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.
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.
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.
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.
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.
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.
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.
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!
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