Medicare is a government program that provides healthcare coverage for those 65 years and older, as well as those with certain disabilities.
In this article, we’ll explore how Medicare works, who’s eligible, how to enroll, and tips for shopping for Medicare plans in Virginia.
The Centers for Medicare & Medicaid Services (CMS) reported the following information on Medicare trends in Virginia for the 2021 plan year:
- A total of 1,543,740 residents of Virginia are enrolled in Medicare.
- The average Medicare Advantage monthly premium slightly decreased in Virginia compared to last year — from $20.93 in 2020 to $19.60 in 2021.
- There are 119 Medicare Advantage plans available in Virginia for 2021, compared to 113 plans in 2020.
- All Virginia residents with Medicare have access to buy a Medicare Advantage plan, including plans with $0 premiums.
- There are 12 different Medigap plans offered in Virginia for 2021.
If you live in Virginia, you can choose between original Medicare and a Medicare Advantage plan. Both are Medicare, but they provide your benefits in different ways.
Original Medicare is run by the government, while Medicare Advantage plans are sold by private insurance companies.
Original Medicare has two parts:
- Part A (hospital insurance). The services covered by Part A include inpatient care in hospitals and short-term skilled nursing facility care. Part A is funded by Medicare taxes, so most people don’t need to pay a monthly premium for it.
- Part B (medical insurance). Part B covers things like doctor’s services, outpatient care, and preventative services. Part B costs vary depending on your income.
Medicare Advantage in Virginia
Medicare Advantage (Part C) plans are your other option in Virginia. They provide all Medicare parts A and B services, and often prescription drug coverage, in one convenient plan.
Many insurance companies offer Medicare Advantage plans in Virginia, including the following:
- Anthem Blue Cross Blue Shield
- Anthem HealthKeepers
- Innovation Health
- Kaiser Permanente
These companies offer plans in many counties in Virginia. However, Medicare Advantage plan offerings vary by county, so enter your specific ZIP code when searching for plans where you live.
If you opt for original Medicare, it doesn’t pay for 100 percent of your medical costs. After meeting a deductible, you may need to pay coinsurance or copayments.
If you want help paying for these costs, you can get Medicare supplement insurance, also called Medigap. These policies are sold by private companies.
In 2021, some of the companies offering Medigap plans throughout Virginia include:
There are a few ways you can qualify for Medicare in Virginia, including:
- You’re age 65 or older. If you’re a U.S. citizen or a permanent resident who’s been in the country for at least five years, you’ll be eligible when you turn age 65.
- You get Social Security Disability Insurance (SSDI). If you have a disability and receive SSDI, you’ll qualify for Medicare after a 2-year waiting period.
- You have end stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS). You’re eligible for Medicare at any age if you’ve been diagnosed with ESRD or ALS.
When can I enroll in Medicare Virginia plans?
You may be automatically enrolled in Medicare in most situations. However, if you aren’t automatically enrolled, you can signup during one of the following enrollment periods:
- Initial enrollment period. This 7-month period is your first chance to get Medicare when you turn 65 years old. It starts 3 months before the month of your 65th birthday and ends 3 months after your birthday month.
- Medicare open enrollment period. Between October 15 and December 7 every year, you can change your Medicare coverage. At this time, you’re allowed to sign up for a Medicare Advantage plan.
- Medicare Advantage open enrollment period. From January 1 to March 31 every year, you can switch to a different Medicare Advantage plan.
- Special enrollment periods. If you experience certain life events, you may qualify for a special enrollment period.
Tips for enrolling in Medicare in Virginia
When deciding between original Medicare and Medicare Advantage, and the different parts and supplements, keep these things in mind:
- CMS star rating. The Centers for Medicare & Medicaid Services (CMS) uses a 5-star quality rating system to help you compare the quality of Medicare plans. Plans are rated roughly 45 factors, including care coordination and customer service.
- Doctor network. When you join a Medicare Advantage plan, you usually need to see doctors in the plan’s network. If you have a preferred doctor, find out what plans they participate in before you choose your plan.
- Plan costs. When you sign up for a Medicare Advantage plan, you may need to pay a monthly premium on top of the Medicare part B premium. Other costs to consider include the plan’s deductibles, coinsurance, and copayments.
- Covered services. Medicare Advantage plans may cover services that original Medicare doesn’t, such as dental, hearing, or vision care. If there are certain services you know you’ll need, make sure your plan covers them.
Medicare is a complex program, so don’t hesitate to askquestions. To learn more, you can contact:
- Virginia Insurance Counseling & Assistance Program: 800-552-3402
- The Social Security Administration: 800-772-1213
- More than 1.5 million Virginia residents are enrolled in Medicare.
- There are several private insurance companies offering various types of Medicare Advantage and Medigap plans throughout the state.
- Overall, monthly premium costs have decreased for 2021 Medicare Advantage plans in Virginia.
- There are also several Medigap plan options if you live in Virginia and are looking for additional coverage.