You are eligible for Medicare Advantage plans in Virginia if you are enrolled in both Parts A and B of Original Medicare .
Medicare Advantage plans are offered by private insurance companies in conjunction with the federal Medicare program. They provide the same coverage as Parts A and B and offer additional coverage and the protection of an out-of-pocket maximum .
Many Medicare Advantage plans bundle prescription drug coverage in the form of Part D, which also is available as a stand-alone offering for those on Original Medicare.
Every person in Virginia who is enrolled in Parts A and B of Original Medicare is eligible to enroll in a Medicare Advantage plan.
More good news? In 2023, every Virginia resident has access to at least one Medicare Advantage plan with a $0 monthly premium.
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In a nutshell, Medicare Advantage plans bundle the coverage provided by Parts A and B of Original Medicare while usually adding other benefits, ranging from dental insurance to transportation for medical visits to stipends for over-the-counter purchases related to your health.
Coverage varies by Medicare Advantage plan, as do costs. Some Medicare Advantage plans in Virginia can offer more for less in part because the plans are designed around a regional network of providers. By contrast, Original Medicare can be used at any provider nationwide that agrees to work with the federal Medicare program.
To understand what Medicare Advantage plans in Virginia cover, you first should understand what Original Medicare covers:
- Medicare Part A is often referred to as “hospital insurance” because it covers some of the out-of-pocket expenses related to inpatient hospital stays.
- Medicare Part B is often referred to as “medical insurance” because it covers some of the out-of-pocket expenses related to outpatient medical needs such as doctors visits, lab tests and durable medical equipment.
Both Original Medicare and Medicare Advantage offer Part A and B coverage as well as the option for Part D , which is the name given to the Medicare program’s version of prescription drug coverage. While people on Original Medicare can add a stand-alone Part D plan to their coverage, people on Medicare Advantage can pick a plan that includes Part D drug coverage.
While both Original Medicare and Medicare Advantage beneficiaries can choose to include drug coverage, Medicare Advantage alone offers coverages like:
- A stipend for over-the-counter supplies
- Transportation for routine medical appointments
While a Medicare Advantage plan from a private insurance company under the guidance of the federal program replaces Parts A and B of Original Medicare, you still are responsible for Part A and B monthly premiums . The large majority of people don’t have to pay a Part A premium. The standard premium for Part B in 2023 is $164.90.
Some Medicare Advantage plans in Virginia carry their own monthly premium. Others offer $0 premiums. Additionally:
- Some Medicare Advantage plans actually help pay your Part B premium.
- Across all Medicare Advantage plans in Virginia, the average monthly premium in 2023 is just $12.80. While Original Medicare has a set structure of costs, each of the 132 Medicare Advantage plans available in Virginia in 2023 has its own cost structure. That may sound overwhelming, but a GoHealth licensed insurance agent has the tools and knowledge to identify which plan is right for you based on your needs.
All Medicare Advantage plans feature an out-of-pocket maximum that prepares for you the worst-case scenario in a given plan year. Once you reach your out-of-pocket max, your plan will pay the rest of your medical bills for the year. Original Medicare doesn’t offer the protection of an out-of-pocket maximum, although two of the 10 standard Medigap plans sold by private insurance companies to people on Original Medicare do have an out-of-pocket maximum.
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If you are eligible to enroll in Parts A and B of Original Medicare, you are eligible to enroll in Medicare Advantage.
So, who is eligible?
- You’re eligible if you’re a U.S. citizen age 65 and older.
- You’re eligible, regardless of age, if you have received Social Security Disability Insurance for at least 24 months.
- You’re eligible, regardless of age, if you have end-stage renal disease or Lou Gehrig’s disease.
If you are first eligible at age 65, your first opportunity to enroll in Original Medicare is during the seven-month Initial Enrollment Period that surrounds your 65th birthday. If you choose to enroll in both Parts A and B at that time, you can then — during the same period — switch to Medicare Advantage.
If your Initial Enrollment Period has come and gone, you can enroll in a Medicare Advantage plan in Virginia whenever you are first enrolled in both Parts A and B. This is called an Initial Coverage Election Period (ICEP) . If you consider switching to a Medicare Advantage plan when first eligible — whether it’s at age 65 or after — your ICEP is the three months before coverage from both Parts A and B is set to start for the first time.
The majority of Medicare Advantage plans in Virginia include prescription drug coverage in the form of Part D.
The state also has 23 stand-alone Part D plans in 2023 that can be added to Original Medicare with premiums as low as $7.10. Everyone in Virginia who was on a stand-alone Part D plan in 2022 has access to at least one plan in 2023 that cost less.
Whether you are interested in a Medicare Advantage plan that includes drug coverage or pairing a Part D plan with your Original Medicare coverage, a GoHealth licensed insurance agent can help.
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