Medicare Part C in Virginia

Medicare Part C in Virginia is provided through Medicare Advantage Plans. These Medicare Plan C HMOs, PPOs and other types of plans provide another way to get Medicare coverage in VA. Medicare Part C plans provide all the same services that those enrolled in Original Medicare receive, namely, all the services offered from Medicare Part A and Part B. Medicare Part C cost to the participant is usually lower than for those enrolled in Original Medicare, although each Part C plan has its own out-of-pocket costs. One big advantage of Medicare Part C coverage is that Medicare Advantage Plans usually offer more services than Original Medicare, including vision and dental coverage. Most Medicare Part C plans include Medicare Part D prescription drug coverage as well. Continue reading to learn more about Medicare C plans in VA, including how to enroll, expected costs and what to do if you have a Medicare supplemental insurance (Medigap) policy when you decide to join a Medicare Advantage Plan.

How to Enroll in Medicare Part C in Virginia

You are eligible for a VA Medicare Part C plan if you are enrolled in Medicare Part A and Part B. Enrollment in Medicare C follows the same guidelines as enrollment in Original Medicare in that you can only join during certain Medicare-mandated periods of time. Medicare Part C enrollment can happen during your initial enrollment period (IEP) and during Special Enrollment Periods (SEPs). SEPs are additional enrollment periods that Medicare offers to help participants avoid paying late enrollment fees. After you have settled on a Medicare C plan that fits your needs, contact the company and ask for enrollment instructions. Each Medicare Plan C in Virginia will have its own method of enrollment.

Medicare Part C Costs in Virginia

Your Medicare Part C cost in Virginia will be determined by the plan, and each type of Medicare Part C program has its own unique fee structure. Medicare Part C plans are required to provide participants with current, accurate costs and levels of coverage and to update this information whenever it changes. Most Medicare Plan C policies include the payment of a monthly premium in addition to what you pay Medicare for Part B coverage. Some Part C Medicare Advantage Plans in VA require you to meet an annual deductible before they begin paying for services, but many do not have this requirement. Medicare Plan C co-payments and co-insurance percentages can also vary greatly from company to company and are something you should consider when deciding on the right Medicare Advantage Plan for you.

Medicare Part C Services in Virginia

By law, Medicare Part C Advantage Plans must cover all of the same services that Original Medicare recipients get from Part A hospital insurance and Part B medical insurance. This means that VA Medicare C Plan participants will receive every benefit included in Part A and Part B, such as inpatient and outpatient hospital care, routine doctor’s visits, wellness programs, hospice care, physical therapy and more. Medicare Part C coverage usually extends further than Original Medicare, providing subscribers with vision care, dental care and Part D prescription drug coverage. For more detailed information about Medicare Part C plan services in Virginia, download our comprehensive guide today.

Types of Medicare Advantage Plans in Virginia

Medicare Part C plans in Virginia are available in several different types. Each Medicare Plan C program offers unique benefits highlighted below:

  • Health Maintenance Organization (HMO) plans use in-network providers and primary care doctors to coordinate care. Most Medicare Plan C HMOs provide Medicare Plan D prescription drug coverage.
  • Preferred Provider Organization (PPO) plans provide access to a wider range of doctors than HMOs, but you must pay more for using out-of-network doctors or hospitals.
  • Private Fee-for-Service (PFFS) plans open access to any Medicare-approved provider that agrees to treat you. Unlike most VA Medicare Part C plans, many PFFS plans do not provide prescription drug coverage.
  • Special Needs Plans (SNPs) must provide Part D prescription drug coverage, but membership in these Medicare Part C plans is limited to those who live in nursing homes and individuals facing several other specific health care issues.
  • HMO Point-of-Service (HMOPOS) plans are similar to Medicare Part C HMO plans, but allow some flexibility to obtain services out-of-network.
  • Medical Savings Account (MSA) plans connect to your bank account. These Medicare Part C plans deposit funds into the account to pay for your health care services. MSA plans have high deductibles and do not include Medicare drug coverage.

Medigap and Medicare Advantage Plans in Virginia

Medicare Supplemental Insurance (Medigap) policies are a form of insurance coverage that helps pay for the out-of-pocket expenses associated with Medicare. These plans cannot be used with Virginia Medicare Part C plans to help cover the co-payments, premiums or other out-of-pocket costs associated with a Medicare Advantage Plan. Medicare supplemental insurance plans are meant to help people enrolled in Original Medicare (Part A and Part B). If you decide to enroll in a Medicare Plan C Advantage Plan in VA, you must cancel any Medigap plan that was affiliated with your Original Medicare coverage.

Virginia Department of Social Services