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Medicare in Virginia

Medicare in Virginia

Whether you love history or enjoy the outdoors, Virginia will keep you busy. You can go to the beach, take in the history of Colonial Williamsburg and Richmond, and enjoy some of the best education in the nation. It’s no wonder that over eight million people call Virginia home.

If you’re a Virginian who is approaching the age of 65, you’re probably thinking a lot about retirement, health care, and other concerns. Should you enroll in Medicare? How do you do so? How much will it cost you?

This guide will answer these common questions along with other concerns we often hear from those exploring Medicare. If you would like more specifics, feel free to contact us anytime!

Let’s take a look at answers to common questions about Medicare in Virginia.

How to Apply for Medicare in Virginia

Medicare was designed to provide health coverage for those without access to employer-provided care. As a result, you qualify for coverage as you approach retirement age, or if you have specific health conditions. 

For most Americans, eligibility starts three months before your 65th birthday, includes your birth month, and extends three months after. During this time, you can be automatically enrolled in Medicare coverage or you can actively choose a plan.

Keep in mind that automatic enrollment will put you in Original Medicare Part A (hospital coverage) and Part B (medical coverage). You won’t have access to prescription drug coverage or the extra benefits you’d get from choosing a Medicare Advantage plan. That’s why it’s important to actively choose your Medicare plan.

You can explore available Medicare coverage in your area both online and over the phone. Be sure to look into which providers and medications are covered. You also want to look at Medicare costs.

When you carefully compare plans, you can choose the right coverage for your needs.

How Much Does Medicare Cost in Virginia?

The cost of a Medicare plan has two parts. First, you’ll look at the monthly premium you’ll pay to maintain your coverage. After you receive care,  you’ll pay out-of-pocket costs that include a yearly deductible and service-specific copayments or coinsurance. 

Original Medicare Part A (hospital insurance) is premium-free for most Americans. If you need hospital care using Medicare Part A, you’ll have a deductible of $1,556 (in 2022) before Medicare coverage begins. Then, you’ll pay a $0 coinsurance for days 1-60 of care, and a $389 coinsurance per day for days 61-90 within a year.

Medicare Part B, medical coverage, helps you pay for visits to the doctor, outpatient care, and medical equipment. Part B has a monthly premium of $170.10 in 2022. When you need care, you’ll pay a deductible of $233, and then you’ll pay 20% of the Medicare-approved costs while Medicare pays the rest.

If you add prescription drug coverage in Original Medicare, you’ll choose a Medicare Part D plan. These plans are sold by private insurance companies. Each plan has its own monthly premium, deductibles, and copayments. Be sure to compare plans before choosing one to ensure the medications you need and the pharmacies you prefer are included.

Medicare Advantage plans are a full replacement for Original Medicare. Generally, you’ll get hospital and medical coverage, along with prescription drug coverage, in a single package. You may also get additional benefits, like vision or dental coverage. Each Advantage plan has its own monthly premium and out-of-pocket costs, so be sure to compare carefully before making a decision. 


Is Medicare Free in Virginia?

While Medicare isn’t free, you can get help paying for your monthly premium and out-of-pocket costs. 

Consider looking at a Medigap plan if you have Original Medicare. These plans help pay for part or all of your deductible and coinsurance amounts when you need care. 

If you have a lower income and assets, there are also ways to get extra help with your Medicare costs. You might be able to enroll in a Medicare Savings Plan (MSP), use Medicaid alongside Medicare, or get Extra Help with Part D. There are other programs as well. 

Creating a plan to cover your out-of-pocket expenses before a medical need will allow you to focus on healing instead of worrying about money.


What is the Income Limit for Medicare in Virginia?

There is no income amount that disqualifies you from getting Medicare coverage. If you are a high earner, you may pay a higher monthly premium for your coverage. This starts to happen (in 2022) if you earn $91,000 or more as an individual or $182,000 or more as a joint return. 

If you have lower income and assets, you might qualify for assistance paying your premiums and out-of-pocket expenses for Medicare. This might mean you qualify for an MSP or can use Medicaid to cover most of your medical expenses. 

You can contact the Social Security office in your area to find out more about qualifying for assistance or having a higher monthly premium.

Is Medicare Advantage Available in Virginia?

Medicare Advantage, also known as Medicare Part C, is a full replacement plan for Original Medicare and is offered by private insurance companies. There are over 4.5 million Medicare Advantage recipients in Virginia.

These plans are based on the local area, so different Advantage plans will be available in different states. However, every state — including Virginia — has at least some Medicare Advantage options.

Many Americans enjoy Advantage plans because they have more predictable out-of-pocket costs, using a flat copayment instead of a percentage of the cost. Also, many Advantage plans have additional benefits above Original Medicare, such as dental or vision care. 

However, Medicare Advantage plans will also have a limited medical network that is usually tied to your local area. It’s likely you won’t be able to get non-emergency medical care covered outside the network. That means that you should be sure you find an Advantage plan that has the doctors you prefer. If you travel often, Original Medicare might be a better choice.

What is the Best Medicare Plan in VA?

There are a wide range of Medicare plans available. Only you can know which option is the best choice for you.

For example, if you travel often, the nationally-focused coverage of Original Medicare could be ideal. On the other hand, if you need specific benefits that Original Medicare doesn’t offer, you might look for an Advantage plan that can give you what you need.

The best idea is to talk to a licensed agent who can help you compare different Medicare options. We have agents available to answer your questions and help you compare plans.

Learn More About Medicare in Virginia

This guide answered most of the common questions about Medicare in Virginia, but we’re available for more specific questions as well. Our licensed agents can address your concerns and help you choose the best plan for your needs. Contact us today!

What you should read next

Medicare In 2023: Changes & Updates

When planning ahead for your healthcare expenses and how they align with your Medicare coverage, it’s very important to stay informed on the changes to Medicare each year.  Several aspects of Medicare - particularly related to out-of-pocket costs - can change on an annual basis. Beyond costs or plan changes, Congress also occasionally proposes and passes legislation that often impacts Medicare benefits.  In this article, we’ll review the recent changes, including the 2023 Medicare costs and an overall look at the state of Medicare in 2023.  2023 Medicare Costs: An Overview  The Medicare costs that change each year are: Part A deductiblePart A daily coinsurancePart B deductible Medicare Part A CostsThe changes to Part A costs include:Part A deductible - $1,600, an increase of $44 from 2022Part A daily coinsurance for hospital stays over 60 days - $400 per day, an increase of $19 per dayPart A daily coinsurance for hospital stays over 90 days - $800 per day, an increase of $22 per dayPart A daily coinsurance for skilled nursing facility stays longer than 20 days - up to 100 days $200, an increase of $5.50 per month Keep in mind that it is possible to pay the Part A deductible more than once in a year. This would only happen when you have multiple hospital stays in one year, and your stays are separated by more than 60 days. In this situation, you’d pay the Part A deductible each time.When you pay the Part A deductible, that gets you 60 days in the hospital and 20 days in a skilled nursing facility. If your stay goes beyond those times, you’ll have to pay the updated daily co-insurance amounts indicated above. Medicare Part B CostsThe Part B deductible for 2023 decreased to $226. It was $233 for 2022. You have to pay the Part B deductible each year before Medicare starts  paying its portion of your outpatient care. Unlike the Part A deductible, you’ll only be required to pay the Part B deductible once per year.After you’ve met the Part B deductible, Medicare will pay the first 80% of the cost for your care; you’ll be responsible for the remaining 20%. Besides standard Part B coinsurance, you might encounter Part B excess charges, which can be as much as 15% of the Medicare-approved cost for your care.There were no changes to these coinsurance costs for 2023. How Much Will Medicare Premiums Increase in 2023? The standard Part B premium for 2023 is $164.90, which is a decrease of $5.20 per month. This decrease takes some of the sting out of last year’s increase, which was one of the largest in history. You may pay a higher premium for Medicare if you have incomes exceeding $97,000 (single filers) or $194,000 (married filing jointly).In addition to the costs for using your coverage, you’ll also have to consider the cost for getting your coverage. Most people don't have to pay a premium for Part A coverage (because it’s been pre-funded through payroll tax deductions), but you do have to pay a premium for Part B coverage. Medicare Part D Changes Another major component of your Medicare coverage is Medicare Part D, also known as Prescription Drug Plans (PDPs). Part D is offered by private insurance carriers with a Medicare contract - not offered by the federal Medicare program. There have been major changes to Part D in the past year as a result of the Inflation Reduction Act. Some of these changes won’t take effect until 2024 or later, but a few of them will be effective in 2023. The changes that will be applicable for 2023 include:Caps on the cost of certain insulinTaxes on excessive increases in the cost for prescription drugsLowering the cost of many vaccinations covered under Part DEach of these changes will have an impact on both standalone Part D Prescription  Drug Plans (PDP) and Medicare Advantage Prescription Drug Plans (MAPD). New Caps On Insulin PricesThe Inflation Reduction Act has brought us the Insulin Savings Program, which was a temporary “test program” that began in 2020. The program is now permanent and mandatory. But previously, it was optional: Part D plans could choose to participate on a voluntary basis.The Inflation Reduction Act limits monthly cost sharing for covered insulin products to no more than $35 for Medicare beneficiaries, as long as the insulin is on the plans formulary. No deductible will apply to these insulin prescriptions. For 2023 and beyond, insulin prescriptions are capped at $35 for a one month supply. This price level stays the same throughout the year, even if you enter the coverage gap or “donut hole.” Excise Tax On Excessive Cost Increases Cost increases on prescription drugs, which are set by the manufacturers, will be subject to a new tax beginning in 2023. Medicare will use 2022 drug prices as a baseline and will investigate the prices for 2023 prescription drugs. If the increases from 2022 to 2023 are larger than the official rate of inflation, the manufacturer will pay a tax equal to 100% of the amount that the increase exceeded inflation for the year. Drug prices will be tracked each year in this way. The hope is that manufacturers will be less likely to increase prices aggressively since they won’t be able to keep any of the extra revenue that large cost increases used to bring them.While this new policy doesn’t directly reduce or limit the prices you pay through your drug plan, over time, it may allow for smaller copayments and coinsurance for your prescriptions. Reduced Vaccine Costs Under Part D The Inflation Reduction Act is also impacting how much you’ll pay for vaccinations under Part D. Prior to 2023, most non-essential vaccines were subject to cost-sharing, which meant that you had to pay a copayment or coinsurance for them. For example, the shingles vaccine was famously expensive. For 2023 and beyond, many Part D covered vaccines will be available at no cost. This brings the Part D vaccinations into alignment with the rules and cost structure for Part B vaccines (like the COVID-19 and flu shots). This includes the shingles shot, so protecting against this painful illness will be cheaper starting in 2023. There are still vaccines that you’ll have to pay for under Medicare, even after these recent changes. Vaccines that are needed to treat injuries or exposure to certain diseases may still require cost-sharing. General Enrollment Period (GEP) ChangesThe last major change to Medicare in 2023 relates to entering Medicare when you’ve missed your original enrollment window. Most people get to enter Medicare when they turn 65-years-old. In that case, you have a seven-month enrollment period known as your Initial Election Period (IEP) during which you can enroll. If you miss this chance, you have to enroll during the General Enrollment Period (GEP). GEP runs from January 1st to March 31st each year. Previously, if you enrolled during the GEP, your Medicare coverage wasn’t effective until July 1, which left you with a significant gap in your medical coverage.For 2023 and beyond, your coverage will be effective on the first day of the month after you sign up during the General Enrollment Period, eliminating the lengthy waiting period. Learn MoreIf you still have questions about 2023 Medicare costs and how they impact you, call 800-620-4519 to speak to one of our licensed insurance agents. You can also view our Medicare resources online:Compare Medicare plans: Visit our Medicare plan comparison tool.Learn about Medicare: View our Medicare Learning Center.Note: These 2023 Medicare costs and updates are courtesy of the Centers for Medicare & Medicaid Services (CMS). For more information, visit the CMS newsroom. 

10 Costly Medicare Mistakes to Avoid

Researching your Medicare plan and understanding how to use your benefits wisely is key to maximizing your Medicare plan. But if you don't take the time to learn all that your current plan has to offer, or if you avoid comparing Medicare plans when it may be time to make a change, you could end up paying more money for your healthcare.   To help you make an informed choice, we’ve put together this guide about 10 costly mistakes to avoid when picking a Medicare plan.   Mistake #1: Using Doctors And Medications That Are Not Covered By Your Plan Medicare Advantage plans have formal networks of providers and lists of medications that are covered (called a formulary). If you see doctors who aren’t in-network, you’ll be paying more for your care than if you use in-network providers. While some PPO plans will allow you to see non-network providers, you’ll save the most money when you use in-network providers. In the same way, plans only provide coverage for medications that are on the formulary. If you use non-covered medications, you’ll end up paying full price for them. So if your current plan doesn’t work with your doctors and medications, you may want to consider making a change to your coverage a qualifying enrollment period.  Our online guided Medicare enrollment tool also allows you to check and see if your doctor and drugs are covered in a Medicare Advantage plan.   Mistake #2: Not Taking Advantage of Additional BenefitsOne of the reasons Medicare Advantage plans are increasingly popular is because they usually provide benefits that are not covered by Original Medicare. These kinds of benefits can include dental, vision, hearing, or prescription drug coverage.These benefits also may be included in your plan at no additional cost. If you don’t use them, you might be paying more than you need to for these services. In addition to the potential cost savings, these additional benefits are designed to help you live a healthier life. Mistake #3: Paying Cash For Your MedicationsIt can be tempting to pay cash for some of your less expensive medications. This is especially true when you look into any of the various prescription discount card programs that are currently available. However, it's wise to avoid paying for your medications if you're expected to reach the third coverage stage of the Medicare Part D drug program (often called the donut hole). Your drug plan tracks your spending, so if you pay cash for a prescription, it doesn’t count towards your official spending. This means that you might not be able to move out of the donut hole if you pay cash for some of your medications. Instead, consider using your plan even if you’ll pay more, if it means that you’ll move out of the donut hole faster. Mistake #4: Not Understanding Your Plan’s CostsWhile Medicare Advantage plans generally help to limit your healthcare costs, it’s important to remember that there are costs you’ll be expected to pay for your care. These costs are usually referred to as cost-sharing. Cost-sharing can include deductibles, copayments, and coinsurance. Besides these amounts, you’ll want to double check your plan’s Out-of-Pocket Maximum (OOPM), which is the most you could possibly spend in one year.  Mistake #5: Choosing A Plan Based On Premiums AloneIt can be tempting to focus on the monthly premium you pay for your coverage, and not dig deeper into the costs you’ll pay to use your benefits. Pay particular attention to any deductible that you have to meet, as well as co-payments for services you’re likely to use. Besides these, consider your total costs in light of any costs for prescription drugs you take, too. Mistake #6: Not Checking To See If You Qualify For Financial AssistanceThere are a number of federal and state programs that are designed to help you pay for the cost of your health care. These can include Medicaid, Extra Help, Low Income Subsidy, and state pharmaceutical assistance programs. While there are income and asset limits for participation in some of these, you should apply for them if you think there is any chance that you could be eligible. Many times the limits are dependent on household size so you may qualify even if your income appears to exceed the limits. The upside is huge and there’s no downside to applying, so don’t miss out any potential for savings with these programs. Mistake #7: Not Considering Late Enrollment PenaltiesIt’s very important to consider the impact of late enrollment penalties, especially when you’re first entering Medicare. You can potentially be subject to enrollment penalties for both Part B and Part D. These penalties are assessed in the form of an additional monthly premium. Importantly, these penalties are generally permanent; once you’re subject to them, you’ll pay them for the rest of your life.If you’re already in Medicare, and you have avoided late enrollment penalties so far, just make sure that you continue to have Part D drug coverage, either from a Medicare Advantage Plan or a standalone Prescription Drug Plan.Mistake #8: Not Reviewing Changes In Your CircumstancesIt's important to review any changes in your circumstances on an annual basis. If you’ve been referred to a new specialist, prescribed a new medication, or diagnosed with a new medical condition, you might be better served by a different plan for the new year. So be sure to consider the impact these kinds of circumstances may have on your Medicare coverage.  Mistake #9: Automatically Renewing Your Plan Each YearEach year, your plan will mail your Annual Notice of Change (ANOC) before the fall Annual Enrollment Period (AEP). The ANOC outlines changes in your plan benefits or costs for the upcoming year. Use this document, along with your plan’s overall Evidence of Coverage (EOC) to know how to use your benefits for this year.If you don’t make a change during AEP, you’ll automatically stay in your current plan. But plan benefits change from year to year, as do Medicare Advantage plan networks. So it's essential to review your coverage each year. Mistake #10: Not Working With A Licensed Insurance AgentAs you research the plans available in your area, consider working with a licensed insurance agent like one of our TogetherHealth agents. We work with a network of the nation’s major insurance carriers and can provide you with a variety of plan options to fit your healthcare needs, remain in-network with your doctors, and give you strategies to save money on prescription drugs.  Get Help With MedicareIf you need more guidance, call 1-800-620-4519 (TTY 711) to speak to one of our licensed agents and get advice on how to avoid these 10 costly Medicare mistakes.

How Healthcare Has Changed Over the Past Quarter Century

With the 2020s underway, let’s take a look back at seven key milestones and issues that marked the evolution of healthcare over the past 25 years. 1. The Affordable Care Act became law Just months into 2010, President Obama signed the Patient Protection and Affordable Care Act (PPACA) into law. The Affordable Care Act, often referred to as the ACA or Obamacare, changed the nation’s health insurance landscape and  brought about numerous provisions to help make health insurance more affordable and accessible to as many Americans as possible. Some key provisions include: The creation of a health insurance marketplace in every state to provide consumers with a place to purchase health insurance.Income-based subsidies, including premium tax credits and cost-sharing reductions, for those who purchase individual coverage through the health insurance marketplace (i.e., the state-based and federal exchanges).A requirement that insurance plans cover young adults on their parents’ policies to age 26.Guaranteed issue and renewal of policies.Medicaid expansion to those with incomes below 138% of the federal poverty level, in participating states. Ten years later, uninsured rates have declined. In 2010, nearly 16% of Americans were uninsured. But in 2016, the uninsured rate hovered just above 8% - its lowest point in the decade. Although, it started to increase again slightly in 2017.2. Short-term health insurance kept its strideShort-term health insurance is temporary insurance that provides coverage in certain medical situations like an unexpected accident or illness. However, it doesn't include the same essential health benefits that ACA plans do, making it a more affordable insurance option for many.Short-term health plans remained a relevant health insurance option throughout the decade with sales increasing sharply after the ACA took full effect in 2014. These plans became an attractive option for people who were exempt from the individual mandate or opted to pay a penalty for not having an ACA-compliant health plan.Obama limits short-term policiesConcerned that short-term health insurance was impacting ACA enrollment, the Obama administration created regulations that limited their availability. In 2016, short-term policies were capped at three months.Trump expands short-term policiesIn 2018, the Trump administration lifted Obama-era limits. Policies can now last up to 12 months and can be renewed for up to 36 months, depending on state laws. Arizona, for example, has adopted the Trump administration’s regulation. Some states, such as Oregon, still limit short-term plans to less than 90 days.3. High-deductible health plans grew in popularityHigh-deductible health plans, called HDHPs, were introduced in the early 2000s and  were considered "mainstream plans" by 2012. People obtained these plans usually through their employer group-based coverage (if offered), the healthcare exchange, or from private insurers. Here are some interesting facts:HDHP enrollment jumped from 10 million people to 11.4 million people in one year (from January 2010 to January 2011).By 2015, HDHPs accounted for 60% to 80% of plans offered in the individual health insurance marketplace. In 2019, the IRS classified high-deductible health plans as any plan with a deductible of at least $1,350 for an individual and $2,700 for a family. The average annual deductible for individual coverage through a group plan was $1,655 in 2019.But while consumers can appreciate the lower monthly premium of a high-deductible insurance plan, they also tend to delay or skip medical care because of the high out-of-pocket costs associated with HDHPs.The popularity of HDHP may be slowing - at least in the group market. The percentage of employers offering a high-deductible health plan as the only option is projected to decrease in 2020, with more employers beginning to offer additional coverage options.4. Healthcare spending continues to climbIf it seems like your healthcare costs increased throughout the past decade, it probably did. In 2018, the average American household spent $5,000 on healthcare, with nearly 70% of the $5,000 going towards health insurance.The more staggering fact: medical bills are reported to be the number one cause of bankruptcies nationwide. And today, medical costs are considered America’s "real healthcare crisis". And while politicians continue to debate issues including health insurance reform and prescription drug pricing, they have not agreed upon a clear solution.Until things change, consumers must continue to find ways to save on their own, from finding flexible and affordable health insurance options and taking advantage of preventive care, to comparing provider rates before seeking services and getting alternative healthcare through options like telemedicine.5. An opioid epidemic devastates our nationThe opioid epidemic might be the most daunting and complex public health crisis of our time. Heroin-related overdoses increased 286% from 2002 to 2013, with a significant spike around 2010. Another wave of opioid-related deaths hit around 2013 and this time, synthetic opioids like fentanyl were behind the surge. The crisis continued to escalate from there, with prescription drugs playing a significant role. Here are some of the most shocking reports:Opioid overdoses accounted for more than 42,000 deaths and increased to 47,600 people in 2017. By 2019, more than 90 Americans per day were dying from opioid overdose. And prescription opioid abuse was costing the nation $78.5 billion per year.The epidemic impacted people in both rural and urban environments. But overdose deaths in rural communities surpass deaths in urban settings. So what’s being done about it? In early 2019, the Trump administration launched a $353 million initiative to cut opioid overdoses by 40% over the next three years. The federal government is also working to hold drug companies accountable. For example, top executives at Insys Therapeutics were found guilty of racketeering conspiracy—a charge typically assigned to drug dealers and mob bosses. In 2018, the CDC reported that drug overdose deaths decreased for the first time since 1990.6. Covid-19 pandemic and the U.S. healthcare systemThe 2020 pandemic was not only the biggest health event in the U.S. in the past decade, but a major burden on an already fragile healthcare system. From shortages of hospital beds and staff to healthcare facilities having to ration medical supplies to keep up with COVID-19 cases, we’ve seen how our healthcare infrastructure is in need of improvements to better prepare for crises. Not only that, researchers at the Massachusetts Institute of Technology assert that the pandemic revealed some deeper issues in our healthcare system, such as disproportionate access to care among marginalized groups and the country’s dependence on healthcare services from underpaid workers.7. Medicare enrollment: Medicare Advantage Plans and Original Medicare Medicare Advantage plans, which are an alternative to Original Medicare, have seen a steady increase in enrollment each year over the past decade. As of 2022, there are 28.4 million Medicare Advantage enrollees which account for 48% of the Medicare-eligible population. People enrolled in MA plans back in 2012 represented about a quarter of all beneficiaries, so enrollment rates have just about doubled.Another interesting fact as reported by Kaiser Family Foundation is that “the average Medicare beneficiary in 2022 has access to 39 Medicare Advantage plans, the largest number of options available in more than a decade.”Here’s a breakdown of MA plan enrollment:About two-thirds (18.7M) of the Medicare population are enrolled in a plan available through individual enrollment.Roughly 5.1 million beneficiaries have coverage through an employer or union group plan available to retirees.More than 4.6 million people are enrolled in Special Needs Plans, the majority of which (89%) are those eligible for both Medicare and Medicaid. The healthcare debate continuesDiscussions about healthcare reform and our healthcare landscape did not stop when the ACA was passed. Conversations about legal challenges continue to this day. There has been proposed legislation to repeal and replace the ACA under the Trump administration. Trump administration removes individual mandateNew tax legislation  passed in December 2017, which changed one key aspect of the ACA. Previously, you could be penalized for not having health insurance, but Congress and President Trump eliminated the mandate rule for all coverage beginning Jan. 1, 2019. Individual mandate challenged as unconstitutionalThe 5th Circuit also ruled in Texas vs. United States that the individual mandate is unconstitutional, at which time, a A Texas Judge was deciding what, if any, of the ACA still stands. But in 2021, the Supreme Court ruled that states don’t have any grounds to challenge the constitutionality of the ACA mandate.The 2020 electionWith the Presidential election in 2020, Democrats were focused on building upon the ACA with tactics like a “Medicare for all” national health insurance system. However, this agenda never took effect with the Democratic party winning the election. Now twelve years after the passing of the ACA, the Biden-Harris administration has promised to continue upholding the ACA and making affordable health insurance accessible. With ongoing talks of a universal health insurance option for Americans and how to navigate health-related issues post pandemic, there’s no doubt that healthcare legislation will continue to make headlines over the next decade. From Obamacare to the opioid epidemic to the Covid-19 pandemic, healthcare-related issues have made major headlines. And it’s inevitable that they’ll only continue to evolve and impact our lives for years to come. We’ll continue to follow the trends and changes as well as their impacts on our nation. 

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