Understand Medicare in Virginia
Medicare, the United States federal medical insurance program, provides coverage for about 1.1 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 $499 per month in 2022. Part B costs $170.10 per month but can be more if you have higher income. There are 94 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||NCQA rating||J.D. Power ranking|
|Aetna||4 stars||A||A+||2.5 to 4.5 stars||5 out of 10|
|Anthem Blue Cross Blue Shield||4 to 4.5 stars||A+||A+||Not rated||Sixth out of 10|
|Cigna||4 stars||A-||Not rated||2.5 to 4.5 stars||Seventh out of 10|
|Humana||4 stars||A-||A+||1.5 to 4.5 stars||Third out of ten|
|Kaiser||5||A||A-||4.5 to 5 stars||First out of 10|
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:
|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 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:
|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.
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|
|1,153,271||Plan A: $0 to $499 per month*
Plan B: $170.10 per month**
*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