If you are 65 years of age and relying upon Medicare Parts A and B alone to cover your medical needs, you might be making an expensive mistake. There are gaps in Traditional Medicare coverage which can get expensive if you don’t have them covered with some sort of supplemental insurance plan. Medicare Advantage is one such plan. It is designed to give you some of the most comprehensive health coverage available, so that you can enjoy your retirement years without the hassle of growing medical expenses.

Federal Regulations for Medicare Advantage

Unlike most Medicare supplements, Medicare Advantage effectively replaces your Traditional Medicare benefits (instead of merely supplementing them). Because of this, the government has passed laws which clearly state that your Medicare Advantage plan must offer the same (or better) coverage than what Medicare offers. It is likely, however, that your Advantage plan will cover much more than Traditional Medicare. We’ll discuss exactly how much more later in this article.

Medicare Advantage Enrollment In Virginia

Medicare Advantage is far from the most popular Medicare supplement insurance in Virginia. Right around 17% of seniors 65+ are enrolled in a Medicare Advantage program. However, there are still a great variety of different plans available, should you choose to go that route. You can see which plans are the most popular below:

Plan Type Enrollment Percentage
HMO Plans 59%
Local PPO Plans 13%
Special Needs Plans 11%
Regional PPO Plans 9%
Private Fee-For-Service Plans 5%
Other (Cost Plans, MSA’s, etc.) 3%

Plan Coverage & Cost

There are dozens of different factors which can influence your monthly premium for a Medicare Advantage policy. Age is certainly a factor, along with gender, health habits, and where you live. Below, you can find price estimates which seniors like you are currently paying in your area:

Most Popular Medicare Advantage Plans in Virginia

Our goal is to help seniors like you shop around for the best Medicare Advantage plan in your area. We try to help make the process easier for you by assigning a 5-star rating system to available plans. The more stars a plan earns, the more confident you can be that you’re getting an affordable Medicare Advantage policy from a financially strong company with a solid customer service record.

Helpful Medicare Advantage Tips & Tricks

Doctor/Provider Network Restrictions

The type of Medicare Advantage plan which you sign up for is determined in part by what sort of provider network your plan is associated with. HMOs, for example, have very restrictive provider networks. This means that you will have a very short list of doctors and facilities where you are permitted to receive medical care. Additionally, seeking care outside of your provider network may come with severe restrictions and financial penalties. PPO plans and PFFS plans are much more inclusive (but, as mentioned earlier, are also more expensive).

  • HMO Plans – Regular health insurance plans with an HMO (Health Management Organization) medical network are usually more affordable, but also more limited in choice. Some may let you choose your primary care doctor, and others may assign it to you. You have to go to that primary physician first when you need care or a wellness visit, and you may only go to other, in-network care providers that they refer you to if they think you need a referral. The only time you can get out of network medical costs covered is in the event of an emergency. If you want to go out-of-network, you’ll have to pay for it yourself.
  • PPO Plans – A PPO plan will give you more choice, but at a greater expense. PPO plans don’t restrict you to one primary care doctor and a small network of economically priced healthcare providers. You can see any doctor you want, anytime, and your insurance will help you cover the costs. Of course, if you stay within your network of preferred providers, you will get a preferably cheaper price. But that choice is up to you.
  • PFFS Plans – Some people find that medical network restrictions are just too much of a hassle. Those people tend to prefer a Private Fee-For-Service plan. These plans let you see any doctor, outpatient facility, or hospital that you want. All you have to do is wait for your insurance company and that care provider to agree on payment terms. If they agree, then you’re all set. If they don’t, then you’ll either have to pay out-of-pocket or get care from somewhere that will agree to your insurance company’s payment terms. And these agreements may change on an appointment by appointment basis, so visiting the same doctors in facilities reliably may prove difficult.
  • Special Needs Plans – If you have a chronic illness and limited means to pay your healthcare costs, you may qualify for a Special Needs Plan. You can’t just choose to purchase a special needs plan; you have to qualify for one based on need. These plans work very similarly to HMO plans. Your health care needs are managed through your primary care doctor, they will refer you to other doctors and facilities within a limited network of providers, and you can only get out of network care in the event of a medical emergency (and still get reimbursed by your insurance company).

Doctor/Providers List

  • HMO Plans – Did you know that an HMO Medicare Advantage plan combines the affordability of Medicare with the convenience of having your needs managed through a primary care doctor? Things can get expensive if you go out of network or if you don’t coordinate with your primary physician, so be careful of that. But if you follow their rules, you can purchase a Medicare Advantage insurance policy that will meet your healthcare needs at a reasonable rate.
  • PPO Plans – Do you want a wider variety of doctors, facilities, and hospitals to choose from? Have Preferred Provider Organization plans been too expensive for you in the past? This may not be the case with a Medicare Advantage PPO plan. The Medicare program will subsidize your monthly premiums and many medical networks will give you a wider selection thanks to medicare’s involvement. Many seniors are pleasantly surprised to discover that the fact that it’s a Medicare Advantage PPO plan puts it within their reach, affordability-wise.
  • PFFS Plans – Have you had trouble in the past keeping up with payment terms and agreements between your chosen care providers and your health insurance company? You might not have as much trouble once you purchase a Medicare Advantage PFFS plan. Many seniors have experienced an easier time getting everyone to agree on payment terms once Medicare gets involved. This can take a lot of the stress and hassle out of getting your health care needs met with a PFFS provider.
  • Special Needs Plans – It’s great that a Medicare Advantage SNP health insurance plan can help seniors with very specific and prohibitively expensive medical needs get high quality care more frequently. But in order to keep your costs as affordable as possible, make sure you coordinate your healthcare closely with your primary care physician and that you do what you can to stay in network.

Did you know that you can use the Physician Search Tool on the Medicare.gov website to check and see whether your doctor will be available on your new Medicare Advantage plan? It’s good to do this research in advance to make sure you choose the right plan. Even though it’s Medicare, it might still be difficult to keep your doctor if you don’t choose wisely.

Drug, Vision and Dental Coverage

Are you worried about your eyesight and your eye health? Then Medicare Advantage has some good news for you: most Medicare Advantage plans give you the option of adding vision coverage to your health insurance policy. But it’s not available in all areas. And even when it is, it’s not always the most economical option. But it gives you the convenience of managing your vision care on the same policy with all your other healthcare needs, which might be worth it in the unlikely event that it is more expensive than private vision insurance.

The same thing goes for dental insurance. If you want the convenience of managing your oral healthcare needs on the same policy as your medical insurance, and if it is available in your area with Medicare Advantage, then you can purchase the additional coverage. It may raise your monthly premium slightly, but that increase in monthly premiums has the potential to be less expensive than purchasing a separate private dental insurance policy. It also conveniently lumps all of your healthcare coverage under one single policy.

Enrollment Options & Best Time To Enroll

If you can enroll in a Medicare Advantage plan during your first 6 months of turning 65 and enrolling in Traditional Medicare, you should. This enrollment period is known as your IEP (Initial Enrollment Period) and you will be met with the fewest number of possible restrictions by enrolling within this timeframe. You may also enroll later without being denied coverage if you qualify for a Special Enrollment Period, or if you are in good health. Seniors with serious pre-existing conditions, such as End Stage Renal Disease, might want to sit down with their insurance agent and discuss options before applying. It can be difficult to get covered by a Medicare Advantage policy outside of your IEP if you have a serious health condition. For more information, consult your state’s department of insurance, or take a look at our Medicare Advantage Enrollment Options page.

  • Initial Enrollment Period: 6-month timeframe when you first enroll in Medicare to purchase a Medicare Advantage plan.
  • Annual Enrollment Period (AEP): This timeframe runs from October 15th through December 7th every year, and during this time you can change or cancel your Medicare Advantage and part D drug plan.
  • Special Enrollment Period (SEP): During special circumstances, you may be eligible to purchase/change a plan outside of the Annual Enrollment Period. Things such as moving out of the plans’ service area, losing group health or employer coverage, a company no longer offering plans in the area, etc. are all events that could trigger a SEP.

What Medicare Advantage Plan Is Best For Me?

Choosing an appropriate Medicare supplement is no easy feat. You have to make sure you purchase it from a good company, for a good price, get good benefits, and that it will provide you with valuable savings over the long-term. And you only have so much time to make a decision!

Thankfully, you have us on your side. We have so much expertise in the field that we know all about what companies in your area are willing to offer – as well as the price they’re offering it for. We can help you shop around and compare quotes so that you get the right plan at the right price. And it’ll take much less time than you think. We can get you ready to purchase a good supplement all in a matter of minutes – and you better hurry, because your enrollment period is closing fast!

by Lindsay Malzone, Lindsay Malzone is the Medicare expert for Medigap.com. She's been contributing to many well-known publications as an industry expert since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.