Medicare Costs & Coverage in Virginia


Medicare costs in Virginia will vary according to your income status, the level of coverage you receive and other factors detailed below. Medicare premiums, Medicare co-pays, deductibles and fees are some of the ways participants pay out-of-pocket for Medicare coverage. Paying for Medicare in VA provides participants with many of the same services, procedures and medications offered by other health insurance plans, but generally at a lower cost. Keep reading the sections below to learn more about Medicare costs, Medicare coverage and how to obtain help with Medicare costs if needed. For quick access to in-depth Medicare coverage information, click here to download our comprehensive guide.

Levels of Medicare Coverage in Virginia

Many residents may wonder, “What does Medicare cover in Virginia?” when exploring affordable health programs. Medicare offers different levels of coverage to meet specific health care needs. Medicare insurance coverage is divided into Parts:

  • Part A Hospital Insurance: Provides Medicare coverage for inpatient hospital stays and other related services.
  • Part B Medical Insurance: Covers preventative and outpatient health care services, including doctor’s visits and home care nurses.
  • Part C Medicare Advantage Plans: Provide Medicare A and B coverage, but through private insurance companies that agree to meet all Medicare standards and rules.
  • Part D Prescription Drug Plan: Provides coverage for prescription medications.

Potential enrollees should get detailed information about Medicare Part A and other coverage options to see what plans are best for their medical needs, along with any information about enrolling procedures they may need to complete.

Services Covered by Medicare in Virginia

Medicare covered services vary based on the coverage plan and the Medicare eligibility requirements you meet. To know what Medicare covers in your specific plan, you should refer to your Medicare plan’s handbook or website. These guides to Medicare coverage help you stay informed of current cost and coverage policies, which can change annually. Medicare insurance coverage provides participants access to a wide variety of health care services, procedures, medications and supplies. Medicare Part A coverage includes inpatient hospital stays and care provided in rehabilitation centers and other skilled nursing facilities. Medicare Part B coverage includes ambulance services, emergency care, routine doctor’s visits and a variety of wellness programs. Medicare covered services in Virginia also include mental health screenings and counseling, substance abuse testing and counseling and end-of-life or hospice care. Plans also offer advance care planning services, so that your relatives know how to meet your wishes if you are unable to communicate for yourself.

Explaining Medicare Premiums, Deductibles, Copayments, Co-Insurance and Fees

Medicare premiums explained in the simplest way is that they are a monthly fee required to participate in the program. Each Part of Medicare insurance coverage has its own premiums, but some Medicare recipients will be eligible for premium-free Medicare due to income or other factors. Medicare costs in Virginia also include deductibles, or the amount you must pay out-of-pocket before Medicare’s financial responsibility begins. Medicare co-pays, or copayments, refer to a dollar amount that you must pay yourself at the time of service to receive treatment, equipment or prescriptions through the program. Another type of Medicare cost is co-insurance, which applies when Medicare only pays for a certain percentage of a service or equipment cost. When paying for Medicare co-insurance, you must use your own money or another, Medicare-compatible insurance plan to pay any percentage of treatment costs that Medicare does not cover. Virginia Medicare costs can also include late enrollment fees for not enrolling in Part A, Part B, Part C or Part D during the initial enrollment period or during a special enrollment period. Getting more information about the costs of Medicare is important step for any potential applicants, as understanding fees can help them make the wisest health decisions for themselves and eligible household members.

Expected Costs of Medicare Services

Medicare premiums, Medicare coverage, deductibles and copayments change annually and vary according to your income and the amount of taxes you paid for Medicare during the required period while working. You may not need to pay a Medicare premium for Part A coverage if you paid Medicare taxes for a set number of years. You may also receive a discount on Medicare costs for Part B coverage if you currently receive benefits from the Social Security Administration. Medicare offers a number of Medicare Savings Programs to assist low-income individuals who need help paying for their Medicare costs. If you need help with Part D Medicare coverage in Virginia for prescription drug costs, you may apply for the Extra Help program when completing the application process, depending on your eligibility.

Costs are lower for Medicare covered services that come from providers and suppliers who accept Medicare assignment. This means that a provider’s Virginia Medicaid coverage fits program-set standards. When providing Medicare covered services, those with Medicare assignment have agreed to accept payment directly from Medicare, at the amounts determined by Medicare, and agree to not bill you more than Medicare’s set deductible and copayments.

Part D Medicare coverage costs for prescription drug plans include a monthly premium that can vary greatly according to income. Participants with an income over predetermined limits must pay an additional amount along with their monthly premiums for Part D coverage. Virginia Medicare costs for Part D are also determined by which pharmacy you use and your drug plan’s formulary, or list of covered medications. Part D Medicare co-pays are determined by whether the medication is a high, medium or low-tier drug, based on costs. You can obtain detailed information about the expected costs of Medicare by downloading our in-depth guide to Virginia Medicare services now.

Virginia Department of Social Services