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Medicare in Virginia: Eligibility, Coverage, and More

Did you know that there are over 1.3 million Medicare beneficiaries in Virginia alone? While Medicare is a federal program, there are countless Virginia Medicare plan options for you to choose from. We’re here to help you figure out what’s best for you.

A Guide to Medicare in Virginia includes:

Medicare Virginia Eligibility Requirements

If you are age 65 or older, you meet the Medicare Virginia Eligibility Requirements! You can also be eligible for Virginia Medicare if you are diagnosed with either ESRD (End-Stage Renal Disease) or ALS (Lou Gehrig’s Disease).

What Does Medicare Cover in Virginia?

Everyone will begin with Original Medicare (Part A, hospital coverage, and Part B, medical coverage). The next step is selecting a form of prescription drug coverage. You can either keep your Original Medicare and purchase a stand-alone prescription drug policy (otherwise known as Part D), or switch to a Medicare Advantage plan (otherwise known as Part C). If Virginia Medicare Advantage is not right for you, you can instead opt for Medicare Supplements, otherwise known as Medigap.

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Medicare Advantage Plans in Virginia

Medicare Advantage plans in Virginia can take all of your coverage (hospital, medical, prescription drug, dental, vision, etc.) and roll it into one convenient plan. These plans, though subject to government regulations, are offered by private insurance companies. They are not the same thing as the Original Medicare that you can enroll in through Social Security. They often offer additional benefits like fitness programs, non-emergency medical transportation, and even meal delivery.

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Medicare Supplement Plans in Virginia

Medigap is a type of policy that is designed to make your copayments, deductibles, and coinsurance more affordable. Virginia Medigap policies are arranged by letter (A, B, C, D, F, G, K, L, M, N). Each letter option is slightly different in coverage amount and cost. Medigap plans can cover items like your Part A and B deductible and copayments, hospice or nursing home copayments, and some other excess out of pocket charges related to your Virginia Medicare services.

Medicare Part D Plans Virginia

Part D plans are also called PDPs, short for prescription drug plans. They are standalone plans, meaning you’ll enroll in a Part D as an addition to your Original Medicare coverage. The standard deductible for Part D plans in 2019 is $415, meaning your coverage will kick in after you’ve spent $415 on prescription drugs. If you don’t want a Part D plan, you can enroll in a Medicare Advantage plan that includes prescription drug coverage instead.

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What is the Cost of Medicare in Virginia?

Medicare costs change nationally every year. In 2019, the standard Part B premium is $135.50 per month with a deductible of $185. Most people will not have to pay a premium for Part A. However, if you were employed for less than 39 quarters (about ten years), you will face a premium. Those who worked between 30 and 39 quarters will face a $240 premium, while those who worked less than 30 quarters will face a $437 premium. You’ll also have Part A coinsurance of $341 per day for your first 90 hospital stays, and then $682 for other hospital days.

*These costs can change based on your income level.

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Can I Have Medicare and Medicaid in Virginia?

If you qualify for Medicare in Virginia and also meet the income requirements for VA Medicaid, you can get benefits from both programs through a “dual special needs plan.” This allows you to get the benefits of an expanded provider network, a larger drug formulary, and in some cases, additional benefits like dental, vision, and hearing coverage. Your dual eligible Virginia Medicare plan often comes at no cost to you due to your Medicaid eligibility.

Virginia Senior Resources

AccessVA - If you’re a Virginian with a disability, AccessVA can help you find an affordable and handicap-accessible housing solution.

Administration for Community Living - The ACL can help older and disabled Virginians access the right services to be able to live their best life.

Project 2025 - If you’re in need of legal assistance in relation to guardianship, Medicaid, abuse, housing, discrimination, etc., reach out to Project 2025.

Caregiver Support - The VCC (Virginia Caregiver Coalition) meets monthly to discuss caregiver education and support.

Live Well, Virginia - Live Well, Virginia is Virginia’s six-week Chronic Disease Self-Management Program that teaches seniors how to better handle their chronic illnesses. Participants learn about healthy eating and physical activity choices, treatment options, appropriate use of medications, and how to talk to healthcare professionals.

Senior Farmer’s Market Nutrition Program - This program helps eligible Virginia seniors have access to fresh produce while supporting local farmers. You must apply every year to find out if you are eligible.

Senior Cool Care - If you are below the Virginia poverty line and meet the eligibility requirements, the Senior Cool Care program can help you keep your home cool during the hot Virginia summers.  https://www.vda.virginia.gov/seniorcoolcare.htm

Office of the State Long Term Care Ombudsman - The Virginia Long-Term Care Ombudsman advocates for those who need long-term care and works to improve quality of life. You can contact the ombudsman if you need help solving a problem related to long-term care, such as care quality complaints and rights violations.

Virginia Health Information - Looking for more information about a provider in your area? Use the Virginia Health Information website to search for a physician, hospital, or long-term care facility for information on locations, hours, Virginia Medicare/Medicaid acceptance, and more.

Virginia Navigator - Virginia Navigator is a website and tool where you can search for Virginia providers in your area. You can find assisted living facilities, rehabilitation centers, veteran resources, caregiver support, adult day care, and more.

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How do I Apply for Medicare in Virginia?

To apply for Original Medicare (Parts A and B, visit your local Social Security office or visit SocialSecurity.gov. You can also call 1-800-772-1213 (TTY 1-800-325-0778).

To apply for a Virginia Medicare Advantage or Medicare Supplement plan, complete this form or give us a call (833-438-3676). We’ll send a licensed agent to come out and help you select the best health plan(s) for you from all the options available to you in Virginia.

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