Medicare Advantage Plans in Virginia

The federal Medicare program is administered by the Centers for Medicare and Medicaid services. Enrollment in Medicare Part A and Part B entitles Medicare beneficiaries to select a Medicare Advantage plan in Virginia. Those interested in extending that basic coverage can sign up for Medicare Part C health plans.

Once enrolled in a Medicare Advantage plan, beneficiaries use a medical card their insurance company provides when seeking medical care. The red, white, and blue card from Original Medical isn’t used regularly, but all beneficiaries should keep it on hand for future use.

There are some benefits of enrolling in a Virginia Medicare Advantage plan:

  • Medicare Advantage prescription drug plans (MAPD) allow beneficiaries to pay one monthly premium for basic health and prescription drug coverage.
  • Insurance companies can add coverage options to their Advantage plans, including services not covered by Original Medicare or Medigap. For example, many plans cover vision, hearing, and dental services.

An insurance agent can help beneficiaries select a plan while assisting in the enrollment process.

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Top-rated Medicare Advantage Plan Providers in Virginia

Here are some of the private insurance companies offering Medicare Advantage plans for 2022:

  • Aetna
  • Anthem HealthKeepers
  • Humana
  • Innovation Health
  • Kaiser Permanente
  • Optima
  • UnitedHealthcare

Popular Medicare Advantage Plan Types in Virginia

Best for network freedom: Medicare Advantage PPO

  • PPO plans are less restrictive than HMO plans when selecting healthcare providers.
  • Larger networks are offered, and most plans do not require referrals.
  • Monthly premiums range from $0 to $100.

Best for lowest out-of-pocket: Medicare Advantage HMO Plan

  • Out-of-pocket costs are reduced by limiting access to medical providers in agreement with the plan’s payment terms.
  • Referrals are generally required, and networks are often narrow.
  • Most beneficiaries have access to $0 premium plans.

Best for low income or health conditions: Medicare Advantage D-SNIP

  • SNP insurance plans are limited to beneficiaries with select chronic health conditions or qualifying income limitations.
  • Combining Medicare and Medicaid can ensure coverage of copayments, coinsurance, deductibles, and other expenses often paid out of pocket.

Virginia Enrollment Facts:

  • Most popular Virginia MA plans: HMOs and PPOs
  • Percent of Virginia Medicare beneficiaries with MA: 17 percent
  • Total Medicare Advantage plan enrollment in Virginia: 241,530

How much does Medicare Advantage in Virginia cost?

The average cost for a Virginia Medicare Advantage plan was $23.18 per month. Every service area in the state offers some $0 premium plan as of 2021. Most premium-free plans are HMOs, but some no-premium PPOs are available in select areas. The general trend is toward PPO plans with premiums.

How much do Advantage Plans cost in Virginia?

PPO Plan $0.00 to $23.18

HMO Plan $0.00

When can I enroll in a Medicare Advantage plan?

Initial Enrollment Period

Every Medicare beneficiary has an initial enrollment period that lasts for seven months. It starts three months prior to the 65th birthday month and ends three months after that birthday month. An Advantage plan's eligibility begins when a beneficiary is enrolled in Original Medicare.

Enrollment in a Virginia Medicare Advantage plan prior to the first day of the 65th birthday month ensures that coverage begins the first day of the birthday month. Later enrollment will delay the effective date for benefits.

Open Enrollment Period – AKA Annual Election Period

The Medicare Open Enrollment or Annual Election Period runs from October 15 to December 7 every year. It allows established beneficiaries to make one of the following plan changes:

  • Enroll in a Medicare Advantage plan
  • Switch between Medicare Advantage plans
  • Switch from an Advantage plan to Original Medicare
  • Add drug coverage through Medicare Part D if switching back to Original Medicare

Medicare Advantage Open Enrollment Period

From January 1 to March 31, Medicare Advantage participants can change to a new plan or return to Original Medicare with or without Part D prescription drug coverage. This is only an option for those already enrolled in a Medicare Advantage plan in Virginia.

Special Enrollment Periods – Special Circumstances

When special circumstances apply, some Virginia beneficiaries have the opportunity to enroll in an Advantage plan outside of the initial and open election periods. Some of the most common special circumstances include:

  • Losing health care coverage from an employer or other source
  • Moving to a service area not covered by an existing health plan

5-star Special Enrollment Period

The federal Medicare program rates Advantage plans based on reviews from beneficiaries, coverage options, and other factors. Nearly 60% of Virginia plans had a star rating of at least 4 in 2020.

From December 8 to November 30 each year, beneficiaries already enrolled in an Advantage plan can switch to a different plan as long as the new plan has a 5-star rating. This one-time change ensures all beneficiaries have access to the top-rated plans in their service area.

Special Enrollment Periods if you get “Extra Help”

Qualifying for Extra Help, Medicare, and Medicaid allows Virginia beneficiaries to join or change Advantage plans one time during the following periods:

  • January – March
  • April – June
  • July – September

Beneficiaries with Extra Help and a standalone Part D drug plan can also make changes to their drug coverage during each of those periods.

Ready to Learn More?

We help educate Medicare beneficiaries on their Medicare Advantage options and help them go through the process of reviewing and comparing plans. We work with most of the nation’s top-rated Medicare Advantage carriers. Call us today, or request a quote online to learn more about plan options.

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