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Nearing your Medicare enrollment date? You’ve no doubt begun researching the best companies for Medicare in Virginia. With so many options out there, how do you know you’re making the best choice? At Benzinga, we’ve done the legwork in reviewing and comparing the top Medicare Advantage insurance companies in Virginia to help you decide with confidence.
The Best Medicare in Virginia:
- Best Overall in Virginia: Kaiser Permanente
- Most Affordable in Virginia: Aetna
- Best For Choosing Your Own Doctors: Humana
- Best for Low Out-Of-Pocket Maximums: Kaiser Permanente
- Best for Healthy Individuals: Anthem
What is Medicare?
Medicare is health insurance for those 65 and older. It helps cover a wide range of healthcare expenses and hospital visits. Every U.S. citizen pays into Medicare over time. The money comes out of their paychecks before they receive them. Medicare is divided into different parts, each of which covers a specific portion of one’s healthcare needs.
Part A: Medicare Part A generally covers hospital care. This may include a limited amount of care in a specialized nursing facility, home health care and hospice care. Part A is similar to the health insurance plans available on state exchanges and those from individual health plans. Because Part A doesn’t cover the full amount of the hospital bill, you’ll be responsible for a portion of the cost and the deductible before Medicare takes over.
Part B: Part B covers expenses that aren’t related to a hospital stay, like physician visits, x-rays and blood tests. It can also cover outpatient care in a hospital. You’ll pay a monthly premium for this part of Medicare. Similar to Part A, you pay a deductible until Part B benefits become active. The amount is usually 20% of the bill, providing you go to doctors that accept Medicare. Medicare usually pays the full cost of most lab and blood tests.
Part C: Also known as a Medicare Advantage plan, this type of Medicare is typically offered by private companies as an alternative to original Medicare (which bundles Part A and B). To make these types of plans more enticing to consumers, they often include additional benefits like vision, dental or hearing screenings. Some Part C plans also offer additional coverage when traveling outside of the U.S. Enrollment in this plan is optional.
Part D: Medicare Part D plans cover prescription drugs. Like Part C, Part D Medicare plans are offered by private companies and enrollment is also optional. The specifics vary from plan to plan, but you may have to pay a deductible and a flat copayment amount, or you may need to pay a percentage of the cost (known as coinsurance). Part D is a standalone program that can be available for a $0 plan premium.
Legalities of Medicare in Virginia
Medicare is overseen by the U.S. Department of Health and Human Services and handled by the Centers for Medicare and Medicaid Services. It’s made possible by the Social Security Administration through taxes that are automatically taken from your paycheck. 1.4% of your earnings go into FICA, the Federal Insurance Contributions Act, and your employer pays another 1.45%, bringing the total to 2.9%. Those individuals that are self-employed pay both parts.
You can start using Medicare as soon as you turn 65, but you don’t have to wait that long to enroll. Your enrollment period begins up to 3 months before the month you turn 65 and lasts 3 months after. It’s smart to enroll as soon as you can so that your health insurance coverage doesn’t disappear as you transition from insurance from your workplace to Medicare.
Types of Medicare Advantage Plans
Private insurers divide Medicare Advantage plans into HMO, PPO and occasionally PFFS plans to make it easier for Medicare members to understand how the plan operates. Private insurers contract with Medicare to handle the billing and claims process for the bundled Part A and B services.
HMO: HMO plans help save money by coordinating care among your primary physician and a network of doctors, hospitals and specialists who have all agreed to accept a certain rate for care. If you need a referral to see a specialist, you’ll need to get that referral from your primary physician. There are a handful of exceptions, including emergency care, out-of-area urgent care and kidney dialysis. Prescription drugs are generally covered by HMOs. If you get care outside of the HMO network, you may need to pay the full cost of your care.
PPO: PPO plans cost less if you use doctors in their network, however you are not as restricted as you are with an HMO. You don’t need a referral to see a specialist and prescription drugs are generally covered, but there is more paperwork involved. If you get care outside of the PPO network, you may need to file a claim with the insurance company to be reimbursed for some of the costs.
PFFS: Another type of Medicare Advantage plan is a “private fee-for-service” plan. It also does not require a referral to see a specialist. In this type of plan, rates are pre-negotiated among doctors, hospitals and specialists. Be aware that just because your healthcare provider accepts this insurance and specific rate for your treatment once, it doesn’t always mean they’ll accept it in the future, so you’ll want to check before your appointment to ensure you’re covered.
How to Sign Up for Medicare in Virginia
There are several ways to sign up for Medicare in Virginia. Keep in mind that this is not the same process as signing up for a Medicare Advantage Plan or Medicare Supplemental Insurance. There are certain requirements you’ll need to know and much of them will depend on your situation when you fall into the enrollment period.
- If you’re already collecting Social Security benefits or Railroad Retirement Board benefits when you turn 65, you’ll automatically be enrolled in Medicare Part A.
- If at the time you signed up for retirement benefits, you also enrolled in Medicare Part B, you’ll also automatically be enrolled in this part of Medicare.
- If you live outside of the U.S. or D.C., you’ll automatically be enrolled in Medicare Part A but will need to manually enroll yourself in Part B.
Although in most cases, enrolling in Medicare Part A is automatic, there are some cases where you’ll need to enroll manually:
- If you aren’t receiving retirement benefits and are within your enrollment period, you can enroll in Medicare only and defer your retirement benefits to a later time.
- If you’re not eligible to receive retirement benefits, you will not be enrolled in Medicare Parts A and B. You can still sign up for them during your enrollment period, however. You may have to pay a premium.
Average Cost of Medicare Advantage Plans in Virginia
How much you pay for a Medicare Advantage Plan in Virginia depends on the type of plan as well as the optional features that you want, such as prescription drug coverage or benefits from private companies, like dental or vision benefits.
|Plan Name||Company||Plan Type||Health & Drug Costs|
|Innovation Health Medicare Voyager||Aetna Medicare||PPO||$88 Medicare Advantage with drug coverage monthly premium. Does not include the $144.60 standard Part B premium. There are a $0 drug deductible and an out-of-pocket maximum of $10,000 for out-of-network doctors and hospitals, and $6,500 for in-network doctors and hospitals.|
|Kaiser Permanente Medicare Plus with Part D Coverage||Kaiser Permanente||AB||$142 Medicare Advantage with drug coverage monthly premium. Does not include the $144.60 standard Part B premium. There are a $0 deductible and a $5,000 in-network out-of-pocket maximum.|
|Erickson Advantage Liberty (without drug coverage)||UnitedHealthcare||HMO||$0 Medicare Advantage without drug coverage. Does not include the $144.60 standard Part B premium. There are an $800 in-network deductible and out-of-pocket maximum of $6,700 for in-network coverage.|
|HumanaChoice||Humana||Regional PPO||$0 Medicare Advantage with drug coverage monthly premium. Does not include the $144.60 standard Part B premium. There are a $5,400 in-network and out-of-network out-of-pocket maximum for care.|
|Anthem MediBlue Plus||Anthem HealthKeepers||HMO||$0 Medicare Advantage with drug coverage monthly premium. Does not include the $144.60 standard Part B premium. There are a $325 drug deductible and a $6,700 in-network, out-of-pocket maximum.|
Best Medicare Insurance Providers in Virginia
Insurance companies offering Medicare Advantage plans in Virginia vary considerably in coverage and price. There is no “one size fits all” plan that will work for everyone. We’ve chosen among the best coverage — from basic coverage to great coverage for the unexpected.
1. Best Overall in Virginia: Kaiser Permanente
As one of the few Medicare private insurance companies to earn the esteemed 5-star rating, Kaiser Permanente offers a variety of plans that fit nearly every need and budget.
With an expansive network throughout Virginia and nationwide, you can be assured of great coverage at an affordable rate.
Dental, vision and hearing coverage may also be added if you want these additional benefits.
2. Most Affordable in Virginia: Aetna
Dollar for dollar, Aetna’s PPO plan is one of the most affordable options in Virginia. It provides low deductibles and reasonable premiums in exchange for a wide degree of care and a large network of providers.
If you’re looking for a Medicare Advantage plan based on sheer affordability and you don’t go outside of your health network often, it’s a solid choice that should fit your needs well.
3. Best for Choosing Your Own Doctor and Hospital: Humana
HumanaChoice is a regional PPO offered throughout Virginia, and it’s a great option for those looking for the most flexibility to choose your doctor and hospital.
Plus, because it’s a PPO, you don’t need a referral to see a specialist, making this a great option if you want greater freedom of choice and tend to stay close to home for your healthcare needs.
4. Best for Low Out-of-Pocket Maximums: Kaiser Permanente
If you’re looking for a health plan that won’t break the bank when it comes to out-of-pocket maximums, Kaiser Permanente is our top choice.
Not only does it have some of the lowest rates for out-of-pocket maximums, but it also has a variety of plans across the full spectrum of healthcare, so you can choose the one that best fits your needs while being assured of quality care.
5. Best for Healthy Individuals: Anthem
Anthem HealthKeepers is our top pick for those individuals who are in relatively good health and just want a simple, no-frills health insurance plan that helps them stay healthy and on track with their health care and life goals.
Virginia is for Lovers… of a Good Deal on Healthcare
Staying healthy in Old Dominion has never been easier thanks to a variety of comprehensive Medicare Advantage plans. We recommend getting quotes from these top providers so that you can get a more customized price and coverage details from private insurance companies that want to make it easy for you to choose a health plan with confidence.
Frequently Asked Questions
Medicare has 4 parts named Parts A, B, C, and D. Part A provides hospitalization coverage while Part B provides outpatient coverage, like doctor visits. Parts A and B make up Medicare’s core coverages. Part C is provides private-market Medicare plans, called Medicare Advantage Plans. Part C coverage often includes additional benefits. Medicare Part D provides coverage for prescription drugs. Get a Medicare Insurance Quote through the top providers here.
Because there are 4 parts to Medicare, there can be different cost structures. Most people won’t have to pay for Medicare Part A (hospitalization). Eligibility for premium-free Part A is based on your work history during which you paid Medicare taxes. Many people do pay a monthly premium for Medicare Part B, however, which covers outpatient medical services, like doctor visits. Deductibles also apply to services covered under Medicare Parts A and B, so you’ll pay a part of the annual cost.
Medicare Parts C and D are optional coverages and have premium costs of their own. Medicare Part C refers to Medicare Advantage Plans that offer additional coverage in exchange for a monthly premium. Part D, the prescription plan, reduces the cost of medications but also requires a monthly premium. Subsidies may be available for low income households to help reduce overall Medicare costs.
If you signed up for Social Security before age 65, you were enrolled in Medicare automatically but benefits will begin at age 65. In most cases, there are penalties for not enrolling at age 65, so it pays to sign up on time. Click here to get a medicare quote in minutes from the best providers.