Private insurance companies provide Medicare Supplement plans in Virginia. Also known as Medigap, these plans help cover a variety of healthcare costs if you have Original Medicare. This page explains how Medigap works, the best time to join a plan, and how to compare your options.
What Is Medigap in Virginia?
Medigap plans help pay for services that are covered by Original Medicare. This includes Part A, hospital insurance, and Part B, medical insurance. It does not include prescription drug coverage, eye exams, dental care, or hearing aids.
There is no limit to your out-of-pocket costs with Original Medicare. Without a Supplement plan, you may owe significant medical bills, particularly if you have any chronic conditions or require a lengthy hospital stay.
Virginia Supplement plans are standardized, meaning you get the same benefits no matter which Medigap insurer you choose. There are 10 basic plans, each represented by a letter (A, B, C, D, F, G, K, L, M, and N). Not every insurance company offers every plan and some insurers offer high-deductible options of one or more Medigap plans.
Unless you have a guaranteed issue right, Medigap applications go through medical underwriting. This process involves answering a series of questions regarding age, tobacco use, medical history, and more. The insurance company uses your answers to decide whether to offer you a Medigap policy and at what rate.
What Does Medigap Cover?
Benefits vary depending on which Medigap plan you choose. At a minimum, every Supplement plan covers the Part A coinsurance and gives you an extra 365 lifetime reserve days for inpatient care.
The following table lists the benefits for each Medicare Supplement plan:
There are no Supplement plans that provide prescription drug coverage. For that, you need either a standalone Medicare Part D plan or a Medicare Advantage Prescription Drug plan (MA-PD). However, if you enroll in an Advantage plan, you cannot also have a Medigap plan.
Who Qualifies for Medicare Supplement Insurance in Virginia?
If you are enrolled in Original Medicare and age 65 or older, you qualify for Medicare Supplement Insurance in Virginia.
If you're eligible for Medicare due to a disability and aren't yet 65 years old, Medigap insurers may refuse to offer you a policy. However, a new Virginia law (VA SB250) extends protections to under-65 Medicare beneficiaries beginning in 2021.
When Is the Best Time to Join a Medicare Supplement Plan in Virginia?
The best time to join a Virginia Medicare Supplement plan is during your Medigap Open Enrollment Period (OEP). This begins the day you enroll in Original Medicare and lasts for 6 months.
The Medigap OEP is one of the few times you have a guaranteed issue right, meaning you cannot be denied coverage. And, if you're age 65 or older, you also cannot be charged a higher premium – even if you have preexisting medical conditions.
If you qualify for Medicare due to a disability, you get a second Open Enrollment Period when you turn 65. Even if you already had a Medigap plan, you get the same 6-month guaranteed issue rights that other over-65 applicants get.
Medigap Plan C and Medigap Plan F in Virginia
Two Supplement plans are no longer available to new Medicare beneficiaries. If you qualify for Medicare on or after January 1, 2020, you may not join Medigap Plan C or Medigap Plan F.
Comparable coverage is available via Medigap Plan D and Medigap Plan G. With the exception of the Medicare Part B deductible, these options include everything that Plans C and F covered. They also usually have a lower overall out-of-pocket.
How to Choose a Medigap Plan in Virginia
Medical underwriting means that it's important to consider future healthcare needs when choosing a Medigap plan. You may not be able to get more comprehensive coverage at a later date if you don't qualify for guaranteed issue rights.
Your next concern is cost. Pricing methods include:
- Community rated: These plans charge the same premium regardless of age. Over time, you pay less for these Medigap plans.
- Issue-age rated: Premiums are based on your age at the time you join the plan, although they may rise due to inflation.
- Attained-age rated: Premiums start out low but go up as you get older. These policies are usually the most expensive option over time.
Most Virginia Medigap insurers use the attained-age rating method.
Our Find a Plan tool makes it easy to compare Medigap plans in Virginia. Simply enter your location information and coverage start date to review Medicare plan options in your area.
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