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Medicare Advantage in Virginia

If you’re a Medicare beneficiary living in Virginia and enrolled in Original Medicare, Part A and Part B, you have the option to sign up for a private Medicare Advantage (Medicare Part C) plan.

Medicare Advantage provides all the benefits of Original Medicare, but can also offer additional benefits. The benefits of Medicare Advantage plans in Virginia depend on the particular zip code in which you live and on the plan you select.

Another important thing to know is that if you enroll in any Medicare Advantage plan, you must still remain enrolled in Original Medicare and continue paying your Medicare Part B premiums.

How Medicare Advantage works in Virginia

Medicare Advantage plans in Virginia are required by law to offer at least the same coverage as Original Medicare, including basic hospitalization and medical benefits. But many Medicare Advantage plans may offer additional benefits such as vision, hearing, and dental coverage. As a Virginia resident, you can buy a Medicare Advantage plan through a private insurance company that offers plans in Virginia.

To avoid a late-enrollment penalty, which translates into higher premiums for as long as you remain enrolled in Medicare, you should sign up for Original Medicare during your Initial Enrollment Period. If you are one of the many Virginia residents qualifying for Medicare at age 65, your Initial Enrollment Period begins three months before you turn 65, includes the month you turn 65, and includes the three months after you turn 65. If you fail to join Original Medicare during your seven-month Initial Enrollment Period, you can still join during the General Enrollment Period, which runs from January 1 through March 31 each year. However, you’ll most likely have to pay the late-enrollment penalty.

Medicare beneficiaries who have already enrolled in a Medicare Advantage plan and wish to switch plans can do so during the Annual Election Period. Also known as the Open Enrollment Period for Medicare Advantage and prescription drug coverage, the Annual Election Period runs from October 15 to December 7 each year. If you switch Medicare Advantage plans during this time, your new coverage usually begins on January 1 of the following year.

There are a few other scenarios in which you may change Medicare Advantage plans, such as moving to a new address, losing your current coverage, qualifying for other coverage, or changes in your current plan that affect your health benefits. If any of these situations affects you, they trigger a Special Enrollment Period, during which you may be able to change your Medicare Advantage plan. The start and end dates for Special Enrollment Periods vary according to each situation.

If, for any reason, you want to disenroll from your Medicare Advantage plan and go back to Original Medicare, Part A and Part B, you’re allowed to do so during the Medicare Advantage Disenrollment Period, which runs from January 1 to February 14 each year in Virginia, as it does in other US states.

Types of Medicare Advantage plans in Virginia

As a Virginia Medicare Advantage beneficiary, it’s important to understand the various types of Medicare Advantage plans available in your state so you can select the plan that may best suit your individual health needs.

When signing up for a Medicare Advantage plan, it’s important to take into consideration your prescription drug needs. There are a number of Virginia Medicare Advantage plans that combine health coverage and prescription drug coverage (Medicare Part D) into one private insurance plan, and such plans are known as Medicare Advantage Prescription Drug plans.

Other Medicare Advantage plan types available in Virginia include Health Maintenance Organization (HMOs) and HMO Point-of-Service (HMO-POS) plans. Under an HMO plan, beneficiaries are required to visit doctors, health care providers, and hospitals in the health plan’s HMO network. Some HMOs may also require a referral from the beneficiary’s primary doctor in order to receive certain health services. HMO-POS plans are similar to standard HMO plans, but they generally cost a bit more because they offer greater flexibility, allowing beneficiaries to choose their own providers for certain health services.

Medicare Advantage plans available in Virginia also include Preferred Provider Organization (PPO) plans. PPOs allow Medicare beneficiaries to choose doctors, health-care providers, and hospitals outside of the plan’s network, but generally require greater out-of-pocket expenses than HMO or HMO-POS plans.

Beneficiaries who suffer from a specific health condition may want to consider a Medicare Special Needs Plan (SNP). This type of Medicare Advantage plan generally limits enrollment to people with special health needs, with coverage tailored to suit the needs of the specific beneficiaries. Examples of Medicare Special Needs Plans include plans customized for people with diabetes, HIV/AIDS, or congestive heart failure. There are also SNPs available for those living in nursing homes and for those who receive Medicaid benefits.

Under one Medicare Advantage plan type, the Private Fee-for-Service (PFFS) plan, the plan itself decides how much it will pay for your doctor, health care provider, and hospital visits, and also determines your share of each expense.

In Virginia, you might also opt for a Medical Savings Account (MSA) plan. This type of Medicare Advantage health plan generally combines a high deductible with a savings account that beneficiaries can use to pay for their health care expenses.

Once again, keep in mind that even if you join a Medicare Advantage or Medicare Advantage Prescription Drug plan, you have to stay enrolled in Original Medicare and continue paying your Medicare Part B premiums.

Comparing Virginia’s Medicare Advantage plans

In light of all the Medicare Advantage plan options available in Virginia, it can be important for you to learn about and evaluate as many health plans as possible before deciding which one to select. Each Medicare Advantage plan may charge different costs and may have different rules for covered services, and these rules may change on an annual basis, so it’s always a good idea to compare available Virginia Medicare Advantage plans each year, based on your own health needs and your location.

Keep in mind that premiums for a Medicare Advantage plan with the same coverage and benefits can vary between different Virginia counties. And while some Virginia Medicare Advantage plans may offer low premiums, others will require significantly higher premiums, depending on your own individual health need.

Remember that you will want to determine which additional Medicare Advantage benefits you may require beyond the benefits included in your Original Medicare coverage. For example, do you want prescription drug coverage through a Medicare Advantage Prescription Drug plan?

With all these options, you can see why it can be important to compare plans with the benefits and costs best suited to your specific health needs.