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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:
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.
|Original Medicare||Medicare Advantage Plans|
|Original Medicare covers your Part A hospital insurance and Part B medical insurance.||Medicare Advantage Plans combine Part A, Part B, and additional benefits.|
|You can add Part D prescription drug coverage.||Prescription drug coverage is usually included.|
|You’re able to use any medical provider in the U.S. that accepts Medicare.||You’ll usually need to use doctors in your plan’s network.|
|You can buy supplemental coverage to manage out-of-pocket costs, including your coinsurance.||Your Medicare Advantage Plan may have lower out-of-pocket costs than Original Medicare.|
|Vision, hearing, dental, and other benefits aren’t covered.||Your plan may offer additional benefits, including vision, hearing, and dental.|
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.
|Hospital and skilled nursing facility inpatient care||Home health care||Prescription drug coverage (if included in your plan)|
|Medically necessary outpatient services, such as:
||Preventive services, such as:
||Additional benefits (depending on your plan), such as:
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:
There are 147 Medicare Advantage Plans available in Virginia for 2022, including:
|Number of Medicare Advantage Plans available||Medicare Advantage Plan types available||Medicare Advantage Plans rated 3.5 or higher by NCQA|
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.
|HMOs||HMOs typically require that you receive all services from in network providers:
|PPOs||PPOs include a preferred network of providers, but you have the option of choosing doctors or hospitals from outside of the network for a higher cost.
|PFFS Plans||PFFS plans don’t require a primary care physician or referrals for specialists:
|SNPs||SNPs are only for people with specific conditions and characteristics, and include care coordination and targeted benefits tailored to meet your specific needs:
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:
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.
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.
|Enrollment period||When it happens||Medicare plans you can choose||What you can do|
|Initial Enrollment Period||Three months before you turn 65, the month you turn 65, and three months after||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Sign up for Medicare Part A and Part B. Complete your Part B enrollment to avoid a late enrollment penalty.|
|General Enrollment Period||January 1 – March 31||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan. If you enroll in Medicare during this period, your MAP enrollment is April through June.||Sign up for Medicare if you missed your IEP|
|Open Enrollment Period||October 15 – December 7||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Join, switch, or drop a plan|
|Medicare Advantage Open Enrollment Period||January 1 – March 31||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||If you’re enrolled in a Medicare Advantage Plan, you can change your plan or switch to Original Medicare|
|Special Enrollment Period||When you have a qualifying event||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Make changes to your plan|
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.
|Resource||Contact||How they help|
|Virginia Office for Aging Services||(800) 552-3402||The Virginia Office for Aging is the primary advisory body on all matters affecting older persons. The office coordinates services, provides information, and connects older adults to resources including Medicare guidance.|
|Virginia Department of Medical Assistance Services||(888) 221-1590||The department is focused on improving the wellbeing of Virginia aging adults by helping them access health insurance and healthcare resources.|
|Virginia State Corporation Commission (SCC)||(804) 371-9967||Aside from overseeing utilities, financial institutions, railroads, securities, and retail franchises, the Virginia SCC oversees the insurance industry and protects consumers against fraud.|
|Virginia Office of Aging Services Planning & Legal Services||(804) 662-9333||This office offers legal help for low-income Virginians seeking assistance with civil legal needs, including those related to health insurance and Medicare / Medicare Advantage.|
|Virginia Medicare Savings Program||(888) 251-1590||Medicare Savings Programs (MSP) help people with limited income and resources pay for some or all of their Medicare premiums.|
|Virginia Department of Social Services Medical Assistance Programs||(804) 726-7000||The Virginia Department of Social Services offers resources to connect you with medical assistance programs.|
|Resource||Contact||How they help|
|211 Virginia||211||2-1-1 Virginia can connect you to critical resources (such as shelter availability childcare, or rent payment assistance) simply by dialing a three-digit number.|
|Commonwealth Area Agencies on Aging||(804) 758-2386||Coordinated and transitional care for Virginia residents on Medicare and Medicaid.|
|Loudoun County Area Agency on Aging (AAA)||(719) 589-6639||From caregiver education and training to home-delivered meals, and health care assistance, this AAA is a ready resource for older adults in Virginia’s Loudoun County.|
|Western Virginia Bureau of Senior Services||(304) 242-1800||Serving four regions of Virginia as an Area Agency on Aging, you can access Medicare guidance and information, along with a full suite of supportive services and resources.|
|Cover Virginia||(888) 221-1590||Connecting you with affordable health insurance, Cover Virginia helps you request coverage, complete renewals, and obtain general information, along with other services like requesting identity cards.|
|Senior Connections Medicare and Insurance Counseling||(804) 343-3000||The Virginia Counseling and Insurance Program (VCIP) is a part of the national State Health Insurance Programs (SHIP) and offers free Medicare counseling and guidance, along with access to other helpful resources.|
|Prince William Area Agency on Aging||(702) 792-36374943||Access an array of services and resources for aging adults and caregivers, including information and guidance about Medicare.|
|Virginia Community Resources for Seniors||(888) 696-7213||The State Health Insurance Assistance Program (or SHIP) helps Medicare enrollees navigate the Medicare system and provides free, unbiased and individualized information.|
|Fairfax County Human Resource Services Guide||(703) FAIRFAX||Access information and guidance about Medicare and state assistance.|
|Resource||Phone||How they help|
|CMS Medicare Managed Care Appeals & Grievances||(800) MEDICARE||Offers information and guidance on Medicare and its connected programs.|
|CMS Medicare Managed Care Eligibility and Enrollment||(800) 633-4227||This resource contains information for current and future contracting Medicare Advantage (MA) organizations, other health plans, and other parties interested in the operational and regulatory aspects of Medicare health plan enrollment and disenrollment.|
|CMS Medicare Prescription Drug Eligibility and Enrollment||(800) 424-4301||This page contains enrollment and disenrollment guidance for current and future contracting Part D plan sponsors and other parties interested in the operational and regulatory aspects of Part D plan enrollment and disenrollment.|
|Medicare.gov||(800) MEDICARE||The main government website for signing up for (or making changes to) Medicare coverage.|