Medicare in Virginia

In this article...
  • Read up on Medicare in Virginia, including what plans are available, who is eligible and when seniors might need to apply.

What Virginia Medicare Plans Are Available?

Understanding the details of Medicare can be challenging, especially for those without prior experience with this program. Knowing the ins and outs of Virginia Medicare eligibility and enrollment is essential to utilizing it successfully.  

The available Medicare plans in Virginia include several parts that speak to different healthcare needs. 

Part A: This is the hospital insurance component and does not have premiums for those who paid into Medicare taxes during traditional employment. Those who did not pay into Medicare taxes may be able to purchase a Part A plan; however, those that do purchase Part A will also need to purchase Part B. 

Part A covers in-patient hospital care, in-patient skilled nursing facility care, hospice and home health care. It also covers in-patient care in a religious health care institution. 

Part B: There are monthly premiums for this component, and they may fluctuate based on income. Those who are eligible but do not sign up incur a late enrollment penalty of 10% for every 12 months. There's an exception to the penalty for those who had other coverage or were covered by a spouse's insurance policy and needed coverage suddenly. 

Part B insurance covers physicians visits, outpatient health care, home health care, some medical equipment and preventative services. 

Part C: This is the Medicare Advantage Plan and is an alternative to traditional Medicare coverage. If you choose a plan under this umbrella, it kicks in and acts as a replacement of sorts for Parts A and B, providing coverage through the private Advantage Plan instead of traditional Medicare. 

The Advantage Plans are offered through private entities and have different rules. Part of what makes them different is that they might offer coverage for vision, dental and health and wellness. These plans generally include prescription medication benefits as well. 

The different Medicare Advantage plan structures include a Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee-for-Service (PFFS), Special Needs Plans (SNP), HMO Point-of-Service (HMOPOS) and a Medical Savings Account (MSA).

Part D: This is the prescription drug component and is offered to everyone that has a Medicare plan. There is a monthly premium attached to this plan and, as with Part B, premiums may fluctuate based on income. A penalty is levied for late enrollment. 

Part D coverage can be through the Medicare plan as an add on to Parts A and B or C or as part of a Part C plan.

Medigap: This is Medicare Supplement Insurance and is purchased in addition to Medicare to help cover elements that Parts A and B don't cover (such as copays or coinsurance). However, individuals have to be enrolled in the original Medicare program before adding the supplement plan.

More than 1.1 million Virginians were enrolled in the original Medicare plan in 2020 and more than 360,000 individuals were enrolled in the Medicare advantage plan in 2020. 

Medicare coverage is available in every state, though Alaska does not have the Medicare Advantage option. Also, Medicare supplement insurance has different standards in Wisconsin, Minnesota and Massachusetts. 

Who Is Eligible for Virginia Medicare?

Medicare is available for Americans who are age 65 and older. Those eligible must have been employed and paid into the system via payroll taxes or they may need to purchase the plan. The program also provides health insurance to some with disabilities (so determined by the Social Security Administration) and a few chronic/terminal conditions. 

Automatic enrollment occurs for those who are already receiving retirement benefits from the Social Security Administration in the four months prior to turning 65. 

The initial enrollment period is 3 months before a person's 65th birthday extended to 3 months after a person's 65th birthday. Enrollment outside of this period is permissible but does incur penalties. 

After the initial enrollment period, individuals may sign up for Parts A and B during general enrollment between January 1 and March 31. Coverage for these plans begins July 1. 

Special enrollment options are available for certain situations. For instance, those with a traditional Medicare plan can switch to a Medicare Advantage Plan, Medicare Cost Plan or Medicare drug plan if a 5-star rating option becomes available. This special enrollment period is only available for use one time between December 8 and November 30. 

Special enrollment also applies to those who are still working (or who are married to people who are still working) or those covered by a group health plan. These individuals can sign up for Parts A and B at any time when they lose coverage through their employer or opt out of it.

Medicare also offers a fall enrollment period. It occurs annually from October 15 through December 7, with changes taking effect as of January 1. This is the only point at which individuals who are already enrolled in a plan can choose a new Medicare Advantage or Medicare Part D plan. 

How Do I Enroll in Medicare in Virginia?

Those who are eligible to enroll may do so via the website at www.SocialSecurity.gov. Eligible citizens can also call the Social Security Administration at (800) 772-1213 Monday through Friday from 7 a.m.-7 p.m. 

Local Social Security Administration offices can also facilitate sign-up. 

Contact Information for Virginia Medicare, Medicaid and Insurance Help

For more information and assistance with Medicare, Medicaid and additional help, reach out to the Virginia Insurance Counseling & Assistance Program (VICAP): Call (800) 552-3402 or visit https://www.vda.virginia.gov/vicap.htm. Virginia also has numerous resources to help with Medicare needs, including the Virginia Drug Assistance Program.

The state also offers a Medicare Savings Program for low-income residents signed up for Medicare, which helps with deductibles and premiums.