Medicare Advantage plans remain popular among Virginia residents as replacements for Original Medicare coverage. Participation rates vary between Virginia’s major cities, but Richmond alone boasts 85,037 beneficiaries. Knowing the difference between Virginia Medicare Advantage plans is beneficial if you’re considering replacing an Original Medicare plan.
Medicare Advantage plans in Virginia
Virginia Medicare Advantage plans offer residents an alternative to Original Medicare coverage. These plans entirely take over the federal government’s Medicare insurance plan and can provide unique benefits and coverage options. Virginia residents can access many Medicare Advantage plans, ranging from 18 to 39 in each county. Availability of Medicare Advantage plans, and individual plan benefits will vary based on location and carrier, so thoroughly explore each plan before enrolling.
Since private carriers offer Virginia Medicare Advantage plans, these plans aren’t standardized by the federal government. Different plans and benefits will be available in each Virginia ZIP code. Below, we discuss Virginia Medicare Advantage plans that boast zero-dollar premiums or drug deductibles, 5-star ratings, or a Part B reduction. Use this information to consider your options when deciding which plan to enroll in.
Medicare Advantage plans with a zero-dollar premium
While a plan with a zero-dollar premium works for many beneficiaries, it’s essential to know that this type of plan typically comes with higher out-of-pocket benefit costs. Consider these costs before deciding which plan to enroll in.
The Humana Medicare Advantage Local PPO plan offers a zero-dollar premium and a 4-star rating in the chart below. This plan also carries a high out-of-pocket maximum of $7,550.
Beneficiaries can choose a plan like Aetna for a 4-star Virginia Medicare Advantage plan with a zero-dollar premium and a lower out-of-pocket maximum. This HMO-POS plan offers more flexibility than an HMO Medicare Advantage plan and an out-of-pocket maximum of $5,900.
The chart below shows Optima as a 4-star Medicare Advantage plan with a low out-of-pocket maximum of $3,400. However, beneficiaries should note that the Optima plan is an HMO Medicare Advantage plan. HMO plans have tighter provider network restrictions than PPO or HMO-POS plans.
| PLAN | PREMIUM | MOOP | PLAN TYPE | STAR RATINGS |
| Humana | $0 | $7,550 | LOCAL PPO | 4 |
| Optima | $0 | $3,400 | HMO | 4 |
| Anthem BCBS | $0 | $6,700 | LOCAL PPO | 4 |
| Aetna | $0 | $5,900 | HMO-POS | 4 |
| $0 | $6,700 | LOCAL PPO | 3 |
Medicare Advantage plans with a zero-dollar drug deductible
Virginia residents seeking a PPO Medicare Part C option with a zero-dollar drug deductible can choose a plan like Humana’s. This PPO plan offers an out-of-pocket maximum of $7,500 and has a 4-star rating from beneficiaries.
The Aetna Medicare Advantage plan on the chart below also boasts a 4-star rating and a zero-dollar drug deductible. This plan offers a somewhat lower out-of-pocket maximum of $5,900 and a moderate amount of provider flexibility as an HMO-POS plan.
With a mid-range out-of-pocket maximum and the flexibility of a local PPO, offers considerable benefits despite a lower rating. The plan carries a zero-dollar drug deductible, and out-of-pocket costs are capped at $6,700.
| PLAN | PREMIUM | MOOP | PLAN TYPE | STAR RATINGS |
| Humana | $0 | $7,550 | LOCAL PPO | 4 |
| Aetna | $0 | $5,900 | HMO-POS | 4 |
| $0 | $6,700 | LOCAL PPO | 3 |
Medicare Advantage plans with a 5-star rating
While the availability of 5-star Virginia Medicare Advantage plans may be limited in some areas, residents in areas offering 5-star plans may be eligible for a Special Enrollment Period.
One 5-star Medicare Advantage plan is offered through Kaiser Permanente. This plan provides a lot to those in select coverage areas with an out-of-pocket maximum of $6,900 and a zero-dollar premium.
| PLAN | PREMIUM | MOOP | PLAN TYPE | STAR RATINGS |
| Kaiser Permanente | $0 | $6,900 | HMO | 5 |
Part C plans With a Part B reduction
Since the availability of Medicare Advantage plans varies by zip code, not all areas offer plans with Part B give-back programs. A plan offers a Part B Reduction of $60 in one Virginia location. Though this plan also boasts an out-of-pocket maximum of $6,700 and a zero-dollar premium, it has a lower rating of 3.
In contrast, the Humana Medicare Advantage plan offered in the same area provides a Part B Reduction of $50. Though the plan has a high out-of-pocket maximum of $7,500, it has a solid 4-star rating from beneficiaries.
| PLAN | PREMIUM | MOOP | PART B REDUCTION | STAR RATINGS |
| $0 | $6,700 | $60.00 | 3 | |
| Humana | $0 | $7,550 | $50.00 | 4 |
Ancillary/DVH
A primary benefit of choosing Medicare Advantage plans is that these programs offer supplemental benefits and coverage that Original Medicare and Medigap don’t. While availability varies by zip code, beneficiaries may find plans that include coverage for:
- Dental
- Vision
- Hearing
- Prescription drugs
Cities in Virginia with estimated premiums for Medicare Advantage coverage
Estimated premiums for each type of Medicare Advantage plan for the cities listed below can be accessed with the accompanying charts linked below:
FAQs
Which Medicare plan is best in Virginia?
With dozens of Virginia Medicare plans available in different locations, the best plan for you may differ from that for someone else. Choose a provider in your area with a premium, deductible, and out-of-pocket maximum that suits your needs.
What is the highest-rated Medicare Advantage plan in Virginia?
Since plan availability changes by ZIP code, the highest-rated plan in your area may be different. In Virginia, Kaiser Permanente has the best reputation overall as a Medicare Part C plan provider.
Why is Medicare Advantage being pushed so hard in Virginia?
A higher number of enrollees translates to more program funding for Medicare Advantage plans. For this reason, Medicare Advantage plans advertising is more common than their government-funded counterparts.
Is Medicare Advantage more expensive than Medicare in Virginia?
Many factors impact the overall cost of Medicare Advantage and Original Medicare plans. Medicare Advantage plans often limit the out-of-pocket amount you must pay during coverage. While Original Medicare has standardized out-of-pocket costs, these plans also have no out-of-pocket maximum. This means you could pay more for your health care needs.
Does Medicare have a maximum out-of-pocket in Virginia?
Medicare has no yearly limit for out-of-pocket costs in Virginia without supplemental coverage.
How to get help enrolling in a Virginia Medicare Advantage plan
Replacing your Original Medicare with a quality Medicare Advantage plan doesn’t have to be challenging. Medigap works with all Medicare carriers in Virginia. We offer free services designed to help you choose the right plan for your lifestyle. Call us at the number above or complete our convenient online form to get rates today.
