Assisted living facilities primarily help residents with non-medical needs. Although minor and infrequent medical services, such as first-aid for a wound, can sometimes be met on-site by nurses. These communities may sometimes also be called ALFs, residential care facilities, retirement homes, or long-term care facilities.
The financial options available to help pay for senior care is dependent on, among other things, the type of care that is required. If you are just beginning the research process on how to pay for long-term care, it is helpful to have an idea about the type of care you or your loved one currently requires, as well as to anticipate future needs. In addition, it is important to be familiar with the associated eldercare terminology.
Can using home care technology help your family save money caring for an aging loved one? The answer is most certainly “Yes”. Our goal is not to provide a comprehensive list, but rather to make sense of those that are available on the market today and can reduce the care hours required by elderly persons. As such, they can reduce a family’s out-of-pocket care costs or reduce the hours they spend providing care themselves.
Medicare Advantage (Part C), a privately offered alternative to Original Medicare (Parts A and B), has grown in popularity over the years. Despite the growing popularity of Medicare Advantage, some seniors face obstacles that prevent them from truly understanding how it works and who it benefits. Common mistakes about Medicare Advantage include misunderstanding its differences from Original Medicare, getting it confused with other forms of private Medicare insurance (like Medigap or Part D), or not understanding how to look up or evaluate plans.
Virginia has almost 8.7 million residents. Individuals aged 65 and older constitute about 16.9% of the population, and seniors are the group most likely to benefit from Medicare or Medicare Advantage coverage. Medicare is the national health insurance program, administered by the federal government. It is made up of several parts: Part A covers hospital stays, part B covers routine medical care and Part D provides prescription drug assistance. Medicare Advantage, commonly referred to as Medicare Part C, combines health care coverage into one plan with a single monthly premium. Conversely, Original Medicare operates on a fee-for-service basis. Medicare Advantage Plans are managed by private insurance companies.
With the exception of hospice care, Medicare Advantage must cover all services provided by Parts A and B of regular Medicare. Although not a requirement, many insurers include some level of prescription drug cover. Stand-alone Part D plans are decreasing in popularity. Part C plans may also include extra services that aren’t provided by Original Medicare, such as senior nutrition programs, nonemergency medical transportation and dental care. Beneficiaries must generally use medical service providers that are part of an approved network. Insurance companies typically cap the amount an enrollee must pay from their own funds each year, unlike regular Medicare. They can also set their own copay figures, which may be lower than Original Medicare.
In Virginia, roughly 1.64 million people qualify for Medicare as of July 2023. Approximately 36% of these are enrolled in Medicare Advantage. Although this is significantly lower than the national enrollment percentage of 51%, the percentage of eligible individuals enrolled in Medicare Advantage in Virginia has increased 10.46% from the previous year. In 2022, only 33% of around 1.59 million Medicare-eligible persons enrolled in Medicare Advantage.
This guide offers a detailed look at the Medicare Advantage choices available in Virginia. It highlights the top plans in the state, as well as eligibility and coverage information.
The Top 10 Medicare Advantage Plans in Virginia
Several insurance providers offer Part C plans to seniors in Virginia. Some insurers offer a choice of plans, enabling seniors to tailor their health insurance cover to their needs and financial circumstances. Below, the table shows the 11 most popular Medicare Advantage providers in Virginia, with enrollee numbers representing the total number of people signed up for all of a provider’s policies. Prices are given as a range opposed to an absolute to account for plan variations. All information is current as of July 2023, and Medicare.gov provides further details.
Name
Enrollment
Medicare Star Rating
Monthly Cost Range
Plan Types
Humana
169888
3
$0 – $126
PPO, HMO, PFFS
UnitedHealthcare
72835
4.5
$0 – $197
HMO
Anthem HealthKeepers
70270
4
$0 – $26
HMO
Blue Cross Blue Shield of Michigan
62780
4.5
$0 – $15
HMO
Anthem Blue Cross and Blue Shield
38877
3
$0 – $27
PPO, HMO
Aetna Medicare
34378
3.5
$0 – $98
PPO
Kaiser Permanente
30213
5
$0 – $139
HMO
Mary Washington Medicare Advantage
3360
3
$0 – $0
HMO
Vermont Blue Advantage
1950
3.5
$0 – $29
PPO
Highmark Inc.
1119
N/A
$0 – $0
HMO
How Medicare Advantage Plans Work in Virginia
Before selecting a Medicare Advantage plan, it’s important to understand how these plans work in the state of Virginia. Many insurance providers offer several plan options to seniors, such as health maintenance organizations (HMO), preferred providers organizations (PPO) and private fee-for-service (PFFS). When evaluating plans, seniors should compare a variety of factors, including deductibles, copays and prescription drug coverage and learn more about in-network provider, referral and primary care physician requirements. Below is a brief description of the main types of care plans offered in the state
What Medicare Advantage Plans Cover in Virginia
Medicare Advantage plans must provide at least the same types of services provided by Medicare Part A and Medicare Part B, including hospital care, regular doctor visits, and preventive and diagnostic lab tests and screenings. Many Medicare Advantage plans offer additional benefits, such as prescription medicine along with hearing aids, and dental and vision care.
Coverage Available With Medicare Parts A & B?
Coverage Available With Medicare Advantage?
Preventive Screenings
Yes
Yes
Hospital Care
Yes
Yes
Durable Medical Equipment
Yes
Yes
Prescription Drugs
No
Yes**
Vision Care
No
Yes*
Dental Care
No
Yes*
Hearing Aids
No
Yes*
*Select plans offer this coverage
** Most plans offer this coverage
Eligibility for Medicare Advantage in Virginia
Seniors considering signing up for or switching to a Medicare Advantage plan must already be enrolled in or eligible for Medicare Part A and Medicare Part B. To meet this eligibility, you must be a U.S. citizen or lawful immigrant, live in the plan’s service area, be over the age of 65 or have an eligible disability and meet all other plan requirements.
Like most insurance plans, Medicare Advantage has an annual open enrollment timeframe. Seniors interested in enrolling in a Medicare Advantage plan or switching from Original Medicare to Medicare Advantage can only do so during this open enrollment period. View the information below to determine when your open enrollment period starts and ends.
Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.
Start Date
End Date
Initial Coverage Election Period
3 Months Before One’s 65th Birth Month
3 Months After One’s 65th Birth Month
Annual Election Period (AEP)
October 15th
December 7th
Medicare Advantage Open Enrollment Period
January 1st
March 31st
Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.
How to Find & Choose a Medicare Advantage Plan in Virginia
Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.
First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.
Virginia Insurance Counseling and Assistance Program
The Virginia Insurance Counseling and Assistance Program (VICAP) is a state program that operates as part of a nationwide network of certified benefits counselors and senior advisers. Offering free, unbiased advice and counseling services, VICAP helps Medicare-eligible seniors and their loved ones clarify the insurance options they have and better understand how benefits plans work together for full coverage. Program staff offer case worker support and can assist in filling out applications for assistance programs seniors may be eligible for. Counselors can assist seniors who have been denied coverage with their appeals, as well as with planning ahead to meet program income and asset eligibility criteria. Programs and topics VICAP counselors can assist seniors with include:
Contact the VICAP support team by calling the main helpline at 1-800-552-3402. Email inquiries from the public go through the program’s main account at [email protected]. VICAP receives mail at the head office mailing address at the Division for Community Living Office for Aging Services, in Henrico.
Seniors in Virginia who have enrolled in the Virginia AIDS Drug Assistance Program, and who meet income and asset limits, may be eligible for financial assistance with their prescription drug costs. Benefits are provided through the State Pharmaceutical Assistance Program (SPAP), which pays Medicare Part D costs for people with an income less than 400% of the federal poverty limit. Some senior beneficiaries of the SPAP program get assistance managing their co-payment and coinsurance requirements, in addition to help with the monthly premiums charged by their Part D provider. SPAP benefits can also help close the gap in benefits, known as the “donut hole” between co-payment amounts and the coinsurance threshold.
The Virginia HIV SPAP office may be reached by phone at 855-362-0658. Applicants can access the program application online, or they can submit a written application to the program’s mailing address, which is available through the website.
The Virginia Drug Card is a statewide prescription assistance program that seniors can use to help cover the costs left unpaid by their Medicare Part D coverage. No personal information is required to sign up for benefits, and the card is available to all Virginia residents. Using the card at the time of purchase, seniors can save up to 75% of the cost of both generic and prescription drugs at over 56,000 locations around the state. Average savings at the point of sale are 30% off of list price for most drugs.
Virginia seniors can request a drug card by calling 866-413-9778 and signing up for the discount program. Online applications may be submitted via the program’s online contact form here.
Rappahannock Rapidan Community Services (RRCS) serves the communities of Culpeper, Fauquier, Madison, Orange and Rappahannock counties with prescription coverage and Medicare assistance for low-income seniors. Benefits include referrals to prescription drug plans and private sector assistance programs, as well as Medicare and Medicare Advantage counseling. Case workers at RRCS can assist seniors aged 60 and over who meet the program’s income and asset guidelines with signing up for services and managing appeals and denials of service. Advice is unbiased and given by certified staff to help seniors understand and maximize the benefits they are eligible to receive.
RRCS counselors can be reached over the phone by calling 540-825-3100. Email inquiries may be sent through the online contact form here. Application packets should be directed to the program’s mailing address, as should all other mail inquiries, at: Rappahannock Rapidan Community Services (RRCS) 15361 Bradford Road P.O. Box 1568, Culpeper, VA 22701
Care Coordination at AASC works with partner agencies in and around the Cedar Bluff area to maximize the benefit coverage and social support seniors get in the community. Care coordinators can provide advice and planning assistance for managing Original Medicare, Medicare Advantage, Medigap and Part D plans for eligible Virginians aged 60 and over. Outreach, assessment and planning services are offered free of charge. AASC offers seniors insurance counseling (VICAP), health education and screening, emergency interventions and My Medicare Matters computer training in-home or at a training center.
Seniors in the Cedar Bluff area, or their caregivers and loved ones, may reach out to Care Coordination at AASC by phone at 1-800-656-2272, or by email at [email protected]. Mailed correspondence can be sent to the program’s Cedar Bluff mailing address at the Appalachian Agency for Senior Citizens (AASC).
Carilion Medication Assistance Program at Pearisburg
The Carilion Medication Assistance Program (MAP) at Pearisburg offers services to low-income seniors in the Pearisburg, Princeton and Blacksburg areas who need help paying for prescription drugs. Many seniors who participate in the program have primary care physicians through Original Medicare or Medicare Advantage programs, but little or no Part D coverage. Seniors who do have Part D insurance but who struggle to meet the co-payment or coinsurance requirements are also eligible for direct aid through the MAP benefit program. Technically, all program participants are asked to contribute $10 quarterly to support the program, but no senior is turned away for lack of payment and the fee is voluntary. The Carilion Medication Assistance Program at Pearisburg offers extra program assistance for seniors with additional needs. Case managers at the MAP office can assist seniors with the signup process for MAP and various other state and federal programs they might be eligible for. Counseling is available to help seniors plan their benefit profile during Medicare’s annual open enrollment periods, and program staff can personally follow up with seniors who need prescription refill reminders.
Call the program office at 540-922-4282 for information about local areas served, senior eligibility information and other requirements of care. Seniors, caregivers and their loved ones may contact the program via email through the online contact form here. Application packets and other correspondence can be mailed into program headquarters at:Carilion Medication Assistance Program c/o Carilion Giles Community Hospital 159 Hartley Way, Pearisburg VA 24134
