Medicare Advantage Plans in Virginia

When you become eligible for Medicare, you have two primary options for coverage. You could get Original Medicare, which includes Medicare Part A for hospital insurance and Part B for medical insurance. Or you could opt for a Medicare Advantage Plan.

Medicare Advantage Plans (also called Medicare Part C) are an all-in-one alternative to Original Medicare that provide the same coverage as Parts A and B. Plans also frequently include other benefits Original Medicare won’t cover, like prescription drug coverage, hearing, dental, and vision.

This article contains everything you need to know about Medicare Advantage Plans in Virginia.

Compare ratings of insurance companies offering Medicare Advantage Plans in Virginia:

• In 2023, there are 147 Medicare Advantage plans available in Virginia, compared to 132 plans in 2022.
• 100% of Medicare beneficiaries have access to a zero premium Medicare Advantage plan in 2023.
• The average Medicare Advantage monthly premium in 2023 is $12.80, a decrease from 2021.
• Through the CMS Innovation Center’s Value-Based Insurance Design (VBID) Model, 51 plans will offer Medicare Advantage enrollees eliminated Part D cost-sharing; rewards and incentives programs related to healthy behaviors; and customized, innovative benefits that address social determinants of health, such as food insecurity and social isolation, for certain underserved and/or chronically ill enrollees.

You have choices in Medicare coverage. While you can opt to stick with Original Medicare, a Medicare Advantage Plan – also known as Part C – may be a better alternative for you.

Medicare Advantage Plans cover benefits from Original Medicare Part A (hospital insurance), Part B (medical insurance), usually Part D (prescription drug coverage), and sometimes additional benefits that Original Medicare doesn’t cover. Each Medicare Advantage Plan insurer sets the rules about how you receive and pay for these benefits.

With 147 Medicare Advantage Plans available in Virginia, you likely have several options in your area. To help you choose the best plan for you, consider what is most important to you before selecting a plan. There are several factors to keep in mind:

• Monthly premium: This is how much you pay for coverage monthly, regardless of the care you receive. You may need to pay your plan’s premium in addition to the Medicare Part B premium, although some plans have $0 premiums or help pay for your Part B premium.
• Plan network: You may need to use doctors and providers who are within a plan’s network. Before choosing a Medicare Advantage Plan, think about the doctors and facilities (including pharmacies) you prefer to use, then check if the plan offers coverage at those locations. Some plans may provide out-of-network coverage, but this usually comes at a higher cost.
• Deductible: Your deductible is the amount you must pay before your insurance plan starts helping cover the costs. Medicare Advantage Plans set their deductibles, and these may change only once per year on January 1.
• Copayments and coinsurance: Copayments or coinsurance are how much you pay for each service or doctor’s visit, such as $20 per doctor visit. Each Medicare Advantage Plan sets its copayment or coinsurance amount that can differ from what you would pay through Original Medicare.
• Out-of-pocket maximum: Each Medicare Advantage Plan sets a yearly limit on the maximum amount you’d be responsible for paying for services covered by Medicare. Once you reach this limit, you won’t have to pay anything for the services you receive covered by Part A and Part B in that year.
• Additional coverage: Most Medicare Advantage Plans also provide prescription drug coverage and often include additional benefits that Original Medicare won’t cover, such as vision, dental, and hearing. Plans may provide even more benefits, like discounted gym membership or transportation to doctor’s visits. Medicare Advantage Plans can also tailor their benefits to the specific needs of particular chronically ill beneficiaries.

There are 147 Medicare Advantage Plans available in Virginia for 2022, including:

• Cost plans
• Local HMO plans
• Local PPO plans
• PFFS plans
• Regional PPO plans

In Virginia, the most common Medicare Advantage plans available are HMOs or PPOs, although there are also a few SNPs and regional PFFS plans available. Seniors eligible for Medicare may choose from plans provided by multiple private insurers, although the choices available vary by county.

You’re eligible for Medicare when you turn 65 or if you’re younger and have a qualifying disability. A qualifying disability means at least one of the following applies:

• You’ve received Social Security Disability Insurance or Railroad Board Disability Annuity for 24 months
• You have Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease
• You have End-Stage Renal Disease

When you become eligible for Medicare, you are also eligible for Medicare Advantage Plans. There are specific times of the year when you can enroll for the first time in a Medicare Advantage Plan: during your Initial Enrollment Period and the Open Enrollment Period.

• Your IEP begins three months before the month you turn 65 and extends for three months after the month you turn 65. During this period, you can enroll in a Medicare Advantage Plan. If you join before the month you turn 65, your coverage will begin the first day of the month you turn 65. If you enroll in the three months after turning 65, your coverage will begin the first day of the month after you enroll.
• If you miss your IEP, you can sign up for Medicare during the General Enrollment Period from January 1 to March 31.
• After you enroll in Medicare, you can enroll in or make changes to your Medicare Advantage Plan coverage during the Medicare OEP from October 15 and December 7 of each year. During this time, you can change from Original Medicare to Medicare Advantage, switch to a different Medicare Advantage Plan, or change from Medicare Advantage back to Original Medicare.

Medicare Advantage Open Enrollment occurs between January 1 and March 31 of each year. This period is only for beneficiaries already in a Medicare Advantage Plan, and you can change plans or switch to Original Medicare. You cannot switch from Original Medicare to Medicare Advantage during Medicare Advantage Open Enrollment.

There are exceptions to these enrollment periods called Special Enrollment Periods. Certain events or circumstances may make you eligible to change your Medicare Advantage Plan outside of the open enrollment periods, such as if you move outside of your existing plan’s service area or to a location with new plan options you didn’t have before. If you think you may qualify for a Special Enrollment Period, call 1-800-MEDICARE and explain your situation.

Most Medicare Advantage HMO and PPO plans and all SNP plans provide prescription drug coverage like you would get from Medicare Part D. Some PFFS plans may provide prescription drug coverage, but not all do. Evaluate a plan’s prescription drug coverage when deciding which Virginia Medicare Advantage Plan to use.

Prescription drug coverage may vary by cost, coverage, and convenience among Medicare Advantage Plans. Your monthly premium may include a premium for the drug coverage in the plan. There is usually a copayment or coinsurance amount that you have to pay for each prescription after you reach your annual deductible.

Some plans use different cost tiers with different costs for different drugs. For instance, you may pay less for generic drugs than brand-name drugs or less for brand-name drugs within different tiers. If your plan uses tiers, the formulary will list all covered drugs and their tiers. Verify your preferred or local pharmacies are included in the plan’s network.

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• HHS.gov | What is Medicare Part C? | Last reviewed August 2021 | Last accessed December 2024
• KFF.org | A Dozen Facts About Medicare Advantage in 2020 | Published August 2022 | Last accessed December 2024
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• KFF.org | Medicare Advantage Enrollees as a Percent of Total Medicare Population | Last accessed December 2024
• KFF.org | Medicare Part D: A First Look at Medicare Prescription Drug Plans in 2021 | Published October 2020 | Last accessed December 2024
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• Medicare | Special Needs Plans (SNP) | Last accessed December 2024
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• NCQA Health Insurance Plan Ratings | Ratings in New Mexico | Last updated 2022 | Last accessed December 2024