Medicare Advantage plans remain popular among Virginia residents as replacements for Original Medicare coverage. Participation rates vary between Virginia’s major cities, but Richmond alone boasts 85,037 beneficiaries.

If you’re considering replacing an Original Medicare plan, knowing the difference between Virginia Medicare Advantage plans is beneficial.

How Medicare Advantage Plans Work in Virginia

Virginia Medicare Advantage plans offer residents an alternative to Original Medicare coverage. These plans completely replace a federal government insurance plan and can provide unique benefits and coverage options.

Virginia residents have access to many Medicare Advantage plans, with anywhere from 18 to 39 plans offered in each county. Availability of Medicare Advantage plans and individual plan benefits will vary based on location and carrier, so thoroughly explore each plan before enrolling.

Medicare Advantage Plan Offers in Virginia

Since private carriers offer Virginia Medicare Advantage plans, these plans are not standardized by the federal government. Different plans and benefits will be available in each Virginia ZIP code.

Below, we discuss Virginia Medicare Advantage plans that boast zero-dollar premiums or drug deductibles, 5-star ratings, or a Part B reduction. Use this information to carefully consider your options when deciding which plan to enroll in.

Medicare Advantage Plans With a Zero-dollar Premium in Virginia

While a plan with a zero-dollar premium works for many beneficiaries, it’s important to know that this type of plan typically comes with higher out-of-pocket benefit costs. Consider these costs before deciding which plan to enroll in.

The Humana Medicare Advantage Local PPO plan offers a zero-dollar premium and a 4-star rating in the chart below. This plan also carries a high out-of-pocket maximum of $7,550, which is the amount beneficiaries are responsible for paying during a coverage period.

For a 4-star Virginia Medicare Advantage plan with a zero-dollar premium and a lower out-of-pocket maximum, beneficiaries can choose a plan like Aetna. This HMO-POS plan offers more flexibility than an HMO Medicare Advantage plan and an out-of-pocket maximum of $5,900.

In the chart below, Optima stands out as a 4-star Medicare Advantage plan with a low out-of-pocket maximum of $3,400. However, beneficiaries should note that the Optima plan is an HMO Medicare Advantage plan. HMO plans have tighter provider network restrictions than PPO or HMO-POS plans.

PLAN PREMIUM MOOP PLAN TYPE STAR RATINGS
Humana $0 $7,550 LOCAL PPO 4
Optima $0 $3,400 HMO 4
Anthem BCBS $0 $6,700 LOCAL PPO 4
Aetna $0 $5,900 HMOPOS 4
UnitedHealthcare $0 $6,700 LOCAL PPO 3

Medicare Advantage Plans With a Zero-dollar Drug Deductible in Virginia

Virginia residents seeking a PPO Medicare advantage option with a zero-dollar drug deductible can choose a plan like Humana’s. This PPO plan offers an out-of-pocket maximum of $7,500 and has a 4-star rating from beneficiaries.

The Aetna Medicare Advantage plan on the chart below also boasts a 4-star rating and a zero-dollar drug deductible. This plan offers a somewhat lower out-of-pocket maximum of $5,900 and a moderate amount of provider flexibility as an HMO-POS plan.

With a mid-range out-of-pocket maximum and the flexibility of a local PPO, United Healthcare offers considerable benefits despite a lower rating. The plan carries a zero-dollar drug deductible and out-of-pocket costs capped at $6,700.

PLAN PREMIUM MOOP PLAN TYPE STAR RATINGS
Humana $0 $7,550 LOCAL PPO 4
Aetna $0 $5,900 HMOPOS 4
UnitedHealthcare $0 $6,700 LOCAL PPO 3

Medicare Advantage Plans With a 5-Star Rating in Virginia

While the availability of 5-star Virginia Medicare Advantage plans may be limited in some areas, residents in areas offering 5-star plans may be eligible for a Special Enrollment Period.

One 5-star Medicare Advantage plan in Virginia is one offered through Kaiser Permanente. With an out-of-pocket maximum of $6,900 and a zero-dollar premium, this plan has a lot to offer those in select coverage areas.

PLAN PREMIUM MOOP PLAN TYPE STAR RATINGS
Kaiser Permanente $0 $6,900 HMO 5

Medicare Advantage Plans With a Part B Reduction in Virginia

Since the availability of Medicare Advantage plans varies by zip code, not all areas offer plans with Part B give-back programs.

In one Virginia location, a United Healthcare plan offers a Part B Reduction of $60. Though this plan also boasts an out-of-pocket maximum of $6,700 and a zero-dollar premium, it has a lower rating of 3.

In contrast, the Humana Medicare Advantage plan offered in the same area provides a Part B Reduction of $50. Though the plan has a high out-of-pocket maximum of $7,500, it has a solid 4-star rating from beneficiaries.

PLAN PREMIUM MOOP PART B REDUCTION STAR RATINGS
UnitedHealthcare $0 $6,700 $60.00 3
Humana $0 $7,550 $50.00 4

Ancillary/DVH

A primary benefit of choosing Medicare Advantage plans is that these programs offer supplemental benefits and coverage that Original Medicare and Medigap do not. While availability varies by zip code, beneficiaries may find plans that include coverage for:

  • Dental
  • Vision
  • Hearing
  • Prescription drugs

FAQs

Which Medicare plan is best in Virginia?

With dozens of Virginia Medicare plans available in different locations, the best plan for you may be different from the best plan for someone else. Choose a provider in your area with a premium, deductible, and out-of-pocket maximum that suits your needs.

What is the highest-rated Medicare Advantage plan in Virginia?

Since plan availability changes by ZIP code, the highest-rated plan in your area may be different. In Virginia, Kaiser Permanente has the best reputation overall as a Medicare Advantage plan provider.

Why is Medicare Advantage being pushed so hard in Virginia?

A higher number of enrollees translates to more program funding for Virginia Medicare Advantage plans. For this reason, Medicare Advantage plans advertising is more common than for their government-funded counterparts.

Is Medicare Advantage more expensive than Medicare in Virginia?

Many factors impact the overall cost of both Virginia Medicare Advantage plans and Original Medicare. Medicare Advantage plans often have limits to the amount you will have to pay out-of-pocket during a coverage period. While Original Medicare has standardized out-of-pocket costs, these plans also have no out-of-pocket maximum. This means you could pay more for your health care needs.

Does Medicare have a maximum out-of-pocket in Virginia?

Medicare has no yearly limit for out-of-pocket costs in Virginia without supplemental coverage.

How To Get Help Enrolling in a Virginia Medicare Advantage Plan

Replacing your Original Medicare with a quality Virginia Medicare Advantage plan doesn’t have to be challenging. Medigap works with all Medicare Advantage carriers in Virginia. We offer free services designed to help you choose the right plan for your lifestyle. Give us a call at the number above or complete our convenient online form to get rates today.

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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.