Medicare provides health insurance coverage for more than 62 million Americans, including 1.5 million Virginians. This government program covers those over 65 years old, and younger adults with 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.
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.
Original Medicare doesn’t pay for 100 percent of service 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 Virginia, you can also sign up for prescription drug coverage. These plans are known as Medicare Part D, and they’re offered by private companies. A drug plan can help you pay for both generic and brand-name prescription drugs.
Medicare Advantage (Part C) plans are your other option in Virginia. They provide all Medicare parts A and B services, and often Part D, in one convenient plan. Depending on the plan you choose, they may cover extra benefits, such as dental, hearing, and vision care. Some Medicare Advantage plans even cover gym memberships and other perks.
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.
There are a few ways you can qualify for Medicare in Virginia, including:
- You’re 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.
You may be automatically enrolled in Medicare parts A and B if you’re in one of the following situations:
- You’re younger than age 65 and have a disability. Once you’ve received Social Security disability benefits for 24 months, you’ll get Medicare automatically.
- You’re turning age 65 and get Social Security. If you’re already receiving Social Security retirement benefits, your Medicare coverage will start automatically when you turn 65 years old.
If you won’t get Medicare automatically, you can sign up 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.
If you experience certain life events, you may qualify for a special enrollment period. This means you can sign up for Medicare outside of the annual enrollment periods. You may have a special enrollment period if you lose your employer health plan, for example.
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 five-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 ask questions. To learn more, you can contact:
- Virginia Insurance Counseling & Assistance Program 800-552-3402
- The Social Security Administration 800-772-1213
When you’re ready to start shopping for a Medicare plan, you can:
- Contact the Social Security Administration to sign up for Medicare. You can choose to apply online, in person, or over the phone.
- Visit Medicare.gov to find Medicare plans in Virginia.
- Contact the Virginia Insurance Counseling & Assistance Program if you need help comparing Medicare options.
This article was updated on October 5, 2020 to reflect Medicare costs in 2021.
The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.