Before you start

Virginia residence
Income information for Medicaid or subsidy eligibility
An SSN or ITIN for marketplace applications
A qualifying life event, if enrolling outside the annual window

Step-by-step

1
Use Virginia's Insurance Marketplace, not HealthCare.gov
Virginia now runs its own state-based exchange, so the enrolment calendar and the application are the Commonwealth's rather than the federal government's. A national explainer that sends you to HealthCare.gov is out of date for Virginia, and following it is a documented way to miss a window.
OnlineWho: YouWeek 1–2
2
Check Cardinal Care eligibility before buying a plan
Virginia expanded Medicaid, and the programme covers children, pregnant people, adults aged 19–64 on income, and aged, blind or disabled categories. Apply through CoverVA before assuming a marketplace plan is your only option, particularly on a part-year or entry-level income.
OnlineWho: You
3
Read the current federal Medicaid rules before you rely on coverage
Virginia's own Medicaid agency is warning members that a new federal law has made major changes to eligibility for certain adults, including a work requirement. That is a live, moving position rather than settled background, so check the Department of Medical Assistance Services' notices directly rather than an article, and respond to any letter you receive rather than assuming it is routine.
OnlineWho: You
4
Enrol in your employer's plan inside the new-hire window
Typically 30 days from your start date. Compare deductibles and out-of-pocket maximums rather than premiums, and check whether VCU Health, Bon Secours and HCA Virginia are all in network — between them they run most of the beds in the region and the specialist referrals follow the contracts.
Via employerWho: YouFirst 30 days of employment
5
Register with a primary care physician while you are well
Your PCP gates specialist access on most plans. Confirm network status with the practice itself rather than the insurer's directory, which is frequently out of date, and expect a wait for a first appointment. A federally qualified health centre is the fallback if practices are closed to new patients.
OnlineWho: You
6
Plan for the summer, which is the local health hazard
Richmond summers are hot and very humid with frequent afternoon thunderstorms, and the practical risks are heat illness, poor air quality on ozone days and — for anyone spending time in the James River Park System — ticks. Check the river gauge before swimming, treat a heat advisory as instruction, and learn to check yourself for ticks after a trail walk. None of this is dramatic; all of it is routine here and unfamiliar to arrivals from cooler places.
In personWho: You

Documents you’ll need

Proof of Virginia residence
Income documentation for Cardinal Care or marketplace subsidies
SSN or ITIN
Immigration documents for Medicaid and marketplace eligibility categories
Evidence of losing prior coverage, if using a special enrolment period

Things most newcomers don’t know

Virginia left HealthCare.gov, and half the internet has not noticed.

The Commonwealth runs its own state-based marketplace now. The consequence is practical: the enrolment window, the application and the customer service are Virginia's, and the federal dates quoted in national coverage may not be the ones that bind you. Someone who follows a generic US relocation checklist here can lose a plan year over it. Start at the state marketplace, not at a search engine's first result.

Source: CoverVA — Virginia Department of Medical Assistance Services

Virginia's Medicaid rules are moving right now, and the agency says so.

The Commonwealth's own member-facing site states that a new federal law made major changes to Medicaid eligibility for certain adults, including a work requirement. Anything written before that is potentially wrong, including advice from people who enrolled a year ago. Read the agency's current notices, keep your address current with them, and open every letter — a missed redetermination is the commonest way people lose coverage they still qualify for.

Source: Virginia Department of Medical Assistance Services

Richmond carries more specialist capacity than its size implies.

VCU Health runs the region's Level I trauma centre and the Commonwealth's medical school on a downtown campus, alongside Bon Secours and HCA Virginia systems. For a household weighing a move to a mid-sized city, that is meaningful — but it also means the three systems contract separately, so 'a broad network' does not automatically include the one you will be referred to. Check the specific system before choosing a plan.

Source: community-reported

The deductible is what actually shocks people from national health systems.

US plans commonly require you to pay the first several thousand dollars of care each year before the insurer contributes. Someone arriving from the UK, Canada or India reads 'I have insurance' as 'I am covered', then receives a four-figure bill for a scan. Read the deductible and the annual out-of-pocket maximum before the premium — that is where plans genuinely differ.

Source: community-reported

Common mistakes to avoid

Applying HealthCare.gov's dates and website in Virginia — the Commonwealth runs its own marketplace.
Buying a marketplace plan without checking Cardinal Care eligibility first.
Ignoring a Medicaid redetermination letter while federal eligibility rules are changing.
Assuming a broad network includes all three of the region's hospital systems.
Choosing a plan on premium alone and meeting a five-figure out-of-pocket maximum.

Some of this may be out of date. Spotted something inaccurate? Help us keep it right for the next newcomer.