Virginia Medicare Guide

Medicare doesn’t have to be complicated. Get free support from one of our licensed Virginia Medicare Advisors. Schedule a consultation or call us at (888) 604-0055 to ask questions and get the best value from Medicare.

Learn about the basics of Medicare in Virginia below to understand the options available to you and when you should enroll.

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A Snapshot of Medicare in Virginia

There are 1.6 million Medicare beneficiaries in Virginia, making up 18% of the total population. 13% of Virginia Medicare beneficiaries are dually eligible, meaning they have limited income and are also eligible for state Medicaid support.

Enrollment for Medicare Advantage vs. Original Medicare in Virginia

When you first sign up for Medicare, you’ll enroll in Part A and Part B, which make up Original Medicare. On Original Medicare, you can add supplemental coverage (Medigap and prescription drug plans). You have the option to stick with Original Medicare or switch to a Medicare Advantage plan when you first enroll as well as once a year during the Open Enrollment Period.

Deciding between Original Medicare and Medicare Advantage is a personal decision based on your specific financial and health status. 71% of Virginia Medicare recipients are on Original Medicare. 29% are on a Medicare Advantage plan (source).

Virginia Medicare Advantage Plans

Medicare Advantage is also known as Medicare Part C. These plans are offered by private insurance companies to give Medicare beneficiaries an alternative to Original Medicare. 29% of Virginia Medicare beneficiaries are enrolled in one of the 94 Medicare Advantage plans available. Specific plan availability and costs vary by county. For example, in 2023, Fairfax County has 31 Medicare Advantage plans with monthly premiums ranging from $0 to $197. Richmond County has 20 plans with premiums from $0 to $98 each month.

Medicare Advantage plans are an all-in-one approach to Medicare, offering the same coverage as Original Medicare. They also often provide prescription drug coverage and a variety of other benefits, including dental, vision, and hearing coverage, transportation assistance, and grocery cash cards.

While Medicare Advantage plans can provide a number of added benefits, they have big downsides. Medicare Advantage plans have restrictive provider networks and may require prior authorization for some healthcare services. Each plan has its own cost-structure with different premiums, deductibles, and coinsurance, which can lead to surprises when beneficiaries try to use their insurance.

Our licensed Virginia Medicare Advisors can help you pick the best Medicare plan to make sure all your needs are covered and you get the best value from Medicare. Schedule a free consultation at your convenience or call us at (888) 604-0055 to learn about Medicare Advantage plans in Virginia.

Virginia Medicare Supplement Plans

Original Medicare only covers about 80% of costs for covered services. Medicare Supplement (also known as Medigap) plans are there to cover the gaps in coverage. They don’t provide coverage for additional health services, but they significantly reduce your out-of-pocket costs, allowing for better financial predictability. Medicare Supplement plans also have no network restrictions and don’t require prior authorization like many Medicare Advantage plans.

Nationwide, Medicare beneficiaries have ten Medigap plan options that are standardized and regulated by the federal government. This means that coverage for a plan type (e.g., Plan G) is consistent across insurance companies, although prices may vary.

The best time to enroll in a Medicare Supplement (Medigap) plan is during the Medigap Open Enrollment Period. This period occurs during the first six months that you have Medicare Part B. During the Medigap Open Enrollment Period, you have a one-time opportunity to enroll in Medigap with guaranteed acceptance. This means insurance companies can’t reject your application or charge you more due to your age or health history. Outside of this Period, you will likely be asked a series of questions about your health and could be denied coverage.

Virginia Part D (Prescription Drug Coverage) Plans

Original Medicare doesn’t include prescription drug coverage, which is why Medicare introduced Part D. Medicare beneficiaries can secure prescription coverage through either a Medicare Advantage plan that provides it or through a stand-alone prescription drug plan (PDP). There are 23 stand-alone Part D plans in Virginia. Just like with Medicare Advantage, plan availability varies by county. When looking at these plans, it’s important to not only look at the premiums, but also the pricing for the prescriptions you take.

If you don’t currently need any prescriptions, you should still consider enrolling in a low-cost drug plan to avoid the Part D penalty.

Getting help paying for prescription drug coverage

Medicare Extra Help Program

If you have limited income and resources, you may be eligible for Extra Help (also known as the Part D Low-Income Subsidy). Extra Help is a federal program that helps pay for costs associated with prescription drug coverage, including premiums, deductibles, and coinsurance.

You automatically qualify for Extra Help if you:

Receive full Medicaid coverage from Virginia
Virginia pays your Part B premium
Are eligible for Supplemental Security Income (SSI)

If you don’t automatically qualify for Extra Help, you can talk to one of our licensed Virginia Medicare Advisors to see if you're eligible and get free support with your application.

Get help paying for Medicare in Virginia

The Extra Help program provides support for prescription costs, but there are two additional programs that can help you pay for healthcare costs: Medicaid and SSI Benefits.

Medicaid

Medicaid is a joint federal and state program that helps low-income individuals pay for medical costs. Each state manages its own Medicaid program differently, based on an individual’s income and resources.

For those over 65, Virginia has Medicaid for persons who are aged, blind, or disabled (ABD). If you are 65 or older, blind, or disabled and have limited income and resources, you may be eligible. If you don’t qualify for full Medicaid, you may be eligible for partial Medicaid through Medicaid Spenddown if your medical bills are high. Virginia Medicaid also provides long-term care support for aged, blind, and disabled individuals. To qualify, you’ll need authorization to determine the level of care you need.

Medicare Savings Programs

Medicare Savings Programs are a subset of Medicaid created specifically for dual eligible (eligible for both Medicaid and Medicare) individuals. Medicare Savings Programs help beneficiaries with limited finances pay Medicare premiums. In some cases, they also help with deductibles and copayments. When you apply for a Medicare Savings Program, Virginia will determine if you qualify for one of four levels of Medicare Savings Programs.

The four levels of Medicare Savings Programs in Virginia are:

Qualified Medicare Beneficiary (QMB) Program
Specified Low-Income Medicare Beneficiary (SLMB) Program
Qualified Individual (QI) Program
Qualified Disabled and Working Individuals (QDWI) Program

Even if you’re already on Medicaid, you likely need to submit an application for a Medicare Savings Program to receive the benefits. Learn more about eligibility and how to apply for Virginia Medicare Savings Programs here.

Supplemental Security Income (SSI) Benefits

Eligible US citizens receive monthly payments from the SSI program. You’re considered eligible if you meet the following criteria:

You are 65 and older, blind, or have a disability
You have limited income and limited resources

You can apply for SSI Benefits online or by calling 1-800-772-1213 / TTY 1-800-325-0778.

Virginia Medicare Eligibility and Enrollment Steps

If you are a US citizen and meet one of the following criteria, you are eligible for Medicare:

You’re 65 or older
You have certain disabilities, like End-Stage Renal Disease or ALS

Three simple steps for Virginia Medicare enrollment:

Enroll in Original Medicare (Part A & Part B)
Choose your supplemental coverage
1. Medicare Supplement (Medigap)
2. Medicare Advantage (Part C)
3. Part D (drug coverage)
Set yourself up for success by finding doctors, sharing your plan information with your pharmacy, and accessing additional benefits that come with your coverage.

If you’re starting Medicare because you’re turning 65, you have a seven-month period to enroll. This is called your Initial Enrollment Period (IEP). Your IEP begins three months before the month you turn 65 and extends until three months after it. For example, if your birthday is on September 20, then your IEP goes from June 1 until December 31 during the year you turn 65. In some cases, you may choose to delay your enrollment in Part B, but be sure you qualify for a Special Enrollment penalty before you do. Learn more about when to enroll in Medicare here.

If you have questions or want to talk through Virginia Medicare options, we’re here to help! Schedule a free consultation with one of our licensed Virginia Medicare Advisors or give us a call at (888) 604-0055 to get all the help you need. Our advice is always free.

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