Introduction to Medicare Advantage in Virginia (Part C)

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 15% 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

The popularity of any particular Medicare Advantage plan, as you can see in the chart below, is largely determined by cost. The most popular type of plan – an HMO plan – is generally less expensive. However, HMO plans may restrict your access to certain doctors or facilities. More expensive plans with fewer restrictions, such as PPOs, are slightly less popular.

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).

Doctor/Providers List

Drug, Vision and Dental Coverage

Medicare Advantage is different from most other supplements in that it allows for ancillary coverage to be added to your policy. This means that in addition to your Traditional Medicare benefits and any other coverage which protects against Medicare gaps, you have the option to add benefits such as prescription drug coverage (known as MAPD plans), vision, dental, and more. Granted, your monthly rates will go up when you add more coverage. But having all of your medical needs covered by a single insurance policy is worth the money for some retirees.

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?

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