Medicare Plan Options
You’ll find a variety of Medicare plans in Virginia, including the federally run Original Medicare program that lets you choose any health care provider that accepts Medicare. Consider adding a Medicare Prescription Drug Plan, even if you’re not currently taking any prescription drugs. You may want Medicare Supplement Insurance to cover benefits not included with Original Medicare. Virginia’s Medicare Advantage program is an alternative to Original Medicare that’s similar but with additional coverage.
Original Medicare is administered by the federal government and covers most, but not all, of your medical needs. Medicare Part A is your hospital insurance, paying for hospital care, inpatient skilled nursing care for up to 100 days, hospice, and some home health care. Medicare Part B complements Part A by covering outpatient services, including doctors’ visits, medical equipment, and some preventative exams and screenings. You can get Part A at no cost if you worked and paid Medicare taxes, otherwise, there’s a monthly premium. Part B always has a premium, and both have a copay, coinsurance, and deductible costs.
Medicare Advantage Plans
Virginia’s Medicare Advantage program offers an alternative to Original Medicare, and provides the same Parts A and B coverage and pays for additional services. Medicare Advantage Plans are offered by Medicare-approved private insurance companies and are called Medicare Part C. Many Medicare Advantage Plans include a prescription drug component and cover wellness programs and routine dental, vision, and hearing care. You must have Medicare parts A and B and live in a plan’s service area to be eligible for Medicare Advantage. MA Plans limit your out-of-pocket costs but may restrict your medical provider options to those within a network.
Medicare Prescription Drug Coverage Plans
You have the option of enrolling in a stand-alone Medicare prescription drug plan, or Medicare Part D, which works with Original Medicare. Not signing up for Part D when you first become eligible could result in a permanent penalty. If you’re opting for an HMO or a PPO Medicare Advantage Plan, choose a plan that includes drug coverage because you can’t add stand-alone Part D coverage to these plans. Medicare Part D requires a separate premium and has a deductible, copay, and coinsurance costs. These plans may cover different drugs, and your cost for each generic or brand-name drug can vary.
Medicare Supplement Insurance Plans
Medigap policies, or Medicare Supplement Insurance plans, can be added only if you’re enrolled in Original Medicare. Private insurance companies offer these plans, which help pay some or all of your out-of-pocket costs for covered Original Medicare services, like deductibles, copays, and coinsurance. There are 12 Medigap plans available in Virginia, which are identified as Medicare Supplement Insurance and must follow federal and state laws designed to protect you. Medigap policies require you to have Medicare parts A and B coverage and carry a separate monthly premium.
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 $471 per month*
Plan B: $148.50 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
Due to the high number of Medicare options and the complicated application process, you may find signing up or changing coverage confusing. Virginia has several resources available statewide to help you through your initial sign up and whenever you need to make changes to your plan. These organizations provide personalized Medicare counseling, which is usually free, to ensure you find the right Medicare plan for your needs.
Office for Aging Services of the Division for Community Living
Virginia’s Office for Aging Services of the Division for Community Living oversees 25 Area Agencies on Aging throughout the Commonwealth of Virginia that provide a comprehensive array of services. Each agency has trained counselors who offer free, confidential insurance counseling and assistance to individuals and groups. The information provided can help you make better decisions about your Medicare options, including Original Medicare, Medicaid, Medicare Advantage, Part D prescription drug plans, long-term care insurance, and other insurance-related issues. Counselors can help you with filing Medicare claims and appeals.
Contact Information: Website | 804-662-9333 or 800-552-3402
Virginia Insurance Counseling & Assistance Program
The Virginia Insurance Counseling & Assistance Program (VICAP) is part of a national network and provides you with free, unbiased Medicare counseling. VICAP counselors are certified and trained to help you with Medicare, Medicare Advantage Plans, Medicare Part D, Medigap, long-term care insurance, and Commonwealth Coordinated Care Plus. They can help you compare health and prescription drug plans in your area, file for medical benefits, understand medical bills, find low-income subsidies, and file health care appeals and grievances. VICAP offices are available statewide, and all services are confidential.
Contact Information: Website | 804-662-9333 or 800-552-3402 (Nationwide)
Virginia Senior Medicare Patrol
Virginia Senior Medicare Patrol (SMP) utilizes a team of volunteers to educate you, your family, and caregivers on detecting, preventing, and reporting health care errors, fraud, and abuse to protect your medical identity, health, and finances. When you bring a complaint to the SMP and it suspects errors, fraud, or abuse has occurred, it reports your complaint to the appropriate state and federal agencies for further investigation. Virginia SMP provides counseling, working one-on-one with you on your Medicare benefits, and outreach programs through group presentations and exhibits at events.
Contact Information: Website | 804-644-5628
Senior Connections is the Capital Area Agency on Aging with comprehensive services to older adults, disabled persons, and caregivers in Richmond and seven surrounding counties. Senior Connections’ Benefits Enrollment Center has trained staff members who can help you determine your eligibility, enroll in Medicare programs, and apply for benefits. Senior Connections has volunteer counselors who are VICAP-trained to assist with exploring your Medicare coverage options and other health insurance benefits. All counseling services are free, confidential, and unbiased. Although most counseling services are provided over the phone, you can meet in-person with counselors at Senior Connections.
Contact Information: Website | 804-343-3000