Information about Medicare Advantage Plans in Virginia

Quick links:

• Average 2021 Costs
• Eligibility & Enrollment
• Finding Top-Rated Plans
• List of Plans Available
  • Plans by Carrier
  • Plans by County
  • Plans by Type
• Local Resources

There are 69 different Virginia Medicare Advantage Prescription Drug plans (MAPD) plans in 2021.¹

A licensed insurance agent can help you compare the availability, benefits and costs of Medicare Advantage plans in your area of Virginia.

Average costs of Medicare Advantage in Virginia

The average premium for a Medicare Advantage (also called Medicare Part C) plan that includes prescription drug coverage in Virginia in 2021 is $23 per month.

• Average monthly premium cost in 2021 (weighted): $43
• Average in-network out-of-pocket spending limit: $5,463
• Average drug deductible in 2021 (weighted): $177¹

Medicare Advantage out-of-pocket spending limits, deductibles, premiums and other costs may vary depending on where you live.

You can view the average 2021 Virginia Medicare Advantage plan costs by county listed below in this guide.

A licensed insurance agent can help you compare Medicare Advantage plan costs in your area.

Or call 1-800-557-6059 1-800-557-6059 TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!

Medicare Eligibility & Enrollment

You may not sign up for a Medicare Advantage plan in Virginia without first enrolling in Medicare Part A and Part B, otherwise known as Original Medicare.

In order to enroll in Original Medicare, you must meet the following requirements:

• You must be a U.S. citizen or permanent legal resident who has lived in the U.S. for five continuous years.
  
  
• You or your spouse must have worked long enough to be eligible for Social Security or Railroad Retirement benefits.
  
  
• You or your spouse must be government employees or retirees who have not paid into Social Security but have paid Medicare payroll taxes.

You may qualify for Medicare before you turn 65 if:

• You receive Social Security disability benefits or Railroad Retirement Board disability benefits for at least 24 months.
  
  
• You have ALS (amyotrophic lateral sclerosis, or Lou Gehrig's disease).
  
  
• You have End-Stage Renal Disease (ESRD).

If you have ESRD, you may be able to enroll in a Medicare Advantage plan or a Virginia Medicare Special Needs Plan (SNP) that is specifically designed to help meet your health care needs.

How to sign up for a VA Medicare Advantage Plan

The first time you may be able to enroll in a Virginia Medicare Part C plan is during your Medicare Initial Enrollment Period (IEP).

Your Medicare IEP begins three months before your 65th birthday, includes the month of your birthday and extends for three additional months thereafter.

If you do not sign up for a Medicare Advantage plan during your IEP, you may have other opportunities to do so:

Medicare Advantage Open Enrollment Period: January 1 – March 31

The Medicare Advantage Open Enrollment Period lasts from January 1 to March 31 every year. During this period, you may switch Medicare Advantage plans or drop your Medicare Advantage plan and return to Original Medicare.

If you return to Original Medicare during this period, you'll be able to join a Medicare standalone prescription drug plan (Medicare Part D).

Medicare Annual Enrollment Period (AEP): October 15 – December 7

Medicare AEP (also sometimes called the Annual Election Period) lasts from October 15 to December 7 every year. During AEP, you may enroll in a Medicare Advantage plan or switch from one Medicare Advantage plan to another.

You may also drop your existing Medicare Advantage plan and return to Original Medicare.

During AEP, you may also join, switch or drop a Medicare Part D plan. 

Medicare Special Enrollment Periods (SEP)

A licensed insurance agent can help you find out if you qualify for a Medicare Special Enrollment Period (SEP).

Or call 1-800-557-6059 1-800-557-6059 TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!

Top-rated Medicare Advantage Plans in Virginia 2021

The Centers for Medicare & Medicaid Services (CMS) publishes annual Star Ratings that reflect how each Medicare Advantage plan performs across a range of metrics, using a system of one to five stars.²

Plans are rated every year, so the ratings can differ slightly from year to year.

In order for a Medicare Advantage plan to be considered a top-rated plan, it must have four or more stars out of five stars.

There are 44 top-rated 2021 Medicare Advantage Prescription Drug plans in Virginia that are rated four stars or higher. That's over 59 percent of MAPD plans offered in Virginia in 2021.

Medicare Advantage plans are rated in the following five categories:

• Preventive care and health maintenance (screenings, tests, vaccines, etc.)
• Management of chronic conditions
• Member experiences and ratings of the plan
• Member complaints, problems receiving services and member retention
• Customer service

The information for the star ratings is gathered from member surveys, information that is submitted to Medicare and Medicare’s regular monitoring activities.

List of Medicare Advantage Plans Available in Virginia in 2021

To view a list of plans offered where you live in Virginia, use our plan comparison tool.

Or call 1-800-557-6059 1-800-557-6059 TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!

Private insurance companies offer Medicare Advantage plans in Virginia

Several insurance carriers may offer Medicare Advantage plans in Virginia, but the selection of plans available near you may vary.

Private insurance companies offer Medicare Advantage plans that are typically unique to the plan area they serve.

Call to speak with a licensed insurance agent who can help you compare the Medicare Advantage plans that are sold by insurance companies in your area.

The following information may help you as you compare Medicare Advantage plans in 2021:

• The Medicare Star Ratings can give you an idea of a plan’s overall quality.
  
  
• Agencies like A.M. Best, Moody’s and Standard & Poor’s can provide information about an insurance company’s credit rating and financial standing.
  
  
• You can read through Medicare Advantage plan reviews and testimonials from customers.

Virginia Medicare Advantage plans by county

Learn more about Fairfax County Medicare Advantage plans.

The chart below provides more information about MAPD plan costs and enrollment in Virginia by county in 2021.¹

VA Medicare Advantage plans by plan type

The major types of Medicare Advantage plans include:

• HMO
  A Health Maintenance Organization (HMO) typically requires you to designate a primary care physician (PCP). You usually need to get a referral from your PCP before you can visit a specialist.
  
  With most HMO plans, you are required to see doctors and other health care providers that are in your plan network, except for in cases of an emergency.
  
  
• PPO
  Medicare Advantage beneficiaries in a Preferred Provider Organization (PPO) are typically allowed to visit any provider who accepts Medicare, whether or not they are in the plan network.
  
  You will typically pay less out of pocket, however, if you seek medical services from providers within your plan’s network.
  
  PPO plans typically do not require patients to get a referral before visiting with a specialist.
  
  
• PFFS
  A Private Fee-For-Service (PFFS) plan determines how much it will pay to health care providers and how much the beneficiary 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 Medicare as well as your plan terms. Not all providers will accept these terms, however.
  
  
• SNP
  A Special Needs Plan (SNP) is a type of Medicare Advantage plan limited to people with certain chronic conditions and other specific characteristics.
  
  Most SNPs will typically require you to seek services from providers within your SNP network. All Medicare SNPs are required to provider prescription drug coverage.

Not all of these types of plans may be available in your area. A licensed insurance agent can help you compare the types of 2021 Virginia Medicare Advantage plans that are available where you live.

Local health insurance resources in Virginia

• 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.
  
  
• Virginia Prescription Drug Assistance Programs
  The state of Virginia has a number of programs designed to help with the cost of prescription drugs. There are programs for both Medicare beneficiaries and non-Medicare beneficiaries alike that can cover the cost of premiums and cost-sharing or even lower the cost of the drugs themselves.

¹ MedicareAdvantage.com's The Best States for Medicare in 2021 report. (Oct. 27, 2020).

² Medicare evaluates plans based on a 5- star rating system.