This story was reported and written by VPM News.
With the deadline to register for health insurance coverage through the state's marketplace this year fast approaching, thousands fewer Virginians have signed up so far this cycle.
The deadline to register or change insurance coverage is Friday, Jan. 30.
Preliminary estimates show a roughly 20,000-household drop in enrollment in 2026 compared to the same period last year, according to a spokesperson with Virginia's Health Benefit Exchange.
Virginians who don't get health insurance through their employer rely on coverage through Virginia's Insurance Marketplace, which is operated by the Virginia Health Benefit Exchange — a division of the State Corporation Commission.
Roughly 390,000 households enrolled in health care coverage through the state's insurance marketplace in 2025. Nearly 70,000 of those were new enrollees, which was a 21% increase over 2024 enrollment.
"We're proud of the strides we've made in increasing access to affordable, comprehensive health coverage," Keven Patchett, director of the Virginia Health Benefit Exchange, said at the time.
Virginia's Insurance Marketplace won't release final open enrollment numbers for the commonwealth until after the Jan. 30 deadline, but health care advocates say a sharp increase in health insurance costs have forced people to change their insurance coverage or cancel it altogether — potentially reversing the growth in numbers of insured Virginians.
Deepak Madala, director of the Virginia Poverty Law Center's Enroll Virginia program (which helps eligible Virginians enroll in the state's marketplace), said people experienced sticker shock when they received their January insurance bills.
"People are seeing pretty significant increases on the cost of their plans," Madala said. "So they're switching to lower-cost options — switching from silver to bronze — so they can get lower premiums, but they're seeing significant increases in their out-of-pocket costs."
Sticker shock as federal insurance subsidies end
Two factors are major contributors to the cost increases.
One is at the state level. Last summer, Virginia's Bureau of Insurance (also part of the SCC) approved a 20% annual premium increase for 2026 to cover the growing costs associated with providing health care and insurance carriers' assessments of their risk pools.
The other driving force behind rising costs comes from Washington.
As part of the 2021 American Rescue Plan Act, Congress expanded access to subsidies created under the Affordable Care Act in order to enhance access to more affordable health insurance options.
But those credits — which were at the center of the longest federal government shutdown in US history last fall — expired at the end of 2025.
Earlier this month, a bipartisan effort to extend the subsidies for three years passed the US House of Representatives, but the US Senate has yet to take it up — and it hasn't received support from Republican President Donald Trump.
Roughly 335,000 Virginians with annual incomes over 400% of the federal poverty level — $62,600 for an individual or $132,000 for a family of four — relied on those subsidies to lower their health insurance costs, but no longer qualify. That means someone who may have paid between $150 and $200 a month for health insurance coverage could now have to pay $900 for the same level of coverage.
Growth in enrollment "really is at risk this year"
Madala said throughout the current enrollment period, which began in November, people have opted to change their coverage plans to accept higher deductibles — the amount a policyholder is expected to pay out of pocket each year before the insurance company begins to cover the cost of care — in exchange for lower monthly premiums.
He previously told VPM News that deductibles could be as high as $20,000 in some instances.
Virginia's enrollment period runs during the holidays, when checking on insurance coverage may not be top of mind for policyholders. Madala said many people rely on automatic re-enrollment, which is leaving customers confused about the changes in costs and wondering whether they did something wrong.
"Thankfully, for us in Virginia, we have this entire month to change that plan to see if there's a better option," he said, encouraging enrollees to take an active role in maintaining their insurance plan.
Overall, Madala said he has a pessimistic outlook for the year, as additional health insurance cuts passed in HR 1 (the "One Big Beautiful Bill Act") — including cuts to Medicaid eligibility and new work requirements — are set to take effect this fall.
"This year is going to be a difficult year," Madala said. "Virginia has come a very long way in the last 10 years from the start of the ACA, then also the expansion of Medicaid. … All of that really is at risk this year."
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