Medicaid Eligibility in Virginia: Income Limits & How to Apply
Medicaid Eligibility in Virginia
Under the ACA's Medicaid expansion, Virginia residents earning up to 138% FPL can enroll in Virginia Medicaid. For a single adult, that's roughly $21,597 annually; for a four-person household, the cutoff is about $44,367 in 2026.
Key threshold: If your income is below $21,597 (individual) or $44,367 (family of 4), you likely qualify for Virginia Medicaid with free or very low-cost coverage. No premiums, no deductibles.
The following residents are eligible for Virginia Medicaid:
- Adults aged 19-64 with income up to 138% FPL
- Children in families with income up to 200-300% FPL (varies by age)
- Pregnant women with income up to 185-200% FPL
- Seniors and people with disabilities who meet income and asset requirements
About Virginia Medicaid
Virginia Medicaid, known as Cardinal Care, provides health coverage to a significant portion of the state's population. As of 2024, approximately 1.89 million people in Virginia were covered by Medicaid, representing about 21.5% of the state's population. This robust program offers coverage to adults aged 19-64 with incomes up to 138% of the Federal Poverty Level (FPL). For a single person, this means an annual income of about $20,782 in 2024, or $35,631 for a household of three. Children can qualify with household incomes up to 148% of FPL, while pregnant individuals are eligible with incomes up to 143% of FPL, with coverage extending for 12 months postpartum. Additionally, seniors and individuals with disabilities may also qualify, often with different income and asset limits.
If your income is close to the Virginia Medicaid cutoff, you could transition between Medicaid and the Virginia Insurance Marketplace. For example, if your income is slightly above the Medicaid limit, you might qualify for marketplace subsidies. The benchmark Silver plan in Virginia is around $478 per month, and subsidies can significantly reduce what you actually pay. It's important to report any income changes to ensure you're in the correct program. Virginia's uninsured rate rose to 6.9% in 2024, and many of those who lost coverage during the post-pandemic unwinding of continuous enrollment may still be eligible to reapply for Medicaid or find subsidized plans on the marketplace.
Virginia Medicaid provides comprehensive benefits, including a wide range of inpatient and outpatient medical services, behavioral health services, addiction and recovery treatment, and prescription medicines. Notably, Virginia Medicaid offers comprehensive dental benefits for both adults and children. The state also has unique waiver programs, such as the Commonwealth Coordinated Care Plus (CCC Plus) Waiver, which serves individuals of all ages with medical/nursing needs and does not have a waiting list, unlike some Developmental Disability (DD) Waivers. Virginia has also maintained telehealth flexibilities, covering various services including remote patient monitoring and allowing telehealth-only providers to enroll without a physical in-state office.
Be aware that navigating the application process can sometimes involve delays. You'll need to provide thorough documentation to verify your income, residency, and other eligibility factors. While there's no asset test for adults qualifying under the expansion guidelines, specific asset limits do apply to programs for the aged, blind, or disabled, where retirement accounts are generally counted. If you are deemed eligible, your coverage can sometimes be retroactive for up to three months before your application date. A concrete action step you can take is to apply online through CommonHelp or call the Cover Virginia Call Center to get a full review of your eligibility.
Virginia Medicaid Income Limits 2026
The following table shows the key income thresholds for Virginia in 2026:
| Household Size | 100% FPL | 138% FPL (Medicaid Limit) | 400% FPL (Subsidy Limit) |
|---|---|---|---|
| 1 | $15,650 | $21,597 | $62,600 |
| 2 | $21,150 | $29,187 | $84,600 |
| 3 | $26,650 | $36,777 | $106,600 |
| 4 | $32,150 | $44,367 | $128,600 |
| 5 | $37,650 | $51,957 | $150,600 |
| 6 | $43,150 | $59,547 | $172,600 |
If your household income falls below the 138% FPL column, you qualify for Virginia Medicaid. If your income is between 138% and 400% FPL, you qualify for ACA marketplace subsidies to help pay for private insurance.
At $478/month, Virginia's benchmark Silver plan premium is comparable to the national average of ~$525. Subsidies make marketplace coverage accessible for most income levels between Medicaid and 400% FPL.
Marketplace Insurance in Virginia
Virginia residents who do not qualify for Medicaid can purchase private health insurance through Virginia Insurance Marketplace. The average benchmark (second-lowest cost Silver) plan in Virginia costs approximately $478/month for a 40-year-old in 2026.
Premium tax credits (subsidies) are available for households with income between 100% and 400% FPL. Here is what a 40-year-old individual in Virginia might pay after subsidies:
| Income Level | Annual Income | Expected Contribution | Estimated Monthly Premium |
|---|---|---|---|
| 150% FPL | $23,475 | 4.01% of income | ~$78/mo |
| 200% FPL | $31,300 | 6.52% of income | ~$170/mo |
| 250% FPL | $39,125 | 8.33% of income | ~$272/mo |
| 300% FPL | $46,950 | 9.83% of income | ~$385/mo |
| 400% FPL | $62,600 | 9.83% of income | ~$513/mo |
These are estimates for an individual. Actual premiums depend on your age, household size, tobacco use, and the specific plan you choose. Households with income between 100-250% FPL also qualify for cost-sharing reductions (CSR) on Silver plans, which lower deductibles and copays.
Unlike most states, Virginia runs its own insurance marketplace through Virginia Insurance Marketplace. Residents shop for plans and apply for subsidies through this state-run platform rather than HealthCare.gov.
As an expansion state with its own marketplace infrastructure, Virginia demonstrates strong commitment to coverage. Virginia Medicaid benefits tend to be generous, and the enrollment process is well-integrated between Medicaid and marketplace plans.
How to Apply for Virginia Medicaid
- Online application — Start at Virginia Insurance Marketplace. Your Medicaid eligibility is checked automatically when you enter your income details.
- State Medicaid office — Apply directly through Virginia's Medicaid agency at any time during the year. Unlike marketplace insurance, Medicaid has no enrollment deadline.
- Phone assistance — Call Virginia's Medicaid helpline for guided help completing your application.
- In-person help — Visit your county human services office or a local navigator for face-to-face support.
To complete your application, you'll need income documentation (pay stubs, tax returns), a Virginia address for residency verification, Social Security numbers for household members, and information about existing coverage.
Calculate Your Subsidy in Virginia
Enter your income, age, and household size to see if you qualify for Medicaid or marketplace subsidies in Virginia.
Check Your Eligibility →Frequently Asked Questions
What is the Virginia Medicaid income cutoff for 2026?
In 2026, the Medicaid income limit in Virginia is 138% of the federal poverty level: $21,597 per year for an individual, $29,187 for a household of 2, $36,777 for 3, and $44,367 for a family of 4.
Has Virginia expanded Medicaid under the ACA?
Yes, Virginia has expanded Medicaid under the ACA. Adults aged 19-64 earning up to 138% of the federal poverty level qualify for Virginia Medicaid.
Can I get ACA subsidies in Virginia?
Yes. Virginia residents with household income between 100% and 400% FPL ($15,650 to $62,600 for an individual in 2026) qualify for premium tax credits that reduce the cost of marketplace health insurance. Apply through Virginia Insurance Marketplace.
What is the name of Virginia's Medicaid program?
Virginia's Medicaid program is known as Virginia Medicaid. It provides health coverage for eligible low-income residents including children, pregnant women, seniors, and adults up to 138% FPL.
What happens if I lose Medicaid coverage in Virginia?
If your Virginia Medicaid coverage ends due to income changes or redetermination, you qualify for a Special Enrollment Period on the marketplace. This gives you 60 days to sign up for a private plan through Virginia Insurance Marketplace. If your income is between 100-400% FPL, you'll likely qualify for subsidies to help cover the cost.
Does working disqualify me from Medicaid in Virginia?
Yes. Medicaid eligibility in Virginia is based on your Modified Adjusted Gross Income (MAGI), not your employment status. If your household income is at or below 138% FPL ($21,597 for an individual), you qualify for Virginia Medicaid even if you work full-time. Many Virginia Medicaid enrollees are working adults.
Virginia Medicaid vs. marketplace insurance — which is better?
Medicaid (Virginia Medicaid) is free or near-free with no premiums or deductibles. Marketplace plans in Virginia average $478/month before subsidies. If you qualify for Medicaid, it's the more affordable option. If your income puts you just above the cutoff, subsidized Silver plans with cost-sharing reductions are the next best thing.
Medicaid Eligibility in Nearby States
- Kentucky Medicaid Eligibility — Expansion state
- Maryland Medicaid Eligibility — Expansion state
- North Carolina Medicaid Eligibility — Expansion state
- Tennessee Medicaid Eligibility — Non-expansion state