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Understand Medicare in Virginia

Medicare, the United States federal medical insurance program, provides coverage for about 1.6 million people in Virginia who qualify for Medicare.  You can get Medicare if you’re 65 or older or have a qualifying disability.

Your disability typically qualifies if you’ve received at least 24 Social Security or Railroad Retirement Board (RRB) disability insurance payments. You can also enroll in Medicare Advantage Plans if you have End-Stage Renal Disease (ESRD) or amyotrophic lateral sclerosis (ALS).

Most people have premium-free Part A but, if you have to buy it, the cost can reach up to $506 per month in 2023. Part B costs $164.90 per month but can be more if you have higher income. There are 147 Medicare Advantage Plans in the state that are an alternative to Original Medicare.  Learn more about your Medicare options in Virginia.

Medicare Plans in Virginia

Compare ratings of Virginia’s Medicare plan providers:
Insurance company Medicare rating A.M. Best rating BBB rating J.D. Power ranking
Aetna 4 stars A+ A+ 6th out of 9
Anthem Blue Cross Blue Shield 4 to 4.5 stars A+ A+ 5th out of 9
Cigna 4 stars A- Not rated 8th out of 9
Humana 4 stars A- A+ 2nd out of 9
Kaiser 5 A A- 1st out of 9

 

Medicare Plan Options in Virginia

Residents of Virginia have multiple Medicare plans to choose from. Many are tiered to help Virginia seniors find the plan that is best suited to their lifestyle and medical needs. For example, seniors and individuals with disabilities who don’t need much coverage can apply for Original Medicare. Virginia’s Medicare Advantage program might be a better option if you need more comprehensive insurance. Some Medicare policies offer additional prescription drug add-ons or supplementary coverage.

Original Medicare (Parts A and B) Original Medicare is the basic Medicare plan, which is a fee-for-service form of insurance. It has two parts: Part A hospital insurance and Part B medical insurance. Part A covers hospital stays and periods spent at skilled nursing facilities, lab tests an individual has performed, and hospice care. Part B covers doctor’s office visits and home health care services. It may also cover some preventive care, such as screenings for cancers and mental illnesses, including depression. With Original Medicare, you’ll pay a deductible along with your share of the fees incurred during an inpatient or outpatient visit:
  • Original Medicare is a good choice if you want flexibility in choosing and accessing providers that accept Medicare anywhere in the U.S.
  • There is no cap on what you could spend for out-of-pocket expenses, and you must purchase drug coverage separately, so it’s a better choice for you if you don’t need much in the way of health care or prescription drugs.
  • If you don’t purchase a Medigap policy to supplement Original Medicare when you are first eligible, you may not be able to purchase one or may have to pay higher premiums, depending on your health status.
Medicare Advantage Plans (Part C) Medicare Advantage plans, also known as Part C, are an alternative to Original Medicare offered by private insurance companies. These plans include both Part A and Part B coverage, except for hospice care. Most services are provided by network providers, and you may need primary care physicians, referrals for specialists, and prior authorizations for treatment and medications. Medicare Advantage offers additional coverage for essential needs, such as prescription drugs, dental and vision care. Some Medicare Advantage Plans also cover gym memberships and transportation to and from medical appointments. Part C may also pay for adult day care services:
  • Medicare Advantage is a good choice if you want to have all of your health care and drug benefits bundled together in one plan and if you don’t mind being restricted in your choice of providers to save on costs.
  • There is a cap on what you can spend for out-of-pocket Medicare-covered expenses.
  • You also have access to services that Medicare doesn’t cover, like routine dental and vision exams.
Medicare Prescription Drug Coverage Plans (Part D) Many Medicare Advantage policies add Part D drug coverage automatically to their package, but you can also add Medicare prescription drug coverage to Original Medicare. Medicare prescription drug coverage is offered to all Medicare enrollees, but you may have to pay a penalty if you wait to enroll after being initially eligible. Medicare Part D plans may not all cover the same drugs or have the same costs as Medicare Advantage policies. Standalone Part D coverage is provided by Medicare-approved private insurers. Most plans require a deductible and a copay for each prescription drug:
  • Part D is a good choice if you have Original Medicare, or if you have a Medicare Advantage Plan ― not a health maintenance organization (HMO) or preferred provider organization (PPO) ― that doesn’t have prescription drug coverage.
  • You pay a penalty if you wait to enroll in a Part D plan, unless you have creditable coverage from an employer-sponsored group plan.
  • If you don’t require medications now, you can enroll in a low-premium Part D plan to avoid late enrollment penalties later.
Medicare Supplement Insurance Plans (Medigap) Some West Virginia seniors purchase a Medicare Supplement Insurance policy, also known as Medigap. These plans are intended to fill in the gaps Original Medicare doesn’t cover. Some of these gaps include medical coverage while overseas, Part A and Part B copays, and excess Part B charges. Medigap doesn’t pay for anything related to Medicare Advantage. You cannot have a Medigap plan and a Medicare Advantage Plan at the same time.
  • Medigap is a good choice if you have Original Medicare and want help paying for out-of-pocket expenses you incur when you access your Part A and Part B benefits.
  • You pay a monthly premium, and most copays and coinsurance costs are covered.
  • If you have significant health care needs, want the freedom to see any Medicare provider without network restrictions, a Medigap plan offers predictable coverage and costs for Medicare-covered care.
  • Medigap doesn’t cover prescription drugs or other benefits like dental and vision.

Medicare in Virginia by the Numbers

People enrolled in Original Medicare  Average plan cost Annual state spending per beneficiary Spending per beneficiary compared to the national average
1,157,274 Part A: $0 to $506 per month*

Plan B: $164.90 per month**

 $9,761 -15.2%

*Most people pay no premium, but this can vary depending on how long they paid Medicare taxes.
**This is the average number, but it can vary based on income.

Medicare Resources in Virginia

Choosing the right Medicare plan requires getting educated about the process and researching options each year. In Virginia, there are several organizations that offer support to seniors about the enrollment process. In addition, older residents and their caregivers can try reaching out to Area Agencies on Aging (AAAs), state and local public health agencies, and/or nonprofit groups for guidance and other programs related to aging. Here are some examples.

Virginia Office for Aging Services

The Virginia Office for Aging Services of the Division for Community Living works with the state’s 25 local Area Agencies on Aging to support seniors and their caregivers. The Office advocates for the aging population, while providing information to those who need it.

Contact information: Website | (804) 662-9333

Virginia Department for Aging and Rehabilitative Services 

The Department coordinates with community providers to offer resources and services to seniors and people with disabilities. their main mission is to improve the quality of life for older Virginians and their caregivers.

Contact information: Website | (804) 662-7000

Kelly-Blackwell Headshot
Kelly Blackwell
Certified Senior Advisor (CSA)®

As a health care professional since 1987, Kelly Blackwell has walked alongside and cared for seniors as they journey through the season of their fourth quarter of life. Blackwell holds a Bachelor of Science in nursing from the University of Northern Colorado, a Master of Science in health care administration from Grand Canyon University, an interprofessional graduate certificate in palliative care from the University of Colorado Anschutz Medical Campus and holds a Certified Senior Advisor® credential from the Society of Certified Senior Advisors.

Blackwell contributes to the University of Colorado-Anschutz blog and has been published in “The Human Touch” distributed by the University of Colorado Center for Bioethics and Humanities. She cowrote “Dying Is” for Pathways Hospice.

A registered nurse, Blackwell understands health insurance choices influence quality of life and are driven by values, goals, and beliefs. She’s passionate about engaging with, educating, and empowering seniors as they navigate the health care system. She’s equipped to lend an experienced, compassionate voice to beneficiaries seeking information about Medicare Advantage Plans.

As a CSA®, Blackwell has access to valuable resources for Medicare beneficiaries. Her work as a bedside nurse and clinical manager has given her the opportunity to see how Medicare rules, regulations, and benefits work when patients need them. With a passion to learn and to make a difference in the lives of seniors, Blackwell supports seniors through Medicare and fourth-quarter life decisions.

Kelly-Blackwell Headshot
Kelly Blackwell
Certified Senior Advisor (CSA)®

As a health care professional since 1987, Kelly Blackwell has walked alongside and cared for seniors as they journey through the season of their fourth quarter of life. Blackwell holds a Bachelor of Science in nursing from the University of Northern Colorado, a Master of Science in health care administration from Grand Canyon University, an interprofessional graduate certificate in palliative care from the University of Colorado Anschutz Medical Campus and holds a Certified Senior Advisor® credential from the Society of Certified Senior Advisors.

Blackwell contributes to the University of Colorado-Anschutz blog and has been published in “The Human Touch” distributed by the University of Colorado Center for Bioethics and Humanities. She cowrote “Dying Is” for Pathways Hospice.

A registered nurse, Blackwell understands health insurance choices influence quality of life and are driven by values, goals, and beliefs. She’s passionate about engaging with, educating, and empowering seniors as they navigate the health care system. She’s equipped to lend an experienced, compassionate voice to beneficiaries seeking information about Medicare Advantage Plans.

As a CSA®, Blackwell has access to valuable resources for Medicare beneficiaries. Her work as a bedside nurse and clinical manager has given her the opportunity to see how Medicare rules, regulations, and benefits work when patients need them. With a passion to learn and to make a difference in the lives of seniors, Blackwell supports seniors through Medicare and fourth-quarter life decisions.

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