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Best Medicare Advantage Plans in Virginia for 2020

These days, a Virginia Medicare beneficiary has lots of options. In fact, most beneficiaries do enhance their Medicare Part A and Part B benefits by finding additional insurance. Some of the best Medicare Advantage plans in Virginia for 2020 may make it easier for you to manage a variety of coinsurance, copayments, or deductibles that you’d have to pay if you only had Original Medicare.

In addition, you could find that a Virginia Medicare Advantage plan will offer you some additional benefits that you could not get if you were only enrolled in Medicare Part A and Medicare Part B. For example, many companies with top star ratings — such as Blue Cross Blue Shield and Humana — offer Medicare plans that have Medicare Part D prescription drug coverage. Having an included Medicare prescription drug plan is just one of many reasons to talk to an insurance agent about Medicare Advantage plans.

Best Time to Enroll in Medicare Advantage Plans in Virginia for 2020

First, you only have to have enrolled in Medicare Part A and Part B to join a Medicare Advantage plan in Virginia. Sometimes, you may also see these kinds of plans referred to as Medicare Part C in Virginia. The only health question that can disqualify you from a Medicare Part C plan that pertains to End-Stage Renal Disease ESRD. If a Medicare beneficiary does suffer from ESRD, they must join a special plan.

Beyond the basics, you should keep track of certain times when you’re allowed to enroll in Medicare Advantage plans in Virginia. These are the primary enrollment times:

  • Initial Coverage Election Period: Around the time that you first qualify for Medicare Part A and Part B, you get a chance to enroll in a Medicare Advantage plan.
  • Annual Election Period: In the fall, Medicare beneficiaries can switch their plan for coverage that will begin on January 1 of the next year.
  • Special Election Periods: Certain events, like losing prior coverage because your insurance company doesn’t decide on a contract renewal with Medicare, may trigger Special Election Periods that Last for about two months.
  • Medicare Advantage Disenrollment Period: You get a few weeks at the beginning of the year to terminate your Medicare Advantage plan, continue on with Medicare Part A and Part B, and select a Part D plan if you need drug benefits.

Once you have enrolled in a new Virginia Medicare Advantage plan, the insurance company should send you a new ID card. You can usually use this card instead of the ID card you got for enrolling in Original Medicare.

Popular Types of Medicare Advantage Plans in Virginia for 2020

You probably know that Original Medicare works the same way no matter where you live. However, some Medicare Part C plans in Virginia may work very differently from others. Before you compare various plans to find the best option, you should understand common kinds of Medicare Advantage plans in Virginia:

Health Maintenance Organization HMO plans: A beneficiary could expect a very cheap or even $0 premium rates from an HMO, but in turn, the plan will have strict rules about using in-network providers. About 41 percent of all Virginians who joined an MA plan went with an MA HMO.

  • Preferred Provider Organization PPO plans in Virginia:

In exchange for somewhat higher costs, a PPO may offer you more flexibility, so you can use it more. About 41 percent of Virginians with a Medicare Advantage plan enrolled in a PPO.

  • Special Needs Plans SNPs in Virginia:

A Medicare beneficiary who has to manage institutional conditions or chronic health conditions can enroll in Special Needs Plans.

  • Dual-Eligible in Virginia:

Some Medicare beneficiaries get Original Medicare and Medicaid, and a dual-eligible plan is designed for this.

  • End-Stage Renal Disease ESRD plans in Virginia:

These Special Needs Plans help people who have ESRD.

  • Private Fee-for-Service PFFS plans in Virginia:

With most Medicare Advantage plans in Virginia, Medicare requires insurance companies to pay for certain things in the Medicare contract. This is not the case with cost-sharing PFFS plans. Because of this, you may have higher out of pocket costs with one of these plans. However, you don’t have to worry about choosing health care providers in a certain provider network.

  • Medicare Savings Account MSA Plan in Virginia:

These health plans include both a high-deductible health insurance plan and a savings account that you can use to help with health care costs until you meet your deductible.

Enrollment Statistics for Medicare Advantage Plans in Virginia

These are helpful enrollment numbers for Virginia Medicare Advantage plans:

  • Most popular Virginia MA plans: HMOs and PPOs
  • Percent of Virginia Medicare beneficiaries with MA: 17 percent
  • Total Medicare Advantage plan enrollment in Virginia: 241,530

These are the largest Virginia counties by population:

  • Fairfax County, Virginia: 1,148,433
  • Prince William County, Virginia: 463,023
  • Loudoun County, Virginia: 398,080
  • Chesterfield County, Virginia: 343,599
  • Henrico County, Virginia: 327,898

Here are a few changes for 2020:

  • Starting in 2020, insurance companies that provide Medicare Advantage plans in Virginia will be able to add some supplemental non-health related benefits to certain beneficiaries, such as providing help with making structural changes to the home when needed. This is designed to help those who might need help with widening doorways or installing ramps for their homes.
  • The Centers for Medicare and Medicaid Services approved a 2.53% payment increase to Medicare insurers that offer Medicare Advantage plans in Virginia.

How the Best Virginia Medicare Advantage Plans Cover Prescriptions for 2020

Most of the best Medicare Advantage Plans in Virginia also contain Medicare Advantage Prescription Drug plans. Since Medicare Part A and Part B only help pay for prescriptions in special circumstances, this additional benefit may offer you a good value. For instance, you may get both medical and prescription coverage for low or $0 premium rates that could be less expensive than the premiums charged for some stand-alone Part D plans.

If you decide to choose a Medicare Advantage plan in Virginia that does include prescriptions, these are a couple of things to compare in order to make the best choice:

  • RX formulary: You should be able to find a list of covered drugs to review.
  • Prescription Drug tiers: Also note that different classes of prescription medication might be covered at different levels.
  • Network pharmacies: Make sure the network pharmacies are convenient for you.

Network Restrictions for Virginia Medicare Advantage Plans for 2020

If you’re happy with the network, you’ll probably be satisfied with your choice of Medicare Advantage plan. It’s important to see if you can find your favorite doctor or hospital on the list of in-network providers that your Medicare Advantage plan in Virginia publishes each year. Also, expect these networks to change somewhat from year to year. Since Original Medicare doesn’t use a plan network, you may not be used to adhering to these rules if you have only had Medicare Part A and Part B before.

These are very important things to understand about the way these networks work:

  • PPO: With a PPO, you’ll pay more for out-of-network services, but you can still get services covered if you go to an out-of-network hospital or doctor. You also don’t need a primary care doctor to give you referrals to specialists.
  • HMO: You almost always have to seek services from in-network healthcare providers to get them covered. You also need a PCP to give you referrals.

Some regional or national PPOs may have network providers you can visit when you travel. If you permanently move away from your plan’s service area, you will trigger a new Special Election Period that you can use to change to a plan in your new city or town.

Top-Rated Companies Offering Medicare Advantage Plans in Virginia for 2020

Several private companies offer Medicare Advantage plans in the state. To help you start your comparison, you might want to consider this quick summary of some notable insurers that will offer Medicare Part C plans in Virginia for 2020:

  • Kaiser: Kaiser has offered cost plans with high star ratings in Virginia. Cost plans are not that common, but they tend to be more popular in rural areas. They can work like an HMO within the network, and then they work like Original Medicare outside of the network. Kaiser has a nine percent market share.
  • Humana: Humana has 55 percent of the market share for Medicare Advantage plans in Virginia.

Do Medicare’s star ratings indicate the Best Medicare Advantage Plans in Virginia? Medicare accumulates several different kinds of information for each plan within each county. They use this data to create star ratings. The best Medicare Part C plan rating is a 5-star rating. These star ratings give you a quick way to judge the past performance of a plan that you might consider joining.

Virginia Medicare Resources

If you’re 65, it’s time to sign up for Medicare coverage. If you need extra help signing up, if you’d like to see a complete description of benefits that you can enjoy as a Medicare beneficiary or if you are curious about the Medicare Part B premium, these resources can help you out:

When it’s time to look for additional coverage options, you can give us a call. We can help you find the best Medicare Advantage plan in Virginia or a Medicare Supplement plan that will help pay for doctor’s visits, hospital stays, skilled temporary care in a nursing home and more. We’ll also help you look for a plan that has a monthly premium that fits your budget, so don’t hesitate to give us a call for a little help!