Medicare Advantage Plans in Virginia
Key Takeaways
- You are eligible for Medicare Advantage A Medicare Advantage (Medicare Part C) plan is offered by a private insurance carrier to substitute for Original Medicare (Parts A and B). A Medicare Advantage plan must at least match the coverage you would receive from Original Medicare and may include additional benefits. Details vary by plan, and plan availability depends on your ZIP code. plans in Virginia if you are enrolled in both Parts A and B of Original Medicare Original Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). .
- 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, plus additional benefits and the protection of an out-of-pocket maximum The maximum amount of money an individual will pay towards out of pocket expenses like deductibles, copayments, and coinsurance. .
- Most Medicare Advantage plans bundle in Part D prescription drug coverage, which also is available as a standalone 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 2024, every Virginia resident has access to at least one Medicare Advantage plan with a $0 monthly premium.
Get real Medicare answers and guidance — no strings attached.
Virginia Medicare Advantage Plan Coverage
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.
While both Original Medicare and Medicare Advantage beneficiaries can choose to include drug coverage, Medicare Advantage alone offers coverages like:
- Dental
- Vision
- Hearing
- A stipend for over-the-counter supplies
- Transportation for routine medical appointments
VA Medicare Advantage Plan Costs
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 A premium is a fee you pay to your insurance company for health plan coverage. This is usually a monthly cost. . The large majority of people don’t have to pay a Part A premium. The standard premium for Part B in 2025 is $185.
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 2024 is $13.00. Each of these 147 plans available in Virginia in 2024 has its own cost structure, so it can be helpful to consult with a licensed insurance agent about which plan is right for 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.
My Medicare coverage doesn’t address all of my needs.
Medicare Advantage Plan Eligibility and Enrollment in Virginia
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 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) The Initial Coverage Election Period is the period you have when you first enroll in Parts A and B of Original Medicare that allows you to switch to a Medicare Advantage plan. . 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.
Are There Virginia Medicare Advantage Plans With Prescription Drug Coverage?
The majority of Medicare Advantage plans include Part D prescription drug coverage.
Virginia also has 21 stand-alone Part D plans in 2024 that can be added to Original Medicare with premiums as low as $0.
Either way, when you sign up for Part D, be sure to check that the formulary, the list of covered prescriptions, includes any medications you’re currently taking.
Medicare Learning Guides
Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.
Before 65 Guide
Understanding health insurance before age 65, especially when considering early retirement
Medicare Plans Guide
Costs, coverage and enrollment details for each Medicare plan
Medicare Beneficiary Guide
For those currently enrolled in Medicare
Low Income and Medicare Guide
For individuals with a qualifying income status
A Caregiver's Guide
For individuals with a qualifying income status
Have questions about your Medicare coverage?
Sources
- FACT SHEET. CMS.gov.
This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money.
Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.