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Medicare in Virginia

Our guide to Medicare in VA, including enrollment, stats, plans and more

Reviewed by: Eboni Onayo, Licensed Insurance Agent. Written by: Aaron Garcia.

Key Takeaways

  • Medicare in Virginia is for all legal U.S. citizens or legal residents of five or more years, 65 or older. Some Virginians younger than 65 may be eligible.

  • Medicare in Virginia is available in two ways: Original Medicare (Parts A and B)Original Medicare (Parts A and B) is fee-for-service health insurance available to all 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). and Medicare AdvantageMedicare Advantage is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D)..

  • Original Medicare provides some hospital and medical coverage and can be combined with separate Medicare Supplement Insurance (Medigap)Medicare Supplement Insurance (Medigap) are policies designed to provide coverage that Original Medicare (Parts A and B) do not. Medigap policies are purchased in addition to Original Medicare and have their own monthly premiums you'll need to pay. and a Part D prescription drug policyMedicare Prescription Drug Plan (Part D) is prescription drug coverage for people enrolled in Medicare. Part D is optional and is offered by private insurance companies.; Medicare Advantage bundles A & B coverages with Part D and often includes services like hearing, vision and dental.

 

Whether you prefer its beaches, mountains, or anything in between, enjoying what The Old Dominion offers means staying healthy enough to do so. That’s where Medicare in Virginia comes in.

To get the most out of your Medicare, you’ll need answers to some key questions. How old do you need to be to enroll in Medicare in Virginia? What are the different ways you can get Medicare benefits? Do you know how to enroll, and when? What’s the difference between Original Medicare and Medicare Advantage in Virginia?

For these answers and more, check out GoHealth’s guide to Medicare in Virginia.

Who Is Eligible for Medicare in Virginia?

You may be eligible to enroll in Medicare in Virginia if you’re a legal U.S. resident and:

  • You’re 65 or older
  • You’re under 65 but have received railroad retirement benefits or disability-based Social Security for two years
  • You’re under 65 and living with End Stage Renal Disease (ESRD) or Lou Gehrig’s Disease

How Does Medicare Work in Virginia?

Now that you know who’s eligible, you’ll need to understand how Medicare plans in Virginia work. There are two ways you can receive your Medicare: Original Medicare (Parts A and B) and Medicare Advantage. Here’s how they compare:

Original Medicare (Parts A and B)

Parts A and B help cover hospital, preventive, and medically necessary services. You can see any doctor that accepts Medicare, but out-of-pocket costs can be high and most prescription drugs aren’t included. Stand-alone Part D and Medicare Supplement policies are designed to help.

Medicare Advantage (Part C)

Medicare Advantage (Part C) replaces Original Medicare (Part A & B), but offers the same Part A and B benefits or coverage as Original Medicare. Along with receiving Part A and B benefits, Medicare Part C often bundles additional services like dental, hearing, vision and prescription drug coverage.

 

Original Medicare customers with prescription needs must add drug coverage separately through Medicare Prescription Drug Plan (Part D). Virginians looking to control their Original Medicare costs can also add Medicare Supplement Insurance (Medigap).

How much does Medicare in Virginia cost?

What you’ll pay for Medicare in Virginia comes down to your specific needs and policy details, but you can start by understanding some standard costs. These are known as premiums, copayments, coinsurance and deductibles.

Medicare in VA: Part A

Premium:

  • $0 if you or your spouse worked 10 or more years
  • $259 a month if you worked between 7.5 and 10 years
  • $471 a month if you worked fewer than 7.5 years

Deductible:

  • $1,484 for each hospital benefit period

Copayments & coinsurance:

  • Hospital stays: $0 copay for Days 1-60 following deductible payment; daily charges for Days 61 and after
  • Skilled Nursing Facility: $0 for Days 1-20 (each plan period); daily charges for Days 21 and after

Medicare in VA: Part B

Premium:

  • $148.50 monthly and up (income-based)

Deductible:

  • $203 for each plan period

Copayments & coinsurance:

  • Most preventative services: $0
  • Medicare-approved services: 20% coinsurance

Medicare in VA: Part D

Premium:

  • Income-based; varies by plan

Deductible:

  • No more than $445 in 2021

Copayments & coinsurance:

  • Plan- and drug-specific

Is Medicare Required When You Turn 65?

The good news? You’re not required to have Medicare in Virginia. The bad news? Not signing up when you’re first eligible can leave you with substantial enrollment penalties when you do apply.

You can avoid these fees by enrolling when you’re first eligible for Medicare in Virginia. If you don’t, you can expect to pay penalties for:

You may be able to delay your enrollment. If you (or your spouse) work and receive coverage through that employer’s plan when you turn 65, a Special Enrollment Period will open once that coverage ends. You can enroll in Parts A and B after 65 without penalty during this 8-month window.

Eligible for Medicare in VA? When to Enroll.

You may qualify for Medicare when you’re 65, but waiting for your birthday to enroll can be a mistake. Instead, your first chance to sign up for Medicare in Virginia begins three months before you turn 65. This is known as your Initial Enrollment Period (IEP).

It’s important to know about all of Medicare’s enrollment periods. After all, turning 65 means your enrollment in Medicare in Virginia is just beginning, and there are several chances to make sure your plan is keeping up with your needs.

Here are the Medicare Enrollment Periods to know about:

  • Initial Enrollment Period (IEP): seven months around the month you turn 65.
  • Medicare Part C & D Open Enrollment Period: Oct. 15 to Dec. 7
  • Medicare General Enrollment Period: Jan. 1 to Mar. 31
  • Medicare Advantage Open Enrollment Period: Jan. 1 to Mar. 31

What Are the Different Medicare Plans Available?

As we discussed, Medicare in Virginia is available as Original Medicare and Medicare Advantage. But building the right healthcare approach for you means understanding all the available Medicare plans in Virginia. Here’s how they work:

Original Medicare (Parts A and B)

Original Medicare is made up of Parts A and B. They work separately to provide a base level of care.

  • Part A: helps cover stays at hospitals, nursing homes, skilled nursing facilities, hospice care, and some home health care.
  • Part B: covers part of your medically necessary services from doctors and providers, as well as preventive services

Medicare Advantage (Part C)

Medicare Advantage plans are an alternative to Original Medicare in Virginia. Medicare Advantage often includes benefits on top of what enrollees would receive from Parts A and B, including vision, dental, hearing, and even Medicare Part D.

Enrolled in Original Medicare in Virginia? Consider these, too.

Being enrolled in only Original Medicare Advantage in Virginia means you’ll need to add prescription drug coverage separately while battling high out-of-pocket costs. Instead, you may want to consider Medicare Prescription Drug Plan (Part D) and Medicare Supplement Insurance (Medigap).

Medicare Prescription Drug Plan (Part D)

If you have Original Medicare, Part D plans are stand-alone policies that provide prescription drug coverage. Medicare Advantage plans in Virginia often include Part D.

Medicare Supplement Insurance (Medigap)

Medigap insurance is a type of plan that provides additional benefits to Original Medicare. A Medigap plan has a monthly premium and is designed to help with out-of-pocket costs. Virginia has a menu of 10 Medigap plans to choose from

What is the Best Medicare Plan for 2021?

The answer to this question is up to you and your needs. You’ll want to factor in your health, budget, and even which part of Virginia you reside in. In other words, what works for you won’t work for everyone else. To find the Medicare plan that fits your needs, GoHealth has put together some tools and resources to help the process.

  • Pros and Cons: Dive deeper into Original Medicare and Medicare Advantage
  • Enrollment Checklist: Develop your plan to get the most of your Medicare
  • Medicare Star Rating System: Find out what other policyholders think of their plans
  • Pro Tips: Pointers from insiders to make Medicare easier
  • Call GoHealth: We have answers about Medicare plans in Virginia? With our licensed insurance agents, you’ll get the personal attention you need. Call us at 1-855-792-0088.

What’s the Best Medicare Advantage Plan?

If you decide to enroll in Medicare Advantage in Virginia, you’ll have several plans to choose from. But just like the questions above, the answer depends on your personal needs. Also, Medicare Advantage plans vary by location, so what works well in Roanoke may not fit someone in Bristol. To help you get started, here are the different options of Medicare Advantage in Virginia:

  • Health Maintenance Organization (HMO) plans use primary care physicians to manage care. HMOs often limit you to seeing doctors within your provider network.
  • Preferred Partner Organization (PPO) policies give you greater freedom to see out-of-network doctors and providers while still using a primary care physician.
  • Private Fee-For-Service (PFFS) plans pay your providers each time you receive a service.
  • Special Needs Plan (SNP) plans help enrollees living with specific health conditions. [1] D-SNP assists dual eligible individuals, and C-SNP is for people with chronic diseases.

What is the Downside to Medicare Advantage Plans?

Still deciding between Original Medicare and Medicare Advantage in Virginia? Each option has its advantages and disadvantages. The critical thing to remember is that a downside for you may be a selling point for one of your neighbors. There are, however, some main characteristics you can use to compare the two.

  • Original Medicare often has higher out-of-pocket costs but more flexibility to see any doctor that accepts Medicare.
  • Medicare Advantage offers a smaller network of doctors you can see and often costs less out-of-pocket. Medicare Advantage often includes coverages Parts A and B don’t, including prescription drugs (Part D).

If you still have questions about Medicare plans in Virginia, the licensed insurance agents at GoHealth will show you your options and answer your questions. Give GoHealth a call today to see what Medicare plans in Virginia will work for you.

Medicare in Virginia by the Numbers

Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 1,361,988 people are enrolled in Medicare in Virginia. The total number of beneficiaries enrolled in Medicare Advantage in Virginia is 315,135. The previous year, 297,574 enrolled in Medicare Advantage. Medicare Advantage participation in Virginia went from 22.43% to 23.14% year over year. If you’d like to dive deeper into how Medicare in Virginia breaks down across the state, we provide a glance at who is using Medicare, and how.

Outline of Virginia
1,361,988
Beneficiaries with Part A & Part B
315,135
Medicare Advantage Beneficiaries
23.14%
Medicare Advantage Participation Rate
55.60%
% Female
44.40%
% Male
0.95
Average HCC Score
$9,470.21
Actual Per Capita Costs
14.05%
% Eligible for Medicaid
31.91%
% of Beneficiaries with an Emergency Department Visit
17.48%
Hospital Readmission Rate
77.04%
% Non-Hispanic White
15.62%
% African American
2.06%
% Hispanic
5.28%
% Other/Unknown

Table reflects the latest Beneficiary Demographics data: 2018, All Beneficiaries by State, Centers of Medicare & Medicaid Services (CMS)

Average HCC Score: The Hierarchical Condition Category score gauges a population’s overall health. The score is based on a value of 1.0. Populations with an HCC score of less than 1.0 are considered relatively healthy. The score can be used to estimate health costs.

Virginia Medicare Resources & Contacts

Beneficiaries spend an average of $9,470.21 each year on Medicare in Virginia. To be certain you are not leaving anything on the table, let us help. A GoHealth licensed insurance agent can assess your coverage or explain which Virginia-based resources, like these, may be able to help:

Office for Aging Services of the Division for Community Living (DARS)

1-804-662-9333

https://www.vda.virginia.gov

What should I know about DARS?

Find caregiver services and connect with several local senior-focused resources

CommonHelp (Medicaid)

1-855-635-4370

https://commonhelp.virginia.gov/

What should I know about CommonHelp?

Virginia’s Medicaid program; visit here to apply as well as check, change and renew your Medicaid benefits

Virginia Insurance Counseling & Assistance Program

1-804-662-9333

https://www.vda.virginia.gov/vicap.htm

What should I know about the Virginia Insurance Counseling & Assistance Program?

Access Virginia’s State Health Insurance Assistance Program (SHIP) to see if you’re eligible for help paying your Part D and B costs

Virginia Department of Veterans Services

1-804-786-0286

https://www.dvs.virginia.gov/

What Should I know about the Virginia Department of Veterans Services?

Virginia veterans can access a host of benefits and supports through this department

Nationwide Resources

Speak with an insurance agent that is licensed in Virginia about your Medicare questions.

1-855-792-0088 TTY: 711

Monday - Friday, 8 AM - 9 PM CT

Medicare & Medicaid

If you have general questions about Medicare in VA, or need help with current Medicare benefits.

1-800-MEDICARE (1-800-633-4227)

Social Security Administration

You can reach the SSA by phone for general questions. Not all questions can be answered over the phone.

Also, SSA.gov provides online resources for the following: Review information, apply for benefits, or manage your account online

Speak to SSA Representative, Monday - Friday, 8 AM - 7 PM ET

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.

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New to Medicare Guide

Helpful information to get you started with enrolling in Medicare.

Medicare Beneficiary Guide

For those currently enrolled in Medicare.

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Costs, coverage and enrollment details for each Medicare plan.

Low Income & Medicare Guide

For individuals with a qualifying income status.

A Caregiver’s Guide

For those helping a loved one with Medicare.