Medicare Supplement Plans in Viriginia

Learning about Medicare Supplement Plans in Virginia is important if you live in Virginia and are newly enrolled or about to enroll in Original Medicare (Part A and Part B). Original Medicare is a Federal program that typically covers 80% of Medicare benefits for medical and hospital charges.

Hospital charges include the costs of in-patient hospital care, Skilled Nursing Facility Care, Hospice care, and some home health services.

The Medicare recipient is responsible for paying the remaining 20%. These out-of-pocket costs include things like copayments, coinsurance, and deductibles.

Many people choose to purchase Medicare Supplement Plans in Virginia to help offset these charges. It is important to know that with Original (Part A and Part B) Medicare, no cap is placed on how much out-of-pocket expense you could be responsible for.

Unlike Original Medicare, Medicare Supplement plans (Medigap) are sold by private insurance companies. Medigap works hand-in-hand with Original Medicare. Once Medicare pays the 80%, Medigap pays all or some of the remainder.

Any charges that Medicare does not cover will not be paid by a Medigap policy. Only Medicare-approved charges are subject to supplementation.

Medicare Supplemental Plans in Virginia: Enrollment Statistics

The top five largest counties in Virginia by population are:

• Fairfax County – 1,145,670
• Prince William County – 478,535
• Loudoun County – 429,570
• Chesterfield County – 361,844
• Henrico County – 334,468

As of August 2021, statistics showed that 1,572,332 people were enrolled in Medicare in Virginia. A large number of Medigap enrollees come from these densely populated counties.

At least 441,619 of these Virginians chose to enroll in Medicare Supplement health plans according to statistics from America’s Health Insurance Plans (AHIP). That amounts to approximately one-third of Medicare recipients (about 30%).

Another 30% of Virginia’s Medicare recipients are enrolled in Medicare Advantage Plans.

What are Medicare Advantage Plans?

It is important to note that you cannot enroll in a supplement plan if you have a Medicare Advantage Plan.

A Medicare Advantage plan focuses on Medicare preventive care, and every county in Virginia has access to Medicare Advantage Plans. Availability ranges from Culpepper County’s 15 plans to Loudoun County’s 46 plans.

All Advantage (Part C) plans are required to cover all benefits available through Medicare Part A and Part B (except for Hospice Care, which is still covered by Part A).

Each insurance company that sells Medicare Advantage plans can offer additional benefits to meet more needs of their members.

Some desirable features of Advantage plans include dental, vision, prescription, and hearing benefits along with potential fitness and wellness benefits.

Extra Benefits of Medicare Advantage Plans

Free memberships in fitness facilities through a program like Silver Sneakers draw some Medicare recipients to enroll in a Medicare Advantage plan.

Wellness benefits often include a monthly allowance for over-the-counter medications and certain medical supplies along with an allowance for ‘healthy foods’ that can be purchased at many supermarkets by simply scanning the wellness card at the cash register.

Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO)

Medicare Advantage plans (Medicare Part C) are generally Health Maintenance Organization plans or Preferred Provider plans. With a PPO, there is freedom to choose your provider or change providers at any time. You can also make an appointment with a Specialist without getting a referral from your primary care provider.

With an HMO (Health Maintenance Organization), it will be necessary to choose from the network provided by the insurance company. A referral from your primary care physician will be required for seeing a Specialist.

There will also be a service area that defines the range of places where you can receive medical care through an Advantage plan. People who generally stay close to home with limited travel could be good candidates for a Part C plan.

Medigap plans offer more freedom to choose any doctor who accepts Medicare, and you can see a doctor anywhere in the United States and be covered.

Some supplement plans offer Emergency medical care coverage for recipients traveling in foreign countries.

How Many Medigap Plans are Available in Virginia?

As in most states, there are ten Medigap plans to choose from and each is named by a letter: A, B, C, D, F, G, K, L, M, and N. The plans are regulated by insurance commissioners and state laws.

Each of these Medicare plans is standardized, meaning that according to Federal rules, they cover the same benefits regardless of what state the recipient lives in or what insurance company sells the health care policy.

In 2021, 42 insurers offer Medicare Supplement insurance plans in Virginia.

Medicare Supplement Plan F and Plan G

Medicare Plan F had been the most popular supplement plan for many years, but federal legislation banned supplement plans from covering the Part B deductible as of January 1, 2020, so people newly eligible for Medicare enrollment after that date cannot enroll in Plan F.

One exception to this rule is that people who became eligible for Medicare before January 1, 2020, but who continued working and kept their employer health plans may still be able to enroll in Plan F.

For those newly eligible for Medicare after January 1, 2020, Plan G is rapidly increasing in popularity based on enrollment statistics. It has lower monthly premiums than Medigap Part F and has proven to be a superior value for the cost.

Medicare Supplement Plan N

The third most popular Medigap plan is Medicare Part N. Its benefits are similar to those of Plan G. The main difference in benefits between these two is that Plan G covers Part B Excess charges and Part N does not.

Some doctors who accept Medicare do not accept Medicare assignment (the amount Medicare is willing to pay) and they charge a higher price. The increase in price cannot be greater than 15% of the total charge in order for doctors to accept Medicare patients.

As far as cost goes, Part N has a lower monthly premium than Part G, but it carries higher out-of-pocket costs like copayments at the time of each provider visit.

For Medicare recipients who see a doctor only occasionally and who have no major medical issues, Plan N can be a good choice for saving money.

Those who have serious or multiple medical conditions necessitating frequent physician visits accompanied by diagnostic testing and/or treatments can do better with the somewhat higher monthly premium with Plan G and lower out-of-pocket costs.

Medicare Part D (Prescription Drug Plans)

Medicare beneficiaries who enroll in supplement plans in 2022 will need to know that these plans do not include drug coverage. It will be necessary to purchase a prescription drug plan.

A licensed Medicare agent can answer your questions and help you find the right Prescription Drug plan for your needs.

Note that many Advantage plans include Part D coverage.

Medicare Supplemental Plans in Virginia: When Can I Enroll?

Medicare Supplement enrollment is different from that of Medicare Advantage (Medicare Part C) and Prescription Drug plans in that there are no Annual Enrollment periods.

The best time to purchase a Medigap plan is during your Medigap Open Enrollment Period (OEP). This period begins on the first day of the month you turn 65 and are enrolled in Medicare Part B and extends for six months.

During your Medigap Open Enrollment Period, you cannot be turned down for a Medigap policy, you will have more choices of plans at lower prices than you could get later, and you will not be required to obtain a physical exam. Insurers cannot refuse to cover pre-existing conditions if you enroll during your OEP.

If you do not choose to buy a Medigap plan during this 6-month period and later decide to apply for one, you might have to undergo Medical Underwriting (meaning you must have a physical exam) to determine your eligibility.

You can be turned down, charged a higher premium, or be refused coverage for pre-existing conditions.

In some cases, applicants may have guaranteed-issue rights to purchase a supplement plan at a later date, such as those who work beyond the age of 65 and maintain insurance coverage through an employer-based plan.

Some other circumstances that might give a person guaranteed issue rights are:

• Entering a Skilled Nursing Facility
• Leaving a Skilled Nursing Facility
• Returning to the United States to live after living abroad
• Relocating to an area outside your insurance plan’s service area

For guidance in all things Medicare-related, contact your local Medicare representative. They can help you make the right choices in Medicare coverage. If you need life insurance, the Medicare agent can either sell you a suitable policy or guide you to someone who can.

Virginia Medicare Resources

The following links will lead to websites that offer further information:

https://www.healthinsurance.org/medicare/virginia/