Medicare in Virginia
Key Takeaways
- Medicare in Virginia is for all U.S. citizens or legal residents of five or more years, 65 or older. Some Virginians younger than 65 may be eligible.
- Medicare in Virginia is available in two ways: Original Medicare (Parts A and B)Original Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). and Medicare AdvantageMedicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). .
- Original Medicare provides some hospital and medical coverage and can be combined with Medicare Supplement Insurance (Medigap)Medicare Supplement Insurance (Medigap) is designed to provide coverage that Original Medicare (Parts A and B) does not. Medigap policies are purchased in addition to Original Medicare and have their own monthly premiums you’ll need to pay. and a Part D prescription drug policyMedicare Part D is prescription drug coverage for people enrolled in Medicare. Part D is optional and is offered by private insurance companies. ; Medicare Advantage bundles A & B coverages with Part D and often includes services like hearing, vision, and dental.
Whether you prefer its beaches, mountains, or anything in between, enjoying what The Old Dominion offers means staying healthy enough to do so. That’s where Medicare in Virginia comes in.
To get the most out of your Medicare, you’ll need answers to some key questions. How old do you need to be to enroll in Medicare in Virginia? What are the different ways you can get Medicare benefits? Do you know how to enroll, and when? What’s the difference between Original Medicare and Medicare Advantage in Virginia?
For these answers and more, check out GoHealth’s guide to Medicare in Virginia.
Who Is Eligible for Medicare in Virginia?
You may be eligible to enroll in Medicare in Virginia if you’re a legal U.S. resident and:
- You’re 65 or older.
- You’re under 65 but have received railroad retirement benefits or disability-based Social Security for two years.
- You’re under 65 and living with end-stage renal disease (ESRD) or Lou Gehrig’s Disease.
Start your Medicare PlanFit CheckUp today.
How Does Medicare Work in Virginia?
Now that you know who’s eligible, you’ll need to understand how Medicare plans in Virginia work. There are two ways you can receive your Medicare: Original Medicare (Parts A and B) and Medicare Advantage. Here’s how they compare:
Original Medicare (Parts A and B)
Parts A and B help cover hospital, preventive, and medically necessary services. You can see any doctor that accepts Medicare, but out-of-pocket costs can be high and most prescription drugs aren’t included. Stand-alone Part D and Medicare Supplement policies are designed to help.
Medicare Advantage (Part C)
Medicare Advantage (Part C) substitutes for Original Medicare (Part A & B), offering the same benefits. Medicare Part C usually bundles additional services like dental, hearing, vision, and prescription drug coverage.
Original Medicare members add drug coverage separately through a Medicare prescription drug plan (Part D). Virginians looking to control their Original Medicare costs can also add Medicare Supplement Insurance (Medigap).
How Much Does Medicare in Virginia Cost?
What you’ll pay for Medicare in Virginia in 2025 comes down to your specific needs and policy details, but you can start by understanding some standard costs. These include premiums, copayments, coinsurance, and deductibles.
Medicare Part A
Premium:
- $0 if you or your spouse worked 10 or more years
- $285 a month if you worked between 7.5 and 10 years
- $518 a month if you worked fewer than 7.5 years
Deductible:
- $1,676 for each hospital benefit period
Copayments & coinsurance:
- Hospital stays: $0 copay for Days 1-60 following deductible payment; daily charges for Days 61 and after
- Skilled Nursing Facility: $0 for Days 1-20 (each plan period); daily charges for Days 21 and after
Medicare Part B
Premium:
- $185 monthly and up in 2024 (income-based)
Deductible:
- $257 for each plan period
Copayments & coinsurance:
- Most preventative services: $0
- Medicare-approved services: 20% coinsurance
Medicare Part D
Premium:
- Income-based; varies by plan
Deductible:
- No more than $590 in 2025
Copayments & coinsurance:
- Plan- and drug-specific
Is Medicare Required When You Turn 65?
You’re not required to have Medicare in Virginia, but not signing up when you’re first eligible can leave you with substantial enrollment penalties when you do apply.
You can avoid these fees by enrolling when you’re first eligible for Medicare in Virginia. If you don’t, you can expect to pay penalties for:
Eligible for Medicare in VA? When to Enroll.
You may qualify for Medicare when you’re 65, but waiting for your birthday to enroll can be a mistake. Instead, your first chance to sign up for Medicare in Virginia begins three months before you turn 65. This is known as your Initial Enrollment Period (IEP).
It’s important to know about all of Medicare’s enrollment periods. There are several chances to make sure your plan is keeping up with your needs.
Here are the Medicare enrollment periods:
- Initial Enrollment Period (IEP): seven months around the month you turn 65.
- Medicare Open Enrollment Period: Oct. 15 to Dec. 7
- Medicare General Enrollment Period: Jan. 1 to Mar. 31
- Medicare Advantage Open Enrollment Period: Jan. 1 to Mar. 31
Can I bundle multiple benefits into one plan?
What Are the Different Medicare Plans Available?
Building the right healthcare approach for you means understanding all the available Medicare plans in Virginia. Here’s how they work:
Original Medicare (Parts A and B)
Original Medicare is made up of Parts A and B. They work separately to provide a base level of care.
- Part A: helps cover stays at hospitals, nursing homes, skilled nursing facilities, hospice care, and some home health care.
- Part B: covers part of your medically necessary services from doctors and other providers, as well as preventive services.
Medicare Advantage (Part C)
Medicare Advantage plans are an alternative to Original Medicare in Virginia. Medicare Advantage often includes benefits on top of what enrollees would receive from Parts A and B, including vision, dental, hearing, and Medicare Part D.
Enrolled in Original Medicare in Virginia? Consider These, Too.
Being enrolled in Original Medicare Advantage in Virginia means you’ll need to add prescription drug coverage separately. You may want to consider a Medicare prescription drug plan (Part D) and Medicare Supplement Insurance (Medigap).
Medicare Prescription Drug Plan (Part D)
If you have Original Medicare, Part D plans are standalone policies that provide prescription drug coverage. Medicare Advantage plans in Virginia often include Part D.
Medicare Supplement Insurance (Medigap)
Medigap insurance is a type of plan that provides additional benefits to Original Medicare. A Medigap plan has a monthly premium and is designed to help with out-of-pocket costs. Virginia has a menu of 10 Medigap plans to choose from
What is the Best Medicare Plan?
The answer to this question is up to you and your needs. You’ll want to factor in your health, budget, and even which part of Virginia you reside in. In other words, what works for you won’t work for everyone else. To find the Medicare plan that fits your needs, GoHealth has put together some tools and resources to help the process.
- Pros and Cons: Dive deeper into Original Medicare and Medicare Advantage
- Enrollment Checklist: Develop your plan to get the most of your Medicare
- Medicare Star Rating System: Find out what other policyholders think of their plans
- Pro Tips: Pointers from insiders to make Medicare easier
- Call GoHealth: We have answers about Medicare plans in Virginia? With our licensed insurance agents, you’ll get the personal attention you need. Call us at 1-855-792-0088.
What’s the Best Medicare Advantage Plan?
If you decide to enroll in Medicare Advantage in Virginia, you’ll have several plans to choose from. But just like the questions above, the answer depends on your personal needs. Also, Medicare Advantage plans vary by location, so what works well in Roanoke may not fit someone in Bristol. To help you get started, here are the different options of Medicare Advantage in Virginia:
- Health Maintenance Organization (HMO) plans use primary care physicians to manage care. HMOs often limit you to seeing doctors within your provider network.
- Preferred Partner Organization (PPO) policies give you greater freedom to see out-of-network doctors and providers while still using a primary care physician.
- Private Fee-For-Service (PFFS) plans pay your providers each time you receive a service.
- Special Needs Plan (SNP) plans help enrollees living with specific health conditions. D-SNP assists dual eligible individuals, and C-SNP is for people with chronic diseases.
Find the Medicare Plan that works for you.
What Is the Downside to Medicare Advantage Plans?
Still deciding between Original Medicare and Medicare Advantage in Virginia? Each option has its advantages and disadvantages. There are, however, some main characteristics you can use to compare the two.
- Original Medicare often has higher out-of-pocket costs but more flexibility to see any doctor that accepts Medicare.
- Medicare Advantage offers a smaller network of doctors you can see and often costs less out of pocket. Medicare Advantage usually includes coverages Parts A and B don’t, including prescription drugs (Part D).
Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 1,432,482 people are enrolled in Medicare Part A and B in Virginia. The total number of beneficiaries enrolled in Medicare Advantage increased from 354,950 to 414,487 year over year. Medicare Advantage participation in Virginia went from 25.43% to 28.93% year over year. If you’d like to dive deeper into how Medicare in Virginia breaks down across the state, we provide a glance at who is using Medicare and how.
1,432,482 Beneficiaries with Part A & Part B
414,487 Medicare Advantage Beneficiaries
28.93% Medicare Advantage Participation Rate
55.47% Female
44.53% Male
77.78% Non-Hispanic White
14.39% African American
2.08% Hispanic
5.75% Other/Unknown
11.15% Eligible for Medicaid
0.95 Average HCC Score
$9,317.91 Actual Per Capita Costs
17.25% Hospital Readmission Rate
26.60% % of Beneficiaries with an Emergency Department Visit
354,950 Medicare Advantage Beneficiaries, Previous Year
Increased Medicare Advantage, Year over year
25.43% Medicare Advantage Participation Rate, Previous Year
Table reflects the latest Beneficiary Demographics Data: Medicare Geographic Variation – by National, State & County
Average HCC Score: The Hierarchical Condition Category score gauges a population’s overall health. The score is based on a value of 1.0. Populations with an HCC score of less than 1.0 are considered relatively healthy. The score can be used to estimate health costs.
Office for Aging Services of the Division for Community Living (DARS)
https://www.vda.virginia.gov
What should I know about DARS?
Find caregiver services and connect with several local senior-focused resources.
CommonHelp (Medicaid)
https://commonhelp.virginia.gov/
What should I know about CommonHelp?
Virginia’s Medicaid program; visit here to apply as well as check, change and renew your Medicaid benefits.
Virginia Insurance Counseling & Assistance Program
https://www.vda.virginia.gov/vicap.htm
What should I know about the Virginia Insurance Counseling & Assistance Program?
Access Virginia’s State Health Insurance Assistance Program (SHIP) to see if you’re eligible for help paying your Part D and B costs.
Virginia Department of Veterans Services
https://www.dvs.virginia.gov/
What should I know about the Virginia Department of Veterans Services?
Virginia veterans can access a host of benefits and supports through this department.
Nationwide Resources
Speak with a GoHealth insurance agent that is licensed in Virginia about your Medicare questions.
Mon – Fri, 8 a.m. – 6 p.m. CT
Centers for Medicare and Medicaid Services
You can reach the Social Security Administration by phone for general questions. Not all questions can be answered over the phone.
Also, SSA.gov provides online resources for the following: Review information, apply for benefits, or manage your account online
1-800-722-1213
TTY 1-800-325-0778
Speak to SSA Representative, Monday – Friday, 8 AM – 7 PM ET
Medicare Learning Guides
Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.
Before 65 Guide
Understanding health insurance before age 65, especially when considering early retirement
Medicare Plans Guide
Costs, coverage and enrollment details for each Medicare plan
Medicare Beneficiary Guide
For those currently enrolled in Medicare
Low Income and Medicare Guide
For individuals with a qualifying income status
A Caregiver's Guide
For individuals with a qualifying income status
Sources
- Special Needs Plans (SNP). Medicare.gov.
- Yearly deductible for drug plans. Medicare.gov.
This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money.
Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.