Virginia Medicare Advantage plan enrollment by the numbers

There were more than 241,000 people in the state of Virginia with a Medicare Advantage plan in 2017.¹

There are several major types of Medicare Advantage plans. In the state of Virginia, there are 78 different Medicare Advantage plans available as of 2018.² Not every plan is available in each county, so it's important to find out which ones are offered where you live.

Nearly half of Virginia’s Medicare Advantage beneficiaries were enrolled in an HMO plan in 2017, while local PPO plans accounted for an additional 28 percent of Virginia Medicare Advantage plan enrollees. The major types of Medicare Advantage plans include:

HMO

A Health Maintenance Organization usually requires patients to use health care providers and pharmacies that are part of the plan’s network (except in the case of emergencies) while also typically requiring a referral from a primary care doctor in order to see a specialist.

PPO

Medicare Advantage beneficiaries in a Preferred Provider Organization are able to see providers outside of their plan’s network, often at a higher cost. Beneficiaries in this type of plan typically pay less out of pocket if they choose to receive medical services from providers within their plan’s network. PPO plans typically do not require patients to acquire a referral before visiting with a specialist.

PFFS

A Private Fee-For-Service plan determines how much it will pay to health care providers and how much the patient will pay when care is received. With a PFFS plan, you can typically receive care from any doctor, hospital or health care provider that accepts your plan’s terms. Not all providers will accept these terms, however.

SNP

A Special Needs Plan is a type of Medicare Advantage plan limited to people with certain chronic conditions and  other specific characteristics. Typically, you must receive care from health care providers and hospitals within your SNP network, except for in cases when you need emergency or urgent care and when someone who has End-Stage Renal Disease (ESRD) needs out-of-area kidney dialysis.

Medicare Cost Plans, Medical Savings Accounts (MSA) and HMO Point-of-Service (HMO POS) plans are 3 additional types of Medicare Advantage plans that are less popular in most states. Enrollment in these plans accounted for around 10 percent of Medicare Advantage plan enrollment in the state of Virginia in 2017.

Total number of Medicare Advantage enrollees in Virginia: 241,530 as of 2017¹

VA Medicare Advantage enrollees by plan type:

Data reflects Medicare Advantage enrollment in the state of Virginia as of 2017, as obtained from the Kaiser Family Foundation Medicare Advantage 2017 Spotlight: Enrollment Market Update¹

Virginia Insurance Counseling and Assistance Program (VICAP)

The Virginia Insurance Counseling and Assistance Program provides free, unbiased and confidential information to the state’s Medicare beneficiaries about their Medicare coverage, costs and rights. The certified counselors are also available to answer questions about Medicare Advantage, Medicare Supplement Insurance and other related programs. The program may be reached at 800-552-3402.     

You can also explore more information about the insurance industry in Virginia by visiting the state’s Bureau of Insurance website.

¹Kaiser Family Foundation. Medicare Advantage 2017 Spotlight: Enrollment Market Update. Retrieved from https://www.kff.org/report-section/medicare-advantage-2017-spotlight-enrollment-market-update-appendices.

²Kaiser Family Foundation. State Health Facts: Medicare Advantage Plans. Retrieved from https://www.kff.org/medicare/state-indicator/plans/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D.