Each of the individual states must review its existing insurance regulations to bring them in line with the requirements of the 2010 Patient Protection and Affordable Care Act. Children may no longer be excluded from coverage for pre-existing conditions, and must be allowed to remain on their parents’ health coverage to age 26, regardless of marital or educational status. Adults with pre-existing conditions may currently draw on coverage from high-risk insurance pools, a temporary solution to be replaced on January 1, 2014 by the federally mandated health insurance exchanges.
General Insurance Regulations
Health insurance policies in Virginia must carry a guarantee of renewal if all the terms of the contract are being met and the premiums are being paid. Currently insurers can exclude coverage for a pre-existing condition for up to 12 months with a 12 month look-back period.
In the state of Virginia Blue Cross Blue Shield must offer coverage to all residents regardless of their medical and health status. Other insurance companies in Virginia can deny applicants coverage based upon their health conditions. In most cases, insurers typically charge people similar rates for health status.
Health Care Exchange
Virginia plans to create a health care exchange, but the process is on hold pending the outcome of the Supreme Court’s review of the Affordable Care act in March 2012. Legislation has been put in place, however, to prevent any policies sold by an exchange in the state from covering abortions except in cases of rape, incest, or danger to the mother’s life.
Pre-Existing Condition Insurance
The U.S. Department of Health and Human Services runs the Virginia Pre-Existing Condition Insurance Plan, which covers both primary and specialty care, hospitalization, and prescription drugs. Monthly premiums vary by age and option and range from $93 to $401. Deductibles are $1000 to $3000 with the potential for a separate drug deductible. The maximum annual out-of-pocket expense is $7000.
All Medicaid eligibility is figured according to income as a percentage of the Federal Poverty Level. From birth to age 5, children in Virginia are covered at 133% FPL, with ages 6-19 at 100%. The latter group also qualifies for the Children’s CHIP Medicaid expansion at 133% FPL.
Pregnant women may access Medicaid at 185% FPL, parents at 24%, and non-elderly Social Security disability recipients at 74%.
Approximately 14% of the state’s population is enrolled in Medicare, with more than 1,087,000 people drawing on prescription drug coverage.
In addition, Virginia offers help for Medicare beneficiaries who need Assisted Living, and has established an additional prescription drug program under the Medicare Modernization Act to help with out-of-pocket costs.