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VIRGINIA MEDICARE ADVANTAGE PLANS

Virginia Medicare Advantage Plans are health plans approved by the federal government and run by private companies. These plans also sometimes referred to as Medicare Part C. Virginia Medicare Advantage Plans are not supplemental insurance and must follow rules set by Medicare.

Although Medicare Advantage Plans will provide benefits equal to those in Medicare Part A and Medicare Part B, Medicare Advantage Plans can charge different co-payments, coinsurance, and deductibles for these services. All Medicare Advantage plans must cover all medically-necessary services that Original Medicare does.

Virginia Medicare Advantage Plans might offer added benefits, such as vision, hearing, dental, and/or health and wellness programs and most will include prescription drug coverage for an additional cost.

Types of Virginia Medicare Advantage Plans
  • Health Maintenance Organization (HMO) - Offers low to no copayment for doctor office visits and no deductibles. However, you are required to receive a referral from your Primary Care Doctor before seeing a specialist, and to receive full benefits, you are must use doctors and hospitals that are within your network.


  • Preferred Provider Organization (PPO) These plans also offer low copayments usually slightly higher than those of an HMO but also allow freedom of choice when choosing a doctor or hospital as long as they are part of their network.


  • Private Fee-for-Service (PFFS) Plans A PFFS plans usually offer the most flexibility. As they allow you to choose any doctor or hospital because there is no provider network. However, you doctor or hospital must accept the plans conditions prior to treating you, except in the case of emergencies.


  • Medical Savings Account This is a very popular option. This plan combines a high deductible health plan with a medical savings account. The government will put money in this account, which you can use to pay your deductible or other out-of-pocket medical expenses such as dental, eyeglasses.


What are the differences between Medicare Advantage Plans and Medicare Supplements?

Medicare Advantage Plans
  • Medicare contracts with private insurance companies to administer your Medicare health plan benefits.
  • With most plans, you pay no premium.
  • Some plans will include Medicare Part D prescription coverage.
  • May have co-pays for doctor visits and other services.
  • Typically you are required to see a doctor within a network, unless the plan you have chosen offer freedom of choice.

Virginia Medicare Supplement Plans
  • The government administers Original Medicare health plan benefits.
  • You can purchase a Medicare Supplement plan to assist in paying all or part of your remaining medical bills.
  • Monthly premiums are higher than those of a Medicare Advantage plan.
  • Prescription coverage is not typically provided.
  • You have the freedom to choose any doctor or hospital that accepts Medicare.
  • Premiums can increase with your age.


When Can You Join, Change, or Cancel a Medicare Advantage Plan?
You can join, change, or cancel a Medicare Advantage Plan if the following applies:
  • When you first become eligible for Medicare (3 months before you turn age 65 to 3 months after the month you turn age 65).
  • If you have Medicare due to a disability, you can join during the 3 months before to 3 months after your 25th month of disability benefits.
  • From November 15th to December 31st each year. However, your coverage will begin on January 1st of the following year.


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