If you've started shopping for health coverage in Virginia and you're not sure whether you'll land on an ACA marketplace plan or Medicaid, that's normal — you're not supposed to know in advance. Virginia doesn't run these as two separate applications. One application, through Virginia's Insurance Marketplace, checks both, and where you land depends almost entirely on household income.
One application, two possible outcomes
When you apply through Virginia's Insurance Marketplace (marketplace.virginia.gov), the system automatically screens your household against Medicaid and CHIP eligibility before it ever shows you ACA plan options. In Virginia, that means checking against two programs:
- Cardinal Care — Virginia's Medicaid program for eligible adults and families.
- FAMIS — Virginia's CHIP program, generally covering children (and sometimes pregnant individuals) in households that earn a bit too much for Medicaid but could still use help affording coverage.
If your household qualifies for either one, you're routed there. If not, you move forward into ACA marketplace plans — often with a premium tax credit that lowers your monthly cost, depending on income.
Why this matters more than people expect
Medicaid and ACA marketplace plans work differently — different costs, different provider networks, different rules for changing plans later. Some people are surprised to land on Medicaid when they expected a marketplace plan, or the other way around. Neither outcome is better or worse across the board; they're just different systems built for different income levels. Knowing which one you're likely to land in ahead of time makes the whole process far less confusing.
What's changing for 2026
During the pandemic-era enhancements, ACA premium tax credits temporarily became available above the usual income ceiling, and got more generous throughout the standard range. Those enhanced credits are expiring. For 2026, subsidy eligibility is reverting toward the original ACA structure — generally households between 100% and 400% of the federal poverty level — though some households already enrolled under the more generous rules may see transitional treatment at renewal. If your subsidy amount hasn't been rechecked recently, 2026 is the year to do it rather than assume it's unchanged.
| Medicaid (Cardinal Care / FAMIS) | ACA Marketplace | |
|---|---|---|
| Who it's generally for | Lower-income households, under ~138% FPL | Households roughly 100–400% FPL |
| Monthly cost | Varies | Varies; often reduced by a premium tax credit |
| How you apply | Same application as ACA | Same application as Medicaid |
| 2026 change | No change to the income threshold itself | Enhanced subsidies expiring; reverting toward 100–400% FPL |
Not sure which one you'll land on?
We'll walk through your household numbers with you — free, no pressure, no obligation.
Check my eligibilityWhat if your income is right on the line?
Income near the Medicaid cutoff is exactly where people benefit most from having someone double-check the numbers before they apply — a household size change, a recent raise, or seasonal income can shift which side of 138% FPL you land on. Getting it right the first time avoids the hassle of re-applying or discovering mid-year that your coverage doesn't match your actual eligibility.
Income that isn't a steady paycheck is where this gets trickiest. Self-employed income, 1099 work, seasonal jobs, and irregular hours all have to be estimated and reported carefully — guess too low and you may owe money back at tax time if you received a larger premium tax credit than you actually qualified for; guess too high and you could miss out on savings you were entitled to. This is one of the most common reasons people get an outcome that surprises them, and it's worth walking through with someone before you submit.
What to have ready before you apply
- Social Security numbers (or document numbers for eligible immigrants) for everyone applying
- Recent pay stubs, or a self-employment income estimate for the year
- Information on any current health coverage, including employer-sponsored plans you're offered but not using
- Household size and anyone you claim as a tax dependent
- Your most recent tax return, if your income has changed since then
Having these ready before you start the application makes the process faster and reduces the chance of an estimate that gets flagged for follow-up later.
How Honorbrook helps
We're an independent agency based in Virginia, and helping people navigate Virginia's Insurance Marketplace — including the Medicaid screening step — is something we do routinely, not as an afterthought. We'll walk through your household income with you, tell you honestly which program you're likely to land in, and help you enroll either way. It costs nothing to ask.
This article is general information, not insurance, tax, or legal advice. Income thresholds, subsidy amounts, and program rules change and vary by household — confirm your specific numbers with a licensed agent or Virginia's Insurance Marketplace directly.
Availability and rules vary by state
Health plans, premiums, enrollment rules and state programs differ by state and sometimes by county, and a given plan may not be available in every state. Honorbrook is licensed in the 11 states below; what we can offer you depends on what carriers sell where you live. Each state’s insurance regulator can verify an agent’s license and answer consumer questions.
- Virginia: Virginia Bureau of Insurance
- Maryland: Maryland Insurance Administration
- North Carolina: North Carolina Department of Insurance
- South Carolina: South Carolina Department of Insurance
- Georgia: Georgia Office of Insurance and Safety Fire Commissioner
- Alabama: Alabama Department of Insurance
- Louisiana: Louisiana Department of Insurance
- Texas: Texas Department of Insurance
- Michigan: Michigan Department of Insurance and Financial Services
- Indiana: Indiana Department of Insurance
- West Virginia: West Virginia Offices of the Insurance Commissioner