Medicare Advantage coverage in Virginia provides Seniors with affordable MA health insurance options through reputable companies. These Part C plans are issued by licensed and registered insurance companies that provide a very cost-effective alternative to original Medicare. Part A and Part B benefits are included, and also Part D (prescription drugs) on specified plans.
Plan types include:
HMO (Health Maintenance Organization)
PPO (Preferred Provider Organization)
POS (Point Of Service)
PDP (Prescription Drug Plan)
SNP (Special Needs Plan)
PFFS (Private Fee For Service)
We annually review Va products and provide unbiased and expert information regarding details, costs, and availability. Medicare also provides information regarding doctor and health professional network availability, the claims and appeal process, needed forms and resources, and help with finding medical equipment and supplies. Illustrated below is current data and details of popular plans offered to State residents. Medicare Supplement plans in Virginia are also reviewed by our website.
Virginia Medicare Advantage Plans Without Prescription Drug Coverage
Erickson Advantage Signature -- Available in Fairfax County. $5,000 maximum out-of-pocket expenses. You pay nothing for in-network inpatient hospital care and primary-care physician visits. Specialist visits are subject to a $35 copay. Lab services are also covered at 100% while outpatient x-rays cost only $20. ER and Urgent Care visits cost $50 and $30 respectively. Dental, vision, and eye benefits are provided with annual office visit copays from $20-$35.
Kaiser Permanante Medicare Plus Basic -- Available on several counties, including Arlington, Fairfax, Loudon, and Prince William. $6,700 maximum out-of-pocket expenses with $35 and $50 office visit copays. Lab services and diagnostic tests are covered at 100%, and the ER copay is $75. Ambulance service is subject to a $375 copay while Urgent Care visits are subject to a $65 copay. Dental, vision, and eye benefits are covered with $50 copay on most visits.
Humana Gold Choice -- Three different plans (Regional PPO and PFFS) are offered with low premiums in many counties. Hospital care has a $295 daily copay for the first six days. Office visit copays are $15 and $45 while diagnostic tests, x-rays, and lab expenses are typically subject to a copay of $0-$95. The ER copay is $75 and the Urgent Care copay can vary between $15 and $45. Chiropractor visits are covered with a $20 copay, and dental, vision, and hearing service visits are subject to a $45 copay.
UnitedHealthcare MedicareDirect Essential -- Available in several counties, including Augusta, Greensville, Henry, Mecklenburg, Patrick, Spotsylvania, and Waynesboro City. Hospital care copay is $395 for four days while office visit copays are $25 and $50. You must pay 20$ of the cost of diagnostic tests, although lab services and x-rays are subject to only a $13 or $16 copay respectively. The ER copay is $75 while the Urgent Care copay is $40. Foot care and dental office visit expenses are often subject to a $40 copay while hearing and eye exams are covered with $20 and $50 copays.
Virginia Medicare Advantage Plans With Prescription Drug Coverage
Erickson Advantage Champion -- No out-of-pocket costs for Hospital care, although there is a 30% coinsurance if you are treated out-of-network. Primary-care physician office visits have no copay while specialist visits will cost you $35. Diagnostic radiology services are subject to a $50 copay, while the x-rays copay is $20 and the lab services copay is $0. ER and Urgent Care copays are $50 and $30 respectively.
Tier 1 and Tier 2 drugs have no copay with 90-day cost-sharing mail order. Tier 3 copay is $125 (90 days) or $45 (30 days).
Other Erickson options include the Freedom, Guardian, and Signature With drugs plans.
Kaiser Permanente Medicare Plus Basic w/D (AB) Cost -- Available in various Counties including Arlington, Fairfax, Falls Church City, Loudoun, and Prince William. $360 deductible with maximum out-of-pocket expenses of $6,700. Office visit copays are $35 and $50, while diagnostic radiology services have a 20% copay. no out-of-pocket expense for diagnostic tests, lab services, and outpatient x-rays. ER and Urgent Care copays are $75 and $65 respectively. Most outpatient therapy copays are $35 or $40.
Other Kaiser options include Plus High and Plus Standard plans.
AARP MedicareComplete Plan 1 -- Available in various counties including Bland, Bristol City, Dickenson, Grayson, Lee, Russell, Scott, Washington, and Wise. $0 premium with $90 deductible and $4,500 maximum out-of-pocket expenses. $295 in-hospital copay for first six days while office visit copays are $0 and $35. Lab services and outpatient x-rays cost $17 and $16 respectively. Emergency care has a $75 copay and Urgent Care visits typically cost between $30 and $40. Like most plans, limited dental, vision, and hearing coverage is included.
Mail-order Tier 1 and Tier 2 drugs are covered at 100%. The 90-day copay for Tier 3 and 4 drugs is $125 and $275. Standard retail 30-day cost sharing for Tier 1 and Tier 2 drugs are $2 and $8.
Other AARP options include MedicareComplete Plan 2.
Aetna Medicare Connect Plus -- Available in various counties including Alexandria City, Arlington, Chesterfield, Fairfax, Gloucester, Hanover, Henrico, Loudoun, Pittsylvania, Prince William, Roanoke, Stafford, and York. $0 deductible with $4,500 maximum out-of-pocket expenses. The inpatient hospital copay is $200 per day for four days and the office visit copays are $0 and $15. No charge for in-network lab services and diagnostic x-rays. ER and Urgent Care copays between $0 and $75.
Standard 90-day mail-order copays are $15 and $30 for Tiers 1 and 2. Tier 3 and 4 copays are $117.50 and 50%. Tier 1 copay is $0 for standard retail.
Other Aetna options include Connect Plus (HMO instead of PPO), Essential Plan, Innovation Choice Plan, Innovation Prime Plan, and Medicare Select.
Anthem MediBlue Care To You -- Available in Chesterfield, Goochland, Hanover, Henrico, Powhatan, and Richmond City Counties. 0 deductible with $200 copay for five days for in-hospital stays. There is no out-of-pocket expenses for pcp and specialist office visits. Diagnostic tests, x-rays, and lab tests also have $0 copays. The ER copay is $75 and Urgent Care visits have no copay. Ambulatory services are subject to a $195 copay. Routine foot, eye, dental, and hearing care are covered at 100%.
All Tier 1 generic drugs have a $0 copay. Tier 2 generic 90-day mail order copay is $18.75. Tier 3 preferred brand 90-day copay is $100.
Other Anthem options include MediBlue COPD, MediBlue Diabetes, MediBlue Local, MediBlue Access, and MediBlue Smart Fit.
Humana Gold Plus -- Available in these Counties: Chesterfield, Colonial Heights City, Hanover, Henrico, Hopewell City, Petersburg City, Richmond City, Chesapeake City, Hampton City, Newport News City, Norfolk City, Portsmouth City, and Virginia Beach City. $270 deductible with maximum out-of-pocket expenses of $4,900. Inpatient hospital care copay is $295 for the first five days. The PCP office visit copay is $0 while the specialist copay is $45. Diagnostic tests, lab fees and x-rays are subject to copays ranging from $0 to $105.
All Tier 1 (Preferred Generic) drugs have a $0 copay (similar to Anthem plan above). Tier 2 mail0order drugs also have a $0 copay. 90-day copay is $51 (no mail-order). Tier 3 Preferred Brand mail-order copay is $131.
Other Humana options include HumanaChoice (several options), and Humana Cold Choice.
UnitedHealthcare Nursing Home Plan -- Available in these Counties: Alexandria City, Arlington, Chesapeake City, Fairfax City, Henrico, Norfolk City, and Virginia Beach City. $360 deductible with no copays on pcp and specialist office visits. Diagnostic radiology services cost 0%-20%, depending on the type of service. ER copay is $75, and Urgent care copay is 20% (maximum $65). Routine hearing, dental, vision, and foot care visits are covered at 100%, subject to policy maximums.
Specific prescription coverage is provided upon request. UnitedHealthcare also has a plan website for drug information.
Other UnitedHealthcare options include MedicareDirect Rx.
Piedmont Select Medicare Option One -- Available in these Counties: Amherst, Appomattox, Bedford, Campbell, Charlotte, Halifax, Lynchburg City, Pittsylvania, and Price Edward. $0 deductible with $5,500 maximum out-of-pocket expenses. $175 copay for first five days of in-hospital treatment. Office visit copays are $15 and $30, while diagnostic tests and x-rays are generally subject to a $30 copay or 20% coinsurance. Er and Urgent care copays are $75 and $30. Many dental, vision, eye, and foot expenses are covered with a $30 copay.
Standard mail-order 90-day cost-sharing for Tier 1, 2, and 3 drugs are $12, $36, and $80 respectively. Tier 5 (Specialty) drugs are subject to a 33% coinsurance.
Other Piedmont options include Select Medicare Option Three and Two.
Optima Medicare Basic -- Available in these Counties: Hampton City, Newport News City, Chesapeake City, Norfolk City, Poquoson City, Portsmouth City, and Virginia Beach City. $0 deductible with $4,700 maximum out-of-pocket expenses. In-hospital copay is $225 for the first seven days. Office visit copays are $0 and $40 while the diagnostic radiology service copay varies between $40 and $175. Lab services are covered at 100% and ER copay is $75.
Tier 1 preferred drugs are covered at 100%. Tier 2 mail order and retail copays are $16 and $8 respectively. Tier 3 copays are $100 and $40.
Other Optima options are the "Enhanced" plan.
The US Department of Health and Human Services also provides a Medicare Health Plans in Virginia report. It helps consumers determine costs of coverage in specific areas. Some of the servicing areas include Richmond, Danville City, Newport News, Roanoke, Fairfax County, Mathews County, Tidewater area, and Hampton Roads.