Updated October 29, 2021 | Reading time: 8 minutes
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If it’s expanded Medicare Advantage plans that you’re looking for, Virginia is where you can find them!
The Original Medicare combination of both Medicare Part A and Medicare Part B can offer great foundational health insurance. But what about prescription drug benefits, vision benefits, or hearing benefits? Sure, you could sign up for a variety of additional plans like Medicare Part D or Medicare Supplement Insurance, but another option exists: Medicare Advantage plans, also known as Medicare Part C. There are close to a hundred options with varying costs and coverage, so how do you choose?
If you’re looking for a great way to compare these many plans, check out Insurify’s plan comparison tool! Its intuitive, easy-to-use and totally free format can help you find the right plan for you!
As mentioned previously, there are dozens of Medicare plans coming from a handful of providers. The top providers include Erickson and Kaiser Permanente. While these two sources are great places to start looking, check out the list below to get a feel for some of the highest-rated plans available in Virginia. These plans are rated using a combination of factors including CMS scoring and pricing.
Of course, while these plans seem great, you’ll definitely want to read the finer details and make sure that these plans are right for you.
Best Medicare Advantage Plans In Virginia
1. Kaiser Permanente Medicare Advantage Value VA (HMO) - Score: 66.90
2. Kaiser Permanente Medicare Advantage Standard VA (HMO) - Score: 66.90
3. Huana Gold Plus H6622-005 (HMO) - Score: 66.02
4. Kaiser Permanente Medicare Advantage w/o Part D (HMO) - Score: 64.81
5. Erickson Advantage Liberty with Drugs (HMO-POS) - Score: 64.81
6. AARP Medicare Advantage Plan 2 (HMO) - Score: 63.94
7. Kaiser Permanente Medicare Advantage High VA (HMO) - Score: 63.19
8. Erickson Advantage Signature with Drugs (HMO-POS) - Score: 63.19
Also, as a disclaimer, this list is not intended as an endorsement of these plans or their providers. This is intended as a list of the top-rated MA plans in West Virginia.
#1 Kaiser Permanente Medicare Advantage Value VA
Insurify Composite Score: 66.90
Monthly Premium: $0
Prescription Drug Plan Deductible: $0
Out-of-Pocket Maximum: $6,900
For $0 a month, this plan has a lot to give. You’ll find low cost office visits for primary care, preventive, and specialist visits. And you’ll get low cost prescriptions for Tier 1 and Tier 2 drugs from preferred providers.
Add to that standard hearing, preventive dental, and routine vision. Plus low-cost mental health copays and a covered wellness program.
#2 Kaiser Permanente Medicare Advantage Standard VA
Insurify Composite Score: 66.90
Monthly Premium: $22
Prescription Drug Plan Deductible: $0
Out-of-Pocket Maximum: $6,900
With a fairly low monthly premium, this plan has a lot to offer. Including a robust wellness program. You’ll also find $3 to $9 copays for Tier 1 and Tier 2 prescriptions from preferred providers. Plus )4 copays for preventive office visits, $5 for primary care, and $35 to see a specialist.
There’s also low-cost diagnostic and lab services. Plus low-cost hearing, preventive dental, and vision exams.
#3 Humana Gold Plus
Insurify Composite Score: 66.02
Monthly Premium: $0
Prescription Drug Plan Deductible: $0
Out-of-Pocket Maximum: $6,700
Given its monthly premium and drug plan deductible of $0, this plan seems affordable, despite its moderate out-of-pocket maximum. This plan does have fairly competitive prescription drug co-pays and coinsurance rates but does not offer optional supplemental benefits. However, the doctor and specialist co-pays are fairly low, and the plan offers some hearing, dental, and vision coverage, among other benefits. With all of that considered, this plan earns four stars out of five.
#4Kaiser Permanente Medicare Advantage w/o Part D
Insurify Composite Score: 64.81
Monthly Premium: $10
Prescription Drug Plan Deductible: n/a
Out-of-Pocket Maximum: $6,900
Before we begin, we need to point out that, as the name implies, this plan does not cover prescriptions. That means that you’ll need to purchase a stand-alone Part D plan for coverage.
That being said, there’s a ton of low-cost care to love in this plan. For office visits you’ll pay $0 for preventive care, $10 for primary care, and $35 for specialist care visits. You’ll also get $0 lab and diagnostic services, except for MRI and radiology imaging. Hearing exams, preventive dental, and routine vision are also covered at a low cost.
#5 Erickson Advantage Liberty with Drugs
Insurify Composite Score: 64.81
Monthly Premium: $0
Prescription Drug Plan Deductible: $400
Out-of-Pocket Maximum: $6,700
This plan comes highly rated by its customers and from the Centers for Medicare and Medicaid Services. You’ll find some low-cost prescription copays, especially if you get them from a preferred mail-order provider.
You’ll also get low-cost visits to the doctor’s office— $0 for preventive visits, $0-$30 for primary care, and $50 for specialists. You can also access out-of-network care at 30 percent coinsurance. Plus, you’ll get low-cost diagnostic services, hearing, preventive dental, and routine vision care.
#6 AARP Medicare Advantage Choice Plan 2 H8211-002
Insurify Composite Score: 63.94
Monthly Premium: $23
Prescription Drug Plan Deductible: $0
Out-of-Pocket Maximum: $3,900
This plan has a very wide service area, along with a fairly moderate monthly premium. This plan also offers basic vision, dental, mental health, hearing, and wellness benefits. With other plan aspects carrying hefty costs (such as those for ambulances services and out-of-network medical supplies), this plan earns a score of 63.94 out of 100.
#7 Kaiser Permanente Medicare Advantage High VA
Insurify Composite Score: 63.19
Monthly Premium: $142
Prescription Drug Plan Deductible: $0
Out-of-Pocket Maximum: $5,700
Though this plan has a hefty monthly premium— which should still be lower than premiums paid by non-medicare beneficiaries— this plan packs a lot of low costs into things you actually use.
That includes low-cost prescriptions from preferred providers, low-cost doctor visits, and diagnostic care. You’ll get $30 copays to use urgent care. And you’ll find $30 hearing exams, preventive dental visits, and $5 to $30 routine vision coverage.
#8 Erickson Advantage Signature with Drugs
Insurify Composite Score: 63.19
Monthly Premium: $199
Prescription Drug Plan Deductible: $0
Out-of-Pocket Maximum: $2,600
Though the monthly premium is high, this plan lowers costs for actual use. First, you should take note of the very low out-of-pocket maximum limit. That will certainly help you keep your health costs in check.
You’ll also find low-cost doctor’s visits— $0 for primary and preventive care and just $20 to see a specialist in-network. Plus some of the lowest-cost diagnostic services around. You also have access to $0 hearing exams, $0 preventive dental, and $0 routine vision care.
If you want to get your Medicare Advantage journey started in a fast and accessible way, take advantage of Insurify’s plan-comparison tool! With side-by-side comparisons, detailed information, and an easy-to-use format, this comparison tool can ensure that you are making the most informed insurance decision you possibly can!
How Much Does Medicare Advantage Cost in Virginia?
As mentioned previously, the cost of a plan should have something of an impact on the plan that you choose. With that in mind, the costs of Medicare Advantage plans can vary, but so can the sources of those costs:
Monthly premium: This is the monthly cost of maintaining or keeping your insurance policy. It’s important to remember that even if you enroll in a Medicare Advantage plan, you will still have to pay the Medicare Part B premium.
Deductible: This is the amount of money you must pay out of pocket for medical services before your coverage kicks in. Once you meet your deductible, your insurance plan will begin to either directly cover medical costs or compensate you for covered medical services.
Coinsurance: Once you meet your plan’s deductible, your insurance policy will begin to cover a percentage of medical services. In most situations, the plan will pay a large percentage of these costs, leaving you to pay a smaller percentage.
Co-payments: These are flat-rate payments for specific medical services. As with coinsurance, these become available once you have met your deductible.
Out-of-pocket limit: This is the absolute maximum that you can pay in medical costs during the course of a year. Once you’ve met this limit, your plan is required to pay 100 percent of all subsequent medical costs.
If these costs are too much to bear financially, there are resources available. Assistance programs like Medigap ( Medicare Supplement Insurance plans ) or Extra Help can help you pay for a variety of insurance costs.
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What Kinds of Medicare Advantage Plans Exist in Virginia?
Medicare Advantage plans are essentially insurance plans provided by private insurance companies. These companies, which are approved by the Centers for Medicare & Medicaid Services, must provide the same standard that general Medicare coverage provides. However, these plans also offer much more comprehensive Medicare benefits, including options for prescription drugs, vision, hearing, and dental coverage.
While there are a good number of individual plans to check out and compare, it’s extremely important to take note of the types of plans available in Virginia. Knowing how each type functions can no doubt help you find the right plan:
Health Maintenance Organization ( HMO ): HMO plans provide coverage for various medical services—including doctors, healthcare providers, and hospitals—in your plan’s network. Any services from providers outside of your network will generally not receive coverage unless those visits are for emergency or urgent care. For specialist services, you will likely need a doctor’s referral.
Preferred Provider Organization ( PPO ): A PPO plan is generally flexible, allowing you to visit doctors or other healthcare providers outside of your network, though these visits and services will likely be more expensive. For providers in your plan’s network, you can expect to pay significantly less in coinsurance and co-payments.
Private Fee-for-Service ( PFFS ): While they generally have few limits on which medical service providers you can visit, PFFS plans reserve the right to decide how much they will cover for doctor visits, hospital visits, and other medical services.
Special Needs Plan ( SNP ): SNP insurance policies restrict eligibility to include only individuals who live in an institution (such as a nursing home ) or suffer from a chronic health condition (such as HIV/AIDS, end-stage renal disease, or diabetes). Dual Special Needs Plans (D- SNPs ) exist for individuals who qualify for both Medicare and Medicaid.
Medicare Advantage Prescription Drug Plan (MAPD): MAPD plans roll health and prescription drug coverage into one plan. This type of plan serves as an alternative to the Medicare prescription drug plans you would have to enroll in if you had Original Medicare and needed prescription drug coverage.
How to Find the Best Virginia Medicare Advantage Plan
Before looking at any actual plans, it’s extremely important that you evaluate your individual medical needs, as well as your financial limitations. Take into consideration any current medical conditions, medications, or regular needs that are essential to your continued health. Also, take a look at your income and try to budget out how much you can afford to pay for a Medicare Advantage Plan. With these things in mind, you can get the coverage you need without putting undue strain on your finances.
There’s also specific coverage in each plan to consider. Depending on a plan’s service area, you may or may not be eligible to enroll in that plan. If you require medical service from specialists, it might help you to choose a plan that has lower specialist co-pays. If you need specific medication for ongoing treatment, check the plan’s formulary to make sure that the plan covers that medication.
Through a less subjective lens, however, Medicare Advantage Plans come with star ratings that can help shed some light on the quality of various aspects of a plan. The ratings take into account factors including:
Efficacy of screenings, tests, vaccines, and other preventive services
Assistance in managing chronic illnesses
Responsiveness from the plan provider
Member complaints and the number of plan disenrollments
Customer service
Though these star ratings can no doubt help guide you regarding the quality of some plans, it’s always in your best interest to go with a plan that best covers your medical needs at affordable rates.
FAQ: Virginia Medicare Advantage
There are a few ways that you can join the many Virginia Medicare beneficiaries out there, the first of which is through the Initial Enrollment Period. During this period, which begins three months before your 65th birth month and ends three months after your 65th birth month, you will be able to enroll in a Medicare Advantage plan. The only caveat is that you must first enroll in Original Medicare in order to obtain your Medicare number. To enroll this way, visit the Social Security Administration website at www.ssa.gov.
On the other hand, you can take advantage of the Open Enrollment Period, which takes place from October 15 to December 7 every year. During this time, you can switch from Original Medicare to a Medicare Advantage plan or between different Medicare Advantage plans.
Based on some of the examples provided, Erickson and Kaiser Permanente can be great options for Medicare Advantage plans. It should be noted that, while some plans have practically non-existent deductibles, they might also have no out-of-pocket limits, which could end up costing more depending on how many medical services you require throughout the year. Also, given the coverage areas available, you’ll want to check that an offered plan covers the county you reside in.
Aside from that, just because these two providers made our list, don’t think that other options aren’t worth your consideration.
Medicare Advantage plans definitely have more to offer than standard Original Medicare. The many extra benefits and expanded coverage may seem very attractive to someone who prefers comprehensive insurance plans. The big downside here is that, with all of these extra benefits come extra costs. Add to that other cost variables inherent to Medicare Advantage plans, and it may sometimes seem more attractive to go with the standardized costs of Original Medicare.
Not only can things like premiums, co-pays, coinsurances, and deductibles vary, but so can service areas. It wouldn’t necessarily be feasible to move to another county just to be eligible for a county-specific Medicare Advantage plan. Unfortunately, many of these plans have limited service areas that may not include your county of residence.
Ultimately, you’ll have to evaluate your medical and financial situation to see if a Medicare Advantage plan is right for you.
Conclusion: Compare to find the best plan for you!
As mentioned previously, there are plenty of variables at play when considered which Medicare Advantage plan will work for you. If money is important, then you may want to find a plan with lower premiums and deductibles. If medication is important, find a plan with great prescription drug coverage. As most everyone will sit somewhere between medical needs and finances, you’ll need to compare the coverage and costs of different plans to find the one that can work for you.
Need help getting started on comparing the many plans available? Have a look at Insurify’s plan-comparison tool! It’s free and easy to navigate. Still have questions? One of our talented insurance agents can provide you with all the information you need to decide on the best plan for you!
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Adrian CotoInsurance Writer
Originally from Los Angeles, California, Adrian Coto is a writer living in Brooklyn, New York. A graduate of the NYU Creative Writing MFA program, he's worked as a legal assistant, a law school administrator, and now as a copywriter and editor.
