Chapter 65 of Title 38.2 of the Code of Virginia established the Virginia Health Benefit Exchange Division (the “Exchange") within the State Corporation Commission (the “Commission"). The Exchange is responsible for the administration of Virginia’s Insurance Marketplace. The purpose of the Marketplace is to facilitate the sale and purchase of Qualified Health Plans and standalone Qualified Dental Plans, to support the continuity of health coverage, and to reduce the number of uninsured Virginians.

The plan year 2026 Open Enrollment period for Virginia’s Insurance Marketplace occurred from November 1, 2025, to January 30, 2026. During this reporting year, the Exchange continued its work to help Virginians compare coverage options, access available financial assistance, and maintain enrollment in qualified health plans. During the Open Enrollment Period, the number of new enrollments decreased by 16% compared to 2025, from 69,000 in 2025 to 58,000 in 2026, while overall enrollment decreased by 4.9%, from 389,000 to 370,000.(*1)

Marketplace consumers experienced substantial premium cost increases in 2026 as a result of carrier rate increases and the expiration of the enhanced federal premium tax credits on December 31, 2025. H.R. 1 provisions also eliminated federal tax credits for certain non-citizens under 100% of the federal poverty limit beginning on January 1, 2026. As a result, the Exchange has observed steeper enrollment declines and high rates of terminations for non-payment in the months following the end of Open Enrollment. As of June of 2026, nearly 123,000 enrollees terminated their coverage, resulting in a net enrollment loss of 70,000.

Major federal policy changes continue to impact the Exchange’s enrollment levels and preparation for the upcoming plan year 2027 Open Enrollment. These include the implementation of additional Marketplace and Medicaid eligibility changes required under H.R. 1 and monitoring of multiple regulatory actions by the Centers for Medicare & Medicaid Services and subsequent legal challenges. The Exchange continues to implement operational changes and consumer outreach to prepare Virginians and stakeholders for the resulting eligibility and enrollment changes.

In 2026, the General Assembly established the Virginia Health Insurance Affordability Fund, a $150 million state-funded initiative to improve the affordability of Marketplace coverage. Beginning in plan year 2027, the Exchange will administer Virginia Premium Savings for eligible Marketplace consumers with household incomes between 138% and 250% of the federal poverty level. Virginia Premium Savings will be applied automatically through the Marketplace application and plan-shopping process. The program is expected to provide meaningful premium assistance to qualifying Virginians, including consumers who may no longer qualify for federal advance premium tax credits.

As required by Code § 38.2-6516, the Exchange, in collaboration with the Secretary of Health and Human Resources, submits this report annually to the Chairs of the Senate Committees on Commerce and Labor and Finance and Appropriations and the House Committees on Labor and Commerce and Appropriations. It addresses:

1. Exchange operations and responsibilities,

2. An accounting of the Exchange’s finances,

3. The effectiveness of the outreach and implementation activities of the Exchange in reducing the number of individuals without health insurance coverage, and

4. Other relevant information.
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(*1) Metrics are rounded to the nearest 1,000.