Virginia residents have 30 Medicare Part D plans to choose from—learn how to pinpoint the best one for you.

If you’re searching for Medicare prescription drug coverage in Virginia, you might be overwhelmed with the options available. Unlike Original Medicare, which costs the same nationwide, Medicare Part D plans all vary in cost and coverage details. This is because Part D plans, while regulated by the Centers for Medicare & Medicaid Services, are offered by private insurance companies. Each insurance company works out its own deals with pharmacies and healthcare providers, which is why each provider offers different rates. 

Although there are many plans to choose from and a few nuances to be aware of (such as late enrollment fees), this guide makes choosing Medicare Part D in Virginia easy. Let’s get started.

Saving money on Medicare is easy. Just use the Insurify Medicare comparison tool to find the right Part D plan for you. Uncover options in your area at no cost to you. Try it today!

 

 

What Are the Best Medicare Part D Plans In Virginia?

This is usually a person’s first question—and it’s a difficult one to answer. The truth is that there is no universal answer as to which Medicare Part D is “the best.” This is because one person’s ideal plan may not look so ideal to another.

The first step to determining which Medicare Part D plan is best for you is getting your priorities and preferences clear. Here are some questions you should ask yourself before searching for and comparing prescription drug plans

    • What is my monthly budget?
    • How much can I afford to pay out of pocket on an annual basis?
    • How many prescription drugs am I currently taking?
    • Are any of my prescriptions brand-name or specialty drugs?
    • Do I have a family medical history or a health condition that suggests I may need to take prescription medication in the future?
    • Which pharmacies are in my area that I prefer to go to? Are they included on the insurance plan‘s preferred pharmacy list?
    • Do I want mail-order prescriptions, or do I prefer to pick up at the pharmacy?

Once you think through these questions, you should have a pretty good idea of your preferences, such as if you prefer a high-deductible plan with a low monthly premium or a slightly higher monthly premium in exchange for low co-pays, coinsurance, and deductibles

To help you kick-start your search, we’ll review the eight highest-rated plans in Virginia based on the Centers for Medicare & Medicaid Services(CMS) star rating system, which takes into consideration factors like prescription drug costs (co-payments and coinsurance), monthly deductibles, customer service, and more. 

#1 WellCare Classic S4802-069 (PDP)

    • Monthly premium: $24.50
    • Deductible: $445
    • Star rating: 4/5

With an affordable monthly premium and low co-pays for generic drugs, this Part D plan earns a high ranking on the CMS scale. Tier 1 generic drugs are $0–$6, Tier 2 generic drugs are $3–$27, and Tier 3 brand-name drugs are $30–$105. Each tier has a range of co-pays based on whether you order a 30-day pack or 90-day pack and whether the pharmacy you’re purchasing your prescriptions from is on your insurance’s preferred pharmacy list. This plan also includes mail-ordering options at the same co-pay ranges as regular pharmacy pickup, which is a nice option to have. 

#2 WellCare Value Script S4802-142 (PDP)

    • Monthly premium: $16.30
    • Deductible: $445
    • Star rating: 4/5

This four-star plan also comes with a mail-order option that has the same formulary chart as regular pharmacy pickup. On this plan’s formulary, Tier 1 generic drugs are $0–$15, Tier 2 generic drugs are $8–$39, and Tier 3 brand-name drugs are $43–$141. Tier 4 drugs have a coinsurance on the higher side, leaving you responsible for paying a larger portion of the prescription medication cost. The coinsurance ranges from 47 to 50 percent. Tier 5 specialty drugs have a more management coinsurance of 25 percent.

#3 WellCare Wellness Rx S4802-176 (PDP)

    • Monthly premium: $14.80
    • Deductible: $445
    • Star rating: 4/5

At just $14.80 a month, this Part D plan has the lowest monthly premium on this list of top eight plans. With this plan, you have mail-order options that cost the same as regular pharmacy pickup. Tier 1 generic drugs have a $0–$24 co-pay, Tier 2 generics have a $7–$45 co-pay, and Tier 3 brand-name drugs have a $40–$141 co-pay. The coinsurance for Tier 4 drugs ranges from 46 to 50 percent, and Tier 5 specialty drugs have just a 25 percent co-pay.

#4 AARP MedicareRx Preferred S5820-006 (PDP)

    • Monthly premium: $83.40
    • Deductible: $0
    • Star rating: 3.5/5

Although this plan has a higher monthly premium, there is no deductible, which means your out-of-pocket costs may end up being lower if you take many prescription medications. This PDP plan offers mail-order options at a cheaper rate than pharmacy pickup. For example, the mail-order formulary has a $0–$45 co-pay for Tier 1 generic drugs and a $0–$60 co-pay for Tier 2 generic drugs. The traditional pharmacy pickup formulary has a $5–$45 co-pay for Tier 1 generic drugs and $10–$60 co-pay for Tier 2 generic drugs

This plan also has a unique gap coverage phase that offers a $0–$60 co-pay on Tier 2 generic drugs and 25 percent coinsurance on all other drugs. Most PDP plans tend to have just coinsurance in the gap coverage phase.

#5 AARP MedicareRx Saver Plus S5921-352 (PDP)

    • Monthly premium: $25.20
    • Deductible: $445
    • Star rating: 3.5/5

At $25.20 per month, this PDP plan offers good coverage benefits. There is a prescription mail-order option, though it is only available for 90-day prescription quantities and not 30-day. If you need 30-day packs, you can still receive coverage by picking up at a pharmacy. Co-pays you can expect for Tier 1 generic drugs range between $1 and $18. Tier 2 generic drugs are $7–$36, and Tier 3 drugs are $34–$117. Tier 4 drugs have a 40 percent coinsurance, and Tier 5 specialty drugs have a 25 percent coinsurance for 30-day quantities. 

#6 AARP MedicareRx Walgreens S5921-389 (PDP)

    • Monthly premium: $32
    • Deductible: $445
    • Star rating: 3.5/5

This PDP plan offers mail-order prescriptions for 90-day quantities, and the co-pay and coinsurance rates for mail order are the same as for traditional pharmacy pickup of 90-day prescriptions. Co-pays for generic drugs are manageable, ranging from $0 to $45 for Tier 1 and from $6 to $60 for Tier 2. Brand-name drugs cost a little more and range from $40 to $141. Tier 4 drugs have a coinsurance of 40 to 45 percent, and Tier 5 specialty drugs have a 25 percent coinsurance

#7 Anthem MediBlue Rx Enhanced S5596-068 (PDP)

    • Monthly premium: $23.70
    • Deductible: $330
    • Star rating: 3.5/5

This PDP plan has a mail-order prescription option that may help you save even more on Tier 1 generic drugs. Whether you choose a 30-day or 90-day quantity, the co-pay for Tier 1 generics through mail order is $0. If you did traditional pharmacy pickup, Tier 1 generic drugs could cost $5–$15 if they are purchased at a non-preferred pharmacy. Generally, though, this plan offers affordable co-pays and coinsurance across the board. Tier 2 generic drugs cost $2–$21, Tier 3 generic drugs have a 20 to 22 percent coinsurance, Tier 4 drugs have a 39 to 41 percent coinsurance, and Tier 5 specialty drugs have a 25 percent coinsurance. 

#8 Anthem MediBlue Rx Plus S5596-006 (PDP)

    • Monthly premium: $55.80
    • Deductible: $0
    • Star rating: 3.5/5

If you’re looking for a zero-deductible plan, this one may be a good match for you. While the monthly premium is on the higher side, the co-pays for generic and brand-name drugs are great—particularly if you choose to receive prescriptions by mail. Tier 1 drugs cost $1–$3 by mail order and cost $1–$45 through traditional pharmacy pickup. Tier 2 drugs are $3–$9 by mail order and $3–$60 by pickup. Tier 3 brand-name drugs cost $43–$129 by mail and $43–$141 by pharmacy pickup. You can expect coinsurance rates from 45 to 50 percent for Tier 4 drugs and 33 percent coinsurance for Tier 5 specialty drugs.

Ready to shop plans now? Use the Insurify Medicare comparison tool to find the right Part D plan for you. Start with your ZIP code to compare plans today!

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How Much Does Medicare Part D Cost in Virginia?

When searching for Medicare Part D plans, it’s natural for your eyes to gravitate toward the monthly premium cost and fixate on that. After all, it’s a recurring amount you know you’ll have to dish out every single month. But it’s important to remember that Medicare Part D plan costs are more than just your monthly premium. You should also take into consideration the annual deductible, co-pays, and coinsurance, which all add up to your annual out-of-pocket costs.

With that being said, monthly premiums range from $7.30 to $85.50 in Virginia. You can also find plans with a $0 deductible up to a $445 annual deductible

What Is Medicare Part D, and Who Is Eligible?

Medicare Part D is a prescription drug plan regulated by the Centers for Medicare & Medicaid Services and offered through private insurance companies. Stand-alone Medicare Part D plans are meant to offer prescription drug coverage to those enrolled in health insurance plans without drug coverage. 

You are eligible for Medicare Part D if you’re enrolled in Medicare benefits. Medicare is a federal health insurance program that is available to U.S. citizens and permanent residents over the age of 65. In some cases, you may be eligible for Medicare even if you are under 65. Exceptions include being diagnosed with end-stage renal disease and having received Social Security Disability Insurance for 24 consecutive months. 

If you’re unsure about your eligibility status, you can always visit Medicare.gov or call 1 (800) MEDICARE. TTY users can contact 1 (877) 486-2048.

What Is the Medicare Part D Enrollment Process?

Remember, you can only enroll in a stand-alone Medicare Part D plan as long as your current health plan does not include prescription drug coverage. So, if you have a Medicare Advantage plan, which typically comes with Medicare prescription drug coverage, you cannot also enroll in Part D. Typically, Medicare Part D prescription drug plans are best for Medicare beneficiaries enrolled in Original Medicare.

With this in mind, there are two key enrollment periods you should be aware of: your Initial Enrollment Period and the Open Enrollment Period.

    • Initial Enrollment Period: This begins three months before your 65th birthday and ends three months after. It is critical to enroll in Medicare benefits at this time to avoid late-enrollment penalties

At minimum, it’s advised to enroll in Medicare Part A, Medicare Part B, and Medicare Part D. You can always switch and drop plans during the annual Open Enrollment Period afterward, but if you don’t enroll during your Initial Enrollment Period, you may face penalties that accumulate month by month.

    • Open Enrollment Period: This occurs every year from October 15 to December 7. During this time, Medicare beneficiaries can join or switch to a new prescription drug plan

What Coverage Phases Do Virginia Medicare Part D Plans Include?

Medicare Part D plans are very similar in structure, offering three coverage phases. For the most part, the out-of-pocket thresholds are the same for each.

    • Initial Coverage Phase: After you’ve met your plan’s annual deductible, you enter the initial coverage phase, which has a cost-sharing formulary. A cost-sharing formulary is basically a chart of tiers that outlines the prescription costs you are responsible for—either in the form of a co-pay or coinsurance. A formulary is typically broken into five tiers that categorize prescriptions from generic to brand-name to specialty. 
    • Gap Coverage Phase: This phase can be seen as a coverage gap until you qualify for catastrophic coverage. You enter this phase once you’ve met the annual out-of-pocket cost threshold of $4,131. Most plans offer a 25 percent coinsurance in this phase, but some may offer co-pays or their own unique cost-sharing formulary.
    • Catastrophic Coverage Phase: Once your annual out-of-pocket costs exceed $6,550, you enter this phase of coverage. Here, you will pay the higher of $3.70 or 5 percent for generic drugs and $9.20 or 5 percent for brand-name drugs unless your plan states otherwise.

 

 

FAQ: Virginia Medicare Part D

Is Medicare Part D coverage free?

No, Medicare Part D is not free, and there are no premium-free Part D plans available in Virginia. If affording Medicare Part D coverage seems out of reach, you may want to contact the CMS about the federal Extra Help program, which offers financial assistance for those who meet certain income requirements.

Can I have Medicare Supplement Insurance (Medigap) with a Part D plan?

Yes, just as long as your Medigap plan does not offer prescription drug coverage. Before 2006, some Medigap plans offered prescription coverage. If this is the case and you prefer the benefits that your stand-alone Part D plan offers, you can contact your insurance provider to remove the drug coverage from your Medigap plan. Just note that once drug coverage is removed from your Medigap plan, you can't get it back.

Are Virginia Medicare Part D plans available in all counties?

Each Medicare Part D plan offers different service area coverage depending on the insurance company. So not all plans are available in all Virginia counties. This is where an online tool that matches you to plans based on your ZIP code comes in handy.

Conclusion: A Little Research Goes a Long Way

If you made it this far into the article, you can see there’s no need to work with an insurance agent to find the best Part D plan for your needs. Armed with this knowledge, you can now take your health decisions into your own hands. After all, you are the one who knows your health needs the best—so you save time and money by taking action on your own. 

Ready for a Medicare Part D plan that works for you? Use the Insurify Medicare comparison tool to find options near you. Start with your ZIP code, and you’ll be comparing plans in less than two minutes. Try it today!

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Updated April 26, 2021

Emily Vasquez is a content marketing writer based in Tampa, Florida. A graduate from the University of South Florida, Emily has worked as a copywriter, communications lead, and content strategist for high-growth start-ups and global brands and retailers. You can learn more at www.emvwrites.com