Key Takeaways
Medicare in Virginia is for all 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) and Medicare Advantage .
Original Medicare provides some hospital and medical coverage and can be combined with Medicare Supplement Insurance (Medigap) and a Part D prescription drug policy ; 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.
Looking for dental, vision and hearing coverage?
Call TodayWho 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) substitutes for Original Medicare (Part A & B), offering the same benefits. Medicare Part C usually bundles additional services like dental, hearing, vision, and prescription drug coverage.
Original Medicare members add drug coverage separately through a 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 in 2024 comes down to your specific needs and policy details, but you can start by understanding some standard costs. These include premiums, copayments, coinsurance, and deductibles.
Medicare Part A
Premium:
- $0 if you or your spouse worked 10 or more years
- $278 a month if you worked between 7.5 and 10 years
- $505 a month if you worked fewer than 7.5 years
Deductible:
- $1,632 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 Part B
Premium:
- $174.70 monthly and up in 2024 (income-based)
Deductible:
- $240 for each plan period
Copayments & coinsurance:
- Most preventative services: $0
- Medicare-approved services: 20% coinsurance
Medicare Part D
Premium:
- Income-based; varies by plan
Deductible:
- No more than $545 in 2024
Copayments & coinsurance:
- Plan- and drug-specific
Can I bundle multiple benefits into one plan?
See My OptionsIs Medicare Required When You Turn 65?
You’re not required to have Medicare in Virginia, but 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. There are several chances to make sure your plan is keeping up with your needs.
Here are the Medicare enrollment periods:
- Initial Enrollment Period (IEP): seven months around the month you turn 65.
- Medicare 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?
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.
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 Medicare Part D.
Enrolled in Original Medicare in Virginia? Consider These, Too.
Being enrolled in Original Medicare Advantage in Virginia means you’ll need to add prescription drug coverage separately. You may want to consider a 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 standalone 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 Medicare coverage is right for my specific situation?
Find The Right PlanWhat is the Best Medicare Plan?
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 TTY: 771.
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. D-SNP assists dual eligible individuals, and C-SNP is for people with chronic diseases.
Looking for a plan with prescription drug coverage?
Find My Ideal MA PlanWhat Is the Downside to Medicare Advantage Plans?
Still deciding between Original Medicare and Medicare Advantage in Virginia? Each option has its advantages and disadvantages. 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 usually 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 plans will work for you.
Medicare in Virginia by the Numbers
Medicare
Virginia
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Table reflects the latest Beneficiary Demographics Data: Medicare Geographic Variation – by National, State & County
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.
My Medicare coverage doesn’t address all of my needs.
Find The Right PlanVirginia Medicare Resources & Contacts
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:
Nationwide Resources
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.
Medicare guide
Before 65 Guide
Understanding health insurance before age 65, especially when considering early retirement
Medicare guide
Medicare Plans Guide
Costs, coverage and enrollment details for each Medicare plan
Medicare guide
Medicare Beneficiary Guide
For those currently enrolled in Medicare
Medicare guide
Low Income and Medicare Guide
For individuals with a qualifying income status
Medicare guide
A Caregiver’s Guide
For individuals with a qualifying income status