Medicare Part D in Virginia

Medicare Part D in Virginia provides coverage that is different from other prescription drug plans. Medicare Part D plans provide Medicare recipients with access to comprehensive prescription medication coverage. Medicare Plan D is optional coverage, and you are not required to have it to participate in Medicare.

You may not need this plan if you have another health insurance plan that covers your prescriptions. Even if you do not take prescription medications now, enrolling in Medicare Plan D when it is first available is advised because you may avoid late enrollment penalties later. Continue reading to learn VA Medicare Part D cost estimates, options for getting Medicare prescription drug coverage and what medications are covered.

How to Get Medicare Prescription Drug Coverage in Virginia

Virginia Medicare Part D plans are available to everyone who qualifies for Medicare and is provided through private insurers and companies approved to work with Medicare. Each Medicare Part D plan in VA will vary on which medications are offered and how much each one costs. Options for Medicare Part D coverage include the Medicare Prescription Drug Plan (PDP), Medicare Medical Savings Plans and more. Some participants obtain Medicare Plan D coverage through their Part C Medicare Advantage Plan. Download our comprehensive guide to Virginia Medicare benefits to learn more about how to find a good Medicare Part D plan in your local service area.

How to Enroll in Part D Medicare in Virginia

Enrollment into Medicare Part D plans in VA is usually a simple process after choosing a plan that meets your prescription medication needs. Although each Medicare Part D plan will have its own enrollment instructions, most involve a simple online application or provide a printable application to submit by mail. Some may offer Medicare D enrollment by phone or in person if their company has an office near you. When applying for Medicare Part D plans, be sure to have your Medicare ID card nearby so that you may provide any information they need from your card. After completing your Part D Medicare enrollment, notify Medicare by phone that you have added prescription drug coverage to your plan. Note that it is best to plan your Virginia Medicare Part D application during a special enrollment period (SEP) if you did not enroll when you were first eligible for prescription drug coverage. Waiting to enroll in Medicare Part D during an SEP may keep you from paying late enrollment fees.

Costs of Medicare Part D in Virginia

Your Medicare Part D cost for medications will be paid through premiums, deductibles and co-payments or co-pays. Medicare Part D premiums are the amount that you must pay each month for your prescription drug coverage. The cost of Medicare Part D premiums will vary according to your income status, with higher earners paying higher monthly premiums and lower-income individuals paying less.

The Virginia Medicare Part D cost for deductibles varies greatly by plan. Some Medicare Part D plans charge no annual deductible, while others can cost several hundred dollars. The same is true of Medicare Part D copayments. Copays are the amount that you pay for each prescription medication. Copayments vary by plan and also where you are in the Part D coverage cycle described below. If you struggle to pay any of your Medicare Part D costs in VA, contact Medicare and ask if you are eligible for the Extra Help prescription medication assistance program.

How Virginia Medicaid Part D Coverage Varies Through the Year

One thing that makes VA Medicare Part D plans unique is how the level of coverage varies by which phase of the program you are in at any given point of the year. It can also make it difficult to understand your Medicare Part D cost unless you keep track of which phase you are currently in. Medicare Plan D is divided into four coverage phases, or quarters:

  • Phase One—The Annual Deductible: During this phase, you are working toward meeting your Medicare Part D deductible, if your plan has one.
  • Phase Two—Initial Coverage Period: You pay your normal Medicare Part D cost for copayments during this phase.
  • Phase Three—The Coverage Gap: Also referred to as “The Doughnut Hole,” the gap occurs when you hit a limit defined by Medicare. The amount you must pay toward your prescription drug coverage will change during the gap.
  • Phase Four—Catastrophic Coverage: This phase begins if your Medicare Part D costs in Virginia continue to rise after the gap during one calendar year. Co-pays drop markedly during this phase.

For more information about this system, download our complete guide to Virginia Medicare coverage today.

What is a formulary and what drugs must be covered?

All Virginia Medicare Part D plans include a drug formulary, or list of medications covered by the plan. Each Medicare Part D plan chooses which medications appear on their formulary and how much to charge for each drug. Medicare Part D plans are not required to carry every medication, so you must carefully check the formulary to make sure that the drugs you need are covered by that company. Certain drugs, such as those used for weight loss or cosmetic purposes, are not covered by any Part D plan.

Virginia Department of Social Services