Medicare in Virginia

Last Updated : 09/16/20185 min read

While shopping for Medicare plans in Virginia, can be your resource. Our site offers a plan comparison tool that makes it easy to browse plan options in your area. When it comes to finding the right Medicare plan for you, we can help.

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About Medicare in Virginia

In Virginia, Medicare beneficiaries can get their health care through the federal government with Original Medicare, Part A and Part B, or enroll in a Medicare Advantage plan (also called Medicare Part C). Original Medicare beneficiaries can join a stand-alone Medicare Part D Prescription Drug Plan to receive prescription coverage, and also a Medicare Supplement (Medigap) plan for additional coverage on deductibles, and copayments. Those who go with a Medicare Advantage plan can enroll in a plan that includes prescription coverage as part of the plan.

Types of Medicare coverage in Virginia

Original Medicare, Part A and Part B, or the federal part of the Medicare program, covers inpatient hospital care through Medicare Part A, while Part B is responsible for physician services, some durable medical equipment, and some preventive care.

Medicare Advantage plans, Part C, or private Medicare insurance, must cover at least everything that Original Medicare, Part A and Part B, does (except for hospice care). Some plans may include other benefits, like routine vision, hearing, and prescription drug coverage.

Medicare Part D Prescription Drug Plans (PDPs) provide drug coverage, or Medicare Part D, to Original Medicare beneficiaries. This coverage works alongside their Original Medicare Part A and/or Part B insurance. Not every Medicare Prescription Drug Plan in Virginia may be available in each area. If you’re enrolled in a Medicare Advantage plan, you can get Medicare Part D coverage through a Medicare Advantage Prescription Drug plan.

Medicare Supplement insurance, or Medigap, is sold by private insurance companies. These plans help with certain costs that Original Medicare doesn’t cover, such as copayments, coinsurance, deductibles, and emergency health coverage outside of the country. Like most states, Virginia can offer up to 10 standardized policies, each labeled by a letter (A, B, C, D, F, G, K, L, M, N). Plans of the same letter provide the same benefits, no matter where they are purchased throughout the state.

Local resources for Medicare in Virginia

Medicare Savings Programs in Virginia: Virginia Medicare beneficiaries whose incomes are limited may be eligible for discounts on out-of-pocket Medicare costs such as premiums, deductibles, and other expenses.

Virginia State Health Insurance Counseling and Assistance Program (SHIP): In Virginia, the State Insurance Counseling and Assistance Program (SHIP) provides counseling for Medicare beneficiaries and their loved ones at no cost.

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How to apply for Medicare in Virginia

To qualify for Medicare, you must be either a United States citizen or a legal permanent resident of at least five continuous years.

The process of Medicare enrollment in Virginia is the same in any state, and beneficiaries will find that access to the program can happen a few different ways.

Most beneficiaries are eligible for Medicare when they turn 65; some individuals may qualify before 65 through disability or having certain conditions, such as amyotrophic lateral sclerosis (ALS or Lou Gehrig’s Disease)or end-stage renal disease (ESRD).

Some residents are automatically enrolled at age 65 if they receive retirement benefits through either the Social Security Administration or the Railroad Retirement Board before they turn 65. Disabled residents may obtain Medicare coverage before reaching age 65 if they receive Social Security disability benefits, or certain disability benefits from the Railroad Retirement Board, for 24 consecutive months; those who get Medicare due to disability will be automatically enrolled in the 25th month of disability benefits. If you qualify for Medicare because you have ALS, you’ll be automatically enrolled in the first month that your disability benefits start. If you qualify for Medicare because of end-stage renal disease, you’ll need to manually enroll.

If you’re not already getting retirement benefits when you turn 65, you’ll need to manually apply for Medicare. You can do so during your seven-month Initial Enrollment Period, which starts three months before you turn 65, includes the month you turn 65, and ends three months later.

Those who have to apply manually can visit their local Social Security Administration office or enroll online or over the phone.

  • Visit the Social Security website.
  • Call Social Security at 1-800-772-1213 (TTY users should call 1-800-325-0778), Monday through Friday, 7AM to 7PM.
  • Apply in person at a local Social Security office. Visit the Social Security website to find the closest location to you.
  • If you worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772 (TTY users call 312-751-4701), Monday through Friday, 9AM to 3:30PM.

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