and hospitals. While Sentara operates its own facilities, many of its plans also contract with other major health systems. To confirm if Lewisgale Medical Center in Salem is in-network for a specific Sentara plan, it's essential to check the plan's provider directory or contact Sentara Health Plans directly before enrolling.

What is the uninsured rate in Salem, Virginia?

According to U.S. Census Bureau ACS 2024 5-year estimates, Salem, Virginia, has an uninsured rate of 4.3%. This is significantly lower than the national average, reflecting broad access to coverage options including employer-sponsored plans, Virginia Medicaid, and the Marketplace Virginia.