Medicare plays a key role in providing health and financial security to beneficiaries residing in Virginia. With more than 1.5 million Virginia beneficiaries enrolled in Medicare, we’ll cover some very important information below about Medicare in Virginia. We want to help you better understand your options and make the decision-process as seamless as possible once you’re ready to enroll in Medicare or discover different coverage options.

Who Qualifies for Medicare in Virginia?

Medicare covers most Virginia residents who are 65 or older, and it also covers disabled Virginia residents. In general, Medicare enrollment in Virginia works the same way as it does in the rest of the country. If you qualify for Original Medicare, also known as Part A and Part B, it will help cover 80% of your health care costs.

When you’re first eligible for Medicare, you have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B. If you’re eligible for Medicare when you turn 65, you can sign up during the 7-month period that:

  • Begins 3 months before the month you turn 65
  • Includes the month you turn 65
  • Ends 3 months after the month you turn 65

In most cases, if you don’t sign up for Part B when you’re first eligible, you’ll have to pay a late enrollment penalty. You’ll be responsible for paying this penalty for as long as you have Part B, and you could have a gap in your health coverage.

Once you reach Medicare eligibility, you can begin choosing additional coverage options to help pay for the remaining 20% of your medical expenses through Medicare Advantage (Part C), Medigap, and/or a Medicare Prescription Drug (Part D) plan.

Who Qualifies for Medicare

Virginia Medicare Enrollments

1,152,337

Original Medicare Plans
(Part A and B)

677,201

Medicare Advantage & Other Health Plans

94,076

Stand-alone Medicare
Part D (Drug plans)

1,534,813

Total Medicare Beneficiaries
in Virginia

Virginia Medicare Advantage Plans (Part C)

Nearly 22% of Virginia Medicare beneficiaries select Medicare Advantage plans.

Medicare Advantage plans are private, Medicare-approved insurance companies. They provide all of your Original Medicare benefits and often include extra benefits such as drug, dental, and vision coverage.

The Medicare Advantage Open Enrollment Period runs from January 1 to March 31. During this period, Medicare beneficiaries in Virginia who already enrolled in a Medicare Advantage plan can switch to a different Medicare Advantage plan or drop their Medicare Advantage plan and enroll in Original Medicare.

According to the Centers for Medicare and Medicaid Services (CMS), as of May 2020, there are 382,476 beneficiaries enrolled in Medicare Advantage and other plans in Virginia. Nearly 22% of Virginia Medicare beneficiaries were enrolled in a private Medicare Advantage plan in 2019. 100% of people with Medicare have access to a Medicare Advantage plan.

As of 2020, 115 Medicare Advantage plans are available in Virginia. The average monthly Medicare Advantage premium changed from $25.57 in 2019 to $23.80 in 2020. $0 is the lowest monthly premium for a Medicare Advantage plan in Virginia. In 2020, all 95 counties and 38 independent cities in Virginia have Medicare Advantage plans available for purchase. Depending on the county, Medicare Advantage plan availability ranges from nine to 48 plans.

Virginia Medicare Supplement (Medigap) Insurance Plans

As of 2021, Virginia insurers are required to ensure access to Medigap plans for disabled enrollees under age 65.

Medigap plans are used to supplement Original Medicare, covering some or all of the out-of-pocket costs (for coinsurance and deductibles) that beneficiaries would otherwise incur if they only had Original Medicare on its own. Typically, Medigap plans are popular for those who want little to no copay when they access healthcare services.

Often, Medigap plans in Virginia can be more expensive if you don’t enroll during your Initial Enrollment Period and wait for an Annual Open Enrollment Period. 

There are two initial times to enroll in a Medigap plan before and after you turn 65:

  • 6 months prior to turning 65
  • Once you turn 65, your 6 month period begins the month you enroll in Part B

During this period, an insurance company can’t use medical underwriting. 

There are currently 39 insurers licensed to sell Medigap plans throughout Virginia. In Virginia, Medigap insurers are allowed to pick their own rating approach. Thus, nearly all of the plans for sale in Virginia use attained-age rating. Attained-age ratings mean that your premium is based on your current age (the age you have “attained”), so your premium goes up as you get older.

As of 2021, Virginia will enforce rules to ensure access to Medigap plans for disabled enrollees under age 65. Under the legislation (SB250), Virginia Medigap insurers will be required to offer at least one plan on a guaranteed-issue basis to Virginia residents who become eligible for Medicare prior to the age of 65 years old due to a disability. The legislation to require guaranteed-issue Medigap for beneficiaries under age 65 passed unanimously in Virginia’s Senate in 2020.

Virginia Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t cover outpatient prescription drugs. However, Medicare beneficiaries can get prescription coverage via a Medicare Advantage plan, an employer-sponsored plan (offered by a current or former employer), or a stand-alone Part D plan. Medigap plans don’t cover prescription drugs unless they’re covered under Part B.

As of May 2020, There are 677,201 Medicare beneficiaries in Virginia enrolled in stand-alone Part D prescription drug plans and 336,778 enrolled in Medicare Advantage Prescription Drug plans. For 2020 coverage, there are 29 stand-alone Part D plans available in Virginia, with premiums ranging from about $13 to $75 per month. About 26% of people with a stand-alone Medicare prescription drug plan get Extra Help (also called the low-income subsidy, or LIS).

When deciding on a Part D plan, it’s important to evaluate several factors such as each plan’s premium, formulary, and copays since every plan is different. Learn how you can save money on your out-of-pocket costs with a Medicare Advantage, Part D, or Medigap plan, fill out this form or give us a call.

Local Medicare Health Plan Resources in Virginia

  • The Virginia Insurance Counseling and Assistance Program (VICAP) is part of a national network of programs that offers free, unbiased, confidential counseling and assistance for people with Medicare. VICAP counselors can help all Medicare beneficiaries, including those with disabilities and younger than 65, explore options that best meet their needs. Counselors will help you compare the quality of care and services given by health and prescription drug plans available in your area. Programs and topics VICAP counselors can assist seniors with include:

    • Original Medicare
    • Medicare Part D plans in Virginia
    • Medicare Advantage plans in Virginia
    • Medigap coverage, including Medicaid supplements
    • Commonwealth Coordinated Care Plus (CCC Plus)
    • Private and public long-term care insurance

    Contact: Call 1-800-552-3402 or email [email protected]

  • The Virginia Drug Card is a statewide prescription assistance program to help cover the costs left unpaid by their Medicare Part D coverage. No personal information is required to sign up for benefits, and all residents are eligible to get pharmacy discounts through this program. The program may also be used instead of your insurance coverage when it offers greater savings than your copay.
    Contact: Call 866-413-9778. Online applications may be submitted via the program’s online contact form here.

  • Rappahannock Rapidan Community Services (RRCS) serves the communities of Culpeper, Fauquier, Madison, Orange, and Rappahannock counties with prescription coverage and Medicare assistance for low-income seniors. Options counselors assist persons to understand self-directed and agency supports using a person-centered approach. The individual is made aware of services available in the community that can meet his/her needs.
    Contact: Call 540-825-3100. Email inquiries may be sent through the online contact form here.

  • Care Coordination at AASC works with partner agencies in and around the Cedar Bluff area to maximize the benefit coverage and social support seniors get in the community. Care Coordination links older people with appropriate long-term care services so they can maintain their independence. Care coordinators provide outreach, assessment, and care planning. Through this program, individuals learn about and/or receive assistance from AASC and partner organizations.
    Contact: Call 1-800-656-2272 or email [email protected].

  • The Carilion Medication Assistance Program (MAP) at Pearisburg offers services to low-income seniors in the Pearisburg, Princeton, and Blacksburg areas who need help paying for prescription drugs. The Medication Assistance Program staff works with pharmaceutical companies to provide medications to persons who meet income requirements. They have programs in three areas: Roanoke area, New River Valley, and Giles County.
    Contact: Call 540-922-4282

The licensed agents that are partnered with Timefor65 can help you compare the availability, benefits, and costs of Medicare plans in your specific region of Virginia. Our process makes it easier for you to access your Medicare eligibility in Virginia so that you receive personalized, affordable, and easy-to-use coverage options and solutions. Fill out the form or give us a call at (866) 327‑0148 anytime to get a free quote or to ask any questions.

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