Health Insurance in Virginia

"The Centers for Medicare & Medicaid Services (CMS) administers Medicare. Medicare is a Health Insurance Program for people age 65 or older, some disabled people under age 65, and people of all ages with End-Stage Renal Disease (permanent kidney failure treated with dialysis or a transplant).

Learn more about Medicare: Online Medicare Eligibility Tool

Medicaid and coverage for children under FAMIS Plus are programs that help pay for medical care. To be eligible for Medicaid or FAMIS Plus, you must have limited income and resources and you must be in one of the groups of people covered by Medicaid. Some groups covered by Medicaid are: pregnant women, children, people with disablilities, and people age 65 and older.

Learn more about Medicaid and FAMIS: The Department of Medical Assistance Services Website

Agency for Healthcare Research and Quality - An arm of the U.S. Department of Health and Human Services (AHRQ). Develops practical, science-based information for medical practitioners, consumers, and other health care purchasers.

Bureau of Insurance, Virginia State Corporation Commission - Licenses all health insurance companies, HMOs, and health services plans. The Consumer Services Section, Life and Health Division, assists Virginia consumers in resolving disputes with insurance companies, HMOs, health services plans, and the agents who may sell such insurance programs in Virginia. The bureau will also provide addresses and telephone numbers of insurance companies that are licensed to sell insurance in Virginia.

National Association of Health Underwriters - A trade association of agents, brokers, and consultants of insurance.

National Committee on Quality Assurance - Since 1991, the NCQA has evaluated more than half of the nation's managed care programs in terms of patient records, complaints, equipment, and personnel. NCQA may grant accreditation for three years, for one year, or provisionally, or may deny accreditation. NCQA uses HEDIS, to measure plan quality.

Social Security Administration - Provides regional offices across Virginia. You may receive answers needed by phone or locate office nearest you.

Virginia Association of Health Plans - Publishes an annual directory which includes profiles of Virginia managed care organizations.

Virginia Department of Health/Office of Licensure and Certification - Charged with regulating the quality of health care services provided by managed care health insurance plans in Virginia. Consumers with concerns about access to care and the health services delivered by managed care insurance plans can address their concerns with the Center. In July 2000, managed care health insurance plans will be required to maintain a Certificate of Quality Assurance issued by the Department of Health.

Virginia Medicaid/DMAS - Administers Medicaid program for Virginia.

Updated on: 7/2/2024