Medicare in Virginia

Resources for Virginia Medicare Beneficiaries 

In the US, planning for healthcare costs is crucial; therefore, learning about Medicare’s parts, enrollment dates, as well as comparing and choosing a Medicare plan, is important. Explore our resources on Medicare so you can see how we at Healthpilot are the friends you need in the Medicare business. 

Medicare Basics         Choosing the Right Medicare Plan         Enrolling in Medicare

Choosing the right Medicare coverage options can be difficult and may benefit from assistance. As a Virginian, you have access to numerous resources, including the State Health Insurance Program (SHIP), commonly known as the Virginia Insurance Counseling & Assistance Program (VICAP). VICAP employs Virginia consultants who collaborate with community-based organizations, public health departments, and Area Agencies on Aging (AAAs) to disseminate Medicare education and information. 

Medicare Plan Options in Virginia  

You are not limited to one option when it comes to your Medicare plan if you live in Virginia. Original Medicare is available to eligible people, such as if you are at least 65 years old or have a qualifying disability. A Medicare Advantage plan could be a better option for you if you are interested in receiving more coverage. You may also want to consider getting coverage for your prescription medications and/or getting Medicare Supplement Insurance. 

Original Medicare (Parts A & B)  

Original Medicare is Medicare program’s foundational program. Medicare Part A covers hospitalization costs, whereas Medicare Part B covers medical expenses.  

If considering maintaining Original Medicare coverage: 

• Original Medicare in Virginia is an excellent option if you want the freedom to choose and access Medicare-accepting physicians anywhere in the country. 
• There are no pre-existing condition restrictions, networks, copays, or waiting periods. 

Medicare Advantage (Part C)  

Medicare Part C, commonly known as Medicare Advantage plans, is a private insurance company-provided alternative to Original Medicare. The nicest part about these plans is that they frequently contain additional benefits on top of what Medicare Parts A and B would cover at a minimum. The majority of services are managed by a network of providers, which could require you to have a primary care physician (PCP), a referral to see a specialist, and prior authorization for select treatments, services, and drugs before you can access them (much like how a Health Maintenance Organization or HMO plan does). Other insurance options are also available, including a Preferred Provider Organization (PPO), HMO-POS (a mix of an HMO and PPO), and Private Fee for Service (PFFS) plans. 

Virginia’s Medicare Advantage plans often provide more comprehensive coverage. Visit our Medicare Part C Resource Page to find out more about Medicare Advantage. 

Medicare Prescription Drug Plan (Part D)  

Independent of Original Medicare or Medicare Supplement Insurance, you can enroll in a stand-alone Prescription Drug Plan (PDP) offered by private insurance companies that have been approved by Medicare. Prescription drug coverage, known as Medicare Part D, is also typically included in most Medicare Advantage plans. Each covered prescription may be subject to a deductible, copayment, or coinsurance, depending on the specifics of the chosen plan’s formulary. 

Medicare Supplement Insurance (Medigap)  

Some Virginia residents with Medicare choose to purchase Medigap, also known as Medicare Supplement Insurance. The goal of these plans is to supplement what Original Medicare does not cover. Some of these gaps include coverage for medical care received outside of the United States, deductibles, and coinsurance for Medicare Parts A and B. 

Since Original Medicare doesn’t cover all your medical expenses, the Virginia State Corporation Commission (VSCC) also offers guidance on how Medicare Supplement Insurance coverage might reduce out-of-pocket costs. 

You should also be aware that Medigap does not cover any services or payments related to Medicare Advantage. You cannot have both a Medicare Advantage Plan and a Medigap policy at the same time. Suppose you already have a Medicare Advantage plan and want to purchase a Medigap policy. In that case, the start date of your Medigap policy should begin the day after your Medicare Advantage plan’s expiration date.  

Medicaid 

Since 1965, Medicaid has been a public insurance program. In which both the state government and the federal government pay for it. Each state runs its own Medicaid program, which is how the federal government has it mandated. The federal rules are very broad, so each state has room to make and run its own programs; in addition, Medicaid eligibility and benefits can and often do differ a lot from one state to the next. Medicaid helps eligible children, parents, pregnant women, older people, and people with disabilities who don’t have much money get access to health care. 

How and when to sign up for Medicare in Virginia

Once you reach the age of 65, most U.S. citizens can sign up for Medicare, but Medicare eligibility is also triggered by the following: 

• Suppose you are under 65, permanently disabled, and have been receiving Social Security disability benefits for at least 24 months. In another case, you may also be eligible for disability benefits from the Railroad Retirement Board if you were a railroad employee.  
• You’ve been told by your physician that you have End-Stage Renal Disease (ESRD). 
• You have been told by your physician that you have Lou Gehrig’s disease, also called Amyotrophic Lateral Sclerosis (ALS). 

Medicare Advantage Enrollment Periods in Virginia and nationwide  

Here is a quick overview of the Medicare enrollment periods, and enrollment timeframes in which you can elect or change your Medicare Advantage plan.

Virginia, great job; we’re almost done. Healthpilot knows that figuring out Medicare can be complicated and that adding deadlines for enrollment can add to the stress. 

Ready for the most exciting news you’ll learn today? We can and will do all of the hard work for you. After you complete a few questions, we will show you our best recommended Medicare plan for you. You can even skip the call and safely enroll online. 

More good news? Enrollment periods don’t need to be committed to memory while Healthpilot is on your side. As long as you are a Healthpilot customer, we take care of this for you each and every year. 

Check out your recommended plan

Key Stats

Some interesting facts about Medicare coverage in Virginia:   

• Medicare is used by 1,545,578 people in Virginia. This means that 18% of people have Medicare, which is just below the countrywide average of 19%. 
• About 32% of people with Medicare in Virginia are enrolled in a private Medicare Advantage program, which is less than the national average of 45%. 
• In 2023, there will be 147 Medicare Advantage plans in Virginia, up from 132 plans in 2022. This means that the plan options have grown by 11.4%. 
• A stand-alone Medicare prescription drug plan with a monthly premium of $5.10 is the least expensive in Virginia. 
• Here’s a fun fact about Virginia, as promised: One out of every ten “vanity” plates in the country is from the state of Virginia. With more than 1.2 million registered personalized license plates, Virginia has more vanity plates than there are people in the state of Rhode Island. 

2022-151