How to Find the Best Medicare Advantage Plan in Virginia

Trying to answer the question, what is the best Medicare Advantage plan in Virginia, can feel overwhelming. But the truth is, healthcare is local. The best Medicare Advantage plans in Virginia aren’t a single statewide winner—they’re the ones that fit *your* life, right where you live. Your trusted doctors, preferred hospitals, and go-to pharmacy all play a role. That’s why these Part C plans in Virginia vary so much by county, from provider networks to monthly costs. We’ll show you how to compare your options and find the right fit for your needs.

Key Takeaways

Choose Your Path: All-in-One Coverage vs. Provider Freedom: Medicare Advantage plans bundle your benefits into one convenient package, often with extra perks like dental and vision. In exchange, you agree to use a local network of doctors and hospitals, which is the biggest difference from the go-anywhere flexibility of Original Medicare.
Focus on Your Total Costs, Not Just the Premium: A $0 premium is appealing, but your true out-of-pocket costs depend on deductibles, copays, and drug coverage. Always confirm your doctors are in-network and your prescriptions are on the plan’s formulary to get an accurate picture of your yearly expenses.
Your Plan Isn’t a “Set It and Forget It” Decision: Insurance companies can change a plan’s costs, benefits, and provider network each year. Make it a habit to review your coverage annually during the enrollment period to ensure it still fits your health needs and budget.

What Are Virginia’s Medicare Advantage (Part C) Plans?

When you first become eligible for Medicare, you’ll face a key decision: how you want to receive your benefits. You can stick with Original Medicare (Parts A and B), which is the traditional, government-run program. Or, you can choose a Medicare Advantage plan, also known as Part C. Think of Medicare Advantage as an all-in-one alternative. These plans are offered by private insurance companies in Virginia that are approved by Medicare. They bundle your hospital insurance (Part A) and medical insurance (Part B) into a single, convenient plan. Most also include prescription drug coverage (Part D) and other benefits that Original Medicare doesn’t cover.

Virginia’s Medicare Landscape by the Numbers

To give you a sense of the options available, let’s look at some numbers. In Virginia, more than 1.6 million residents are enrolled in Medicare, making it a significant part of the state’s healthcare system. To serve this population, 15 different insurance companies offer a total of 147 different Medicare Advantage plans. This wide selection means you have plenty of choices, but it can also make finding the right fit feel like a major project. The competition between these companies is generally a good thing for consumers, as it encourages more comprehensive benefits and lower costs.

Speaking of costs, many people are drawn to Medicare Advantage because of the low premiums. The average monthly premium for a plan in Virginia is just $12.91, and every single person eligible for Medicare in the state has access to a plan with a $0 monthly premium. While that sounds fantastic, remember that the premium is only one piece of the financial puzzle. It’s essential to also consider deductibles, copayments, and your potential out-of-pocket maximum. Most importantly, the specific plans and their costs are tied directly to your ZIP code, so your neighbor in the next county over might see a completely different set of options.

How Do They Compare to Original Medicare?

It’s important to understand that Medicare Advantage plans are an alternative to Original Medicare, not a supplement to it. When you enroll in a Part C plan, you are still in the Medicare program and have all the same rights and protections. The main difference is how your benefits are delivered. Instead of the federal government paying your healthcare claims, the private insurance company you choose manages your care. By law, these plans must cover everything that Original Medicare covers, like doctor visits and hospital stays. So, you aren’t giving up your core benefits; you’re just choosing to receive them through a private plan.

What Extra Benefits Can You Get?

This is where Medicare Advantage plans really stand out. To compete for your business, private insurers often include a variety of extra perks not covered by Original Medicare. Many plans in Virginia offer benefits for routine dental, vision, and hearing services, which can be significant out-of-pocket costs for seniors. You might also find plans that include fitness program memberships (like SilverSneakers), an allowance for over-the-counter pharmacy items, and even transportation to medical appointments. These added benefits are designed to provide more comprehensive coverage and support your overall health and wellness in ways that Original Medicare doesn’t.

Examples of Common Extra Perks

So, what do these extra benefits actually look like in a Virginia Medicare Advantage plan? For dental, vision, and hearing, you might find plans that offer a yearly allowance for routine care, such as cleanings, fillings, eye exams, and glasses. Some plans provide a few hundred dollars for eyewear, while others might offer dental allowances ranging from $1,000 to $3,000. Many plans also include popular fitness programs like SilverSneakers at no extra cost, giving you access to local gyms. Other common perks can include an allowance for over-the-counter items like vitamins and cold medicine, transportation to and from doctor appointments, and even coverage for services like acupuncture. These benefits vary widely from plan to plan, which is why it’s so important to compare the details.

Does Your Doctor Accept the Plan?

Unlike Original Medicare, which you can use with almost any doctor or hospital in the country, Medicare Advantage plans operate with local service areas and provider networks. This is a critical detail to check before you enroll. The most common plan types are Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). With an HMO, you typically must use doctors, specialists, and hospitals within the plan’s network. A PPO offers more flexibility to see out-of-network providers, but your costs will be higher. Always confirm that your favorite doctors and preferred hospitals are in a plan’s network before signing up.

How to Read Medicare Star Ratings

To help you compare plans, Medicare uses a Star Rating system. Each year, plans are rated on a scale of 1 to 5 stars, with 5 being the highest quality. These ratings are based on dozens of factors, including member satisfaction surveys, customer service quality, and how well a plan helps its members manage chronic conditions. The Star Ratings are a powerful and objective tool you can use to gauge a plan’s performance. As you shop for plans in Virginia, looking for those with a rating of 4 stars or higher is a great way to narrow down your options to high-quality choices.

How Much Do Medicare Advantage Plans Cost in Virginia?

When you’re looking at Medicare Advantage plans, it’s easy to focus on the monthly premium, especially when you see plans advertised for $0. But the premium is just one piece of the puzzle. To truly understand what a plan will cost, you need to look at the whole picture, including deductibles, copayments, and how much you might pay for your specific health needs throughout the year. Thinking about these different costs will help you find a plan that fits your budget and provides the coverage you need without any surprises.

Breaking Down Your Monthly Premiums

A premium is the fixed amount you pay each month to the insurance company to keep your plan active. While you still have to pay your Medicare Part B premium, many Medicare Advantage plans in Virginia have an additional premium that is quite low, or even $0. For instance, the average monthly cost for a Virginia Medicare Advantage plan is around $12.91. A lower premium can be appealing, but remember to balance it against other costs like deductibles and copays. A $0-premium plan might have higher out-of-pocket costs when you actually use your benefits, so it’s important to weigh all the factors.

What’s Your Out-of-Pocket Maximum?

One of the most important features of a Medicare Advantage plan is the annual out-of-pocket maximum. This is a cap on the amount you’ll spend on covered medical services in a year. Once you hit this limit, the plan pays 100% for your covered care for the rest of the year. This provides a crucial financial safety net. Original Medicare doesn’t have an out-of-pocket limit, which can leave you exposed to high costs. Every Advantage plan has this protection, but the annual out-of-pocket limits can vary significantly from one plan to another, so be sure to check this number when comparing your options.

Don’t Forget Prescription Drug Costs

Most Medicare Advantage plans include prescription drug coverage, often referred to as MA-PD plans. This is a convenient way to get your medical and drug benefits all in one package. However, it’s vital to check the plan’s formulary, which is the list of covered drugs. Make sure your specific medications are on the list and find out what your copayments or coinsurance will be. Some plans have a separate deductible for prescriptions. Taking the time to include coverage for prescription drugs in your cost comparison will help you avoid unexpected expenses at the pharmacy.

A Look Ahead: Future Cost Projections

It’s helpful to know that Medicare Advantage plan costs aren’t set in stone; they can change from year to year. While the average monthly premium for these plans is expected to go down slightly, other key costs are projected to rise. For example, the amount you pay for prescription drugs before your plan helps (the deductible) is set to increase. The total you could pay out-of-pocket for your medications in a single year is also expected to go up. These projected changes highlight why it’s so important to review your plan’s details each fall during the Annual Enrollment Period. A plan that was a perfect fit for your budget this year might have different costs next year, so staying informed helps you make the best choice for your health and finances.

Can You Get Help Paying for Your Plan?

If you’re concerned about affording your Medicare costs, know that help is available. Virginia has Medicare Savings Programs (MSPs) designed to assist people with limited income and resources. These programs can help pay for your Medicare Part A and Part B premiums, and in some cases, your deductibles, coinsurance, and copayments. Each program has specific income and asset requirements. It’s always worth checking to see if you qualify for financial assistance programs, as this support can make a significant difference in your monthly budget and overall healthcare spending.

How to Budget for Healthcare Costs

Planning for healthcare costs is a key part of managing your finances in retirement. To create a realistic budget, think beyond the monthly premium. Add up potential expenses like your annual deductible, copays for doctor visits and specialist appointments, and the cost of your prescription drugs. Having a clear idea of these potential out-of-pocket expenses helps you compare plans more effectively. By taking a few simple tips for health care budgeting, you can choose a plan that not only meets your health needs but also aligns comfortably with your financial situation for the year ahead.

Which Companies Offer Medicare Advantage Plans in Virginia?

When you start looking for a Medicare Advantage plan in Virginia, you’ll find that many private insurance companies offer them. This is great because it gives you plenty of choices, but it can also feel a bit like sorting through a crowded grocery aisle. The key is knowing what to look for so you can find the plan that truly fits your life and health needs. Different companies offer various types of plans with unique networks and benefits, so it’s helpful to get familiar with the main players and the kinds of plans they provide before you make a decision.

Full List of Providers in Virginia

In Virginia, you have a solid selection of about fifteen different insurance companies offering Medicare Advantage plans. The specific options available to you will depend on your ZIP code, but you’ll likely recognize many of the major names. Some of the most prominent providers in the state include Aetna, Anthem Blue Cross and Blue Shield, Humana, and UnitedHealthcare. It’s also worth noting that some of these carriers have earned excellent quality ratings from Medicare. For 2025, top-rated plans from companies like Aetna and UnitedHealthcare received 4.5 out of 5 stars. Other providers, such as Sentara Medicare and Johns Hopkins Advantage MD, also offer competitive plans in certain regions, reinforcing why it’s so important to check which ones serve your specific area.

A Look at Virginia’s Top Insurance Providers

In Virginia, several well-known insurance companies consistently offer highly-rated Medicare Advantage plans. Companies like UnitedHealthcare, Aetna, and Kaiser Permanente are often recognized for providing some of the best Medicare Advantage plans in Virginia due to their comprehensive coverage and customer service. While these companies are a great starting point for your research, remember that the “best” plan is always the one that works for you personally. A plan that’s perfect for your neighbor might not be the right fit for you. It’s essential to choose a plan that covers your specific health needs, includes your doctors in its network, and fits comfortably within your budget.

UnitedHealthcare: Best for Network Size

If having a wide selection of doctors and hospitals is your top priority, UnitedHealthcare is a great place to start your search. They are known for having the largest network for Medicare Advantage plans, with over one million providers nationwide. This extensive network can give you peace of mind, knowing you have plenty of options for your care. In addition to their medical network, they also have the largest dental network, and all of their standard plans include dental coverage—a valuable benefit that isn’t covered by Original Medicare. With several plans in Virginia earning a 5-star rating, UnitedHealthcare combines network size with high-quality care, making them a strong contender for many people.

Humana: Best for Part B Premium Givebacks

For those looking to lower their monthly expenses, Humana offers an attractive feature on many of its plans: the Part B premium giveback. This means the plan pays for a portion of your monthly Medicare Part B premium, putting money back in your pocket each month. This can make your overall healthcare coverage more affordable. According to one analysis, a majority of Humana plans offer a Part B giveback benefit, making it a common feature in their offerings. If you’re on a fixed income or simply want to reduce your fixed costs, looking into a Humana plan with this benefit could be a smart financial move that helps your budget go further.

Aetna: Best for High Ratings and Travelers

Aetna stands out for its consistently high ratings and broad national presence, making it an excellent choice for people who travel. With plans available in 48 states and Washington, D.C., Aetna provides more widespread coverage than most other insurers, which is a huge plus for snowbirds or anyone who spends significant time in another state. Beyond its geographic reach, Aetna also scores well on member experience and often has a lower average monthly premium than other large national companies. This combination of quality, affordability, and flexibility makes Aetna a popular and reliable option for many Medicare beneficiaries in Virginia.

Cigna: Best for Low-Cost Options

If keeping your out-of-pocket costs low is a major concern, Cigna is a provider worth a close look. They are recognized for their low-cost plans and high member satisfaction. A key feature of many Cigna plans is a $0 drug deductible, which means the plan starts paying for your prescriptions right away without you having to meet a deductible first. This can lead to significant savings, especially if you take multiple medications. With an overall rating of 4.8 out of 5 stars, Cigna proves that you don’t have to sacrifice quality to find an affordable plan that fits your budget.

Examples of Highly-Rated Plans in Virginia

As you compare your options, you’ll notice that some plans consistently receive high marks from Medicare. In Virginia, top-rated companies like UnitedHealthcare, Aetna, and Kaiser Permanente offer plans with 4 stars or higher. For example, the Aetna Medicare Choice (PPO) and various Kaiser Permanente Medicare Advantage plans are often noted for their high ratings. However, a high star rating is just the beginning. The best plan for you must also include your doctors in its network and cover your prescriptions affordably. This is where the details matter, and where working with an independent agent at The Big 65 can make a real difference. We can help you verify the specifics of any plan to ensure it’s the right match for your personal health needs.

HMO vs. PPO: Which Plan Type Is for You?

Medicare Advantage plans aren’t one-size-fits-all. They come in several different structures, and understanding the basics can help you narrow down your search. The most common types of Medicare Advantage Plans include Health Maintenance Organizations (HMOs), which typically require you to use doctors within their network and get a referral to see a specialist. Preferred Provider Organizations (PPOs) offer more flexibility to see out-of-network providers, usually at a higher cost. You might also come across Special Needs Plans (SNPs) for individuals with specific diseases or financial circumstances. Thinking about how you prefer to receive care can help you decide which plan type is right for you.

HMO Point-of-Service (HMO-POS) Plans

If you like the structure of an HMO but want a little more freedom, an HMO-POS plan might be a good fit. These plans are a hybrid, mixing the features of an HMO with some of the flexibility of a PPO. Just like a standard HMO, you’ll choose a primary care physician (PCP) to coordinate your care and will likely need referrals to see specialists. The key difference is that you have the option to see doctors and hospitals outside the plan’s network. Keep in mind that while you have this freedom, you will pay more for out-of-network care. This structure offers a middle ground, giving you a safety net for seeing other providers when needed.

Private Fee-for-Service (PFFS) Plans

Private Fee-for-Service (PFFS) plans offer a unique kind of flexibility. Instead of a defined network, these plans allow you to see any Medicare-approved doctor or hospital, as long as they agree to accept the plan’s payment terms and conditions. The important thing to remember is that you must confirm this with the provider before each visit, as not all doctors will accept the plan. This means your access to care can change from one appointment to the next. While Private Fee-for-Service (PFFS) plans provide freedom from traditional networks, they place more responsibility on you to verify acceptance of the plan each time you receive care.

Special Needs Plans (SNPs)

Special Needs Plans (SNPs) are a specific type of Medicare Advantage plan designed for individuals with particular health needs. Eligibility is limited to people who meet certain criteria. For example, some Special Needs Plans (SNPs) are for those with chronic conditions like diabetes or heart failure, while others are for people who live in a long-term care facility or are eligible for both Medicare and Medicaid. The main benefit of an SNP is that its benefits, provider choices, and drug formulary are tailored to the specific needs of its members. They offer specialized care coordination to help you manage your condition more effectively, providing a more focused approach to your healthcare.

Are There $0 Premium Plans Available?

It might sound too good to be true, but it’s possible to find a Medicare Advantage plan with a $0 monthly premium. In fact, every person eligible for Medicare in Virginia has access to at least one of these plans. A zero-premium plan can be a fantastic way to get extra benefits beyond Original Medicare without adding another monthly bill. Just keep in mind that “zero premium” doesn’t mean zero cost. You will still be responsible for other out-of-pocket expenses like deductibles, copayments when you visit a doctor, and coinsurance for services. It’s important to look at the total potential cost, not just the monthly premium.

Confirming Your Local Coverage Options

Before you enroll in a plan, one of the most important steps is to check its provider network. These plans operate within specific service areas and have contracts with a network of doctors, hospitals, and specialists. Some plans, like PPOs, may allow you to get care from providers outside the network, but it will almost always cost you more. You can usually find a provider directory on the insurance company’s website, like these for Virginia UnitedHealthcare Medicare Advantage Plans. Always take the time to confirm that your trusted doctors and preferred hospitals are included to avoid any unexpected and expensive bills down the road.

Potential Downsides of Medicare Advantage Plans

While the extra benefits and low premiums of Medicare Advantage plans are certainly attractive, it’s important to understand the trade-offs. These plans work differently than Original Medicare, and some of those differences can create challenges depending on your health needs and lifestyle. Knowing about these potential drawbacks ahead of time helps you weigh your options more clearly. By looking at the complete picture—both the pros and the cons—you can make a choice that you feel confident about for the year ahead.

Limited Provider Networks

The most significant difference from Original Medicare is that Medicare Advantage plans use local provider networks. Unlike Original Medicare, which is accepted by most doctors and hospitals nationwide, these plans require you to use specific healthcare providers in your service area. The most common plan types are HMOs and PPOs. With an HMO, you generally must use doctors and hospitals within the plan’s network for your care to be covered. A PPO offers more flexibility to see out-of-network providers, but you’ll pay more for it. This is why it is absolutely essential to check the plan’s provider directory to ensure your trusted doctors are included before you enroll.

Prior Authorization Requirements

Because your care is managed by a private insurance company, Medicare Advantage plans often require prior authorization for certain services, procedures, or medications. This means the plan must approve a treatment as medically necessary before it will cover the cost. While this process is designed to control costs, it can sometimes lead to delays in receiving care. You or your doctor may need to submit paperwork and wait for the insurance company’s decision. This is a common frustration for members and a notable difference from Original Medicare, where prior authorization is rarely required for most services.

Inconsistent Coverage Across States

Medicare Advantage plans are designed to be local. As a result, your coverage is tied to the specific county or service area where you live. This can be a major drawback if you travel frequently or live in different states throughout the year. While all plans must cover emergencies anywhere in the U.S., routine care while traveling is typically only covered within your plan’s network and service area. If you see a doctor for a non-emergency issue while you’re away, you could be responsible for the entire bill. This stands in sharp contrast to Original Medicare, which provides the same level of coverage no matter where you are in the country.

How to Find the Right Plan for You

With so many options available, picking the right Medicare Advantage plan can feel like a huge task. But it doesn’t have to be. The best plan is simply the one that fits your unique health needs, budget, and lifestyle. By breaking it down into a few key areas, you can confidently compare plans and find the perfect match. Let’s walk through the most important factors to consider.

Start with Your Personal Health Needs

Start by taking a moment to think about your health. Are you managing a chronic condition? Do you anticipate needing any specific medical services in the coming year? While all Medicare Advantage plans must cover everything Original Medicare (Parts A and B) does, many offer valuable extras. In Virginia, it’s common for plans to include benefits for dental, vision, hearing, and even fitness programs. Making a list of your health priorities will help you spot the plans that offer the benefits you’ll actually use, ensuring you get the most value from your coverage.

Make Sure Your Doctors Are In-Network

One of the biggest differences between plans is their provider network. Most Medicare Advantage plans require you to use doctors, specialists, and hospitals within their network to receive the lowest costs. This means you have a bit less flexibility than with Original Medicare. Before you commit to a plan, it’s crucial to check if your current doctors are included. Make a list of the providers you want to keep seeing and have it handy when you compare plans. If you value flexibility, you might look for a PPO plan, which allows for out-of-network care, though usually at a higher cost.

Does the Plan Cover Your Prescriptions?

Forgetting to check prescription drug coverage is a common and costly mistake. Most Medicare Advantage plans include prescription drug benefits (Part D), but they don’t all cover the same medications. Each plan has its own list of covered drugs, called a formulary. It’s important to check the formulary for each plan you’re considering to make sure your specific medications are included. Also, pay attention to how the plan categorizes your drugs into different “tiers,” as this will affect your copay. Understanding these details upfront can save you from unexpected expenses at the pharmacy.

Weighing the Dental, Vision, and Hearing Perks

The extra benefits are often what make Medicare Advantage plans so appealing. Perks like dental cleanings, new eyeglasses, hearing aids, and gym memberships can make a real difference in your health and budget. As you compare plans, think about which of these extras you will realistically use. A plan with a robust dental benefit is fantastic if you need it, but less valuable if you already have separate dental insurance. Some plans even offer allowances for over-the-counter items. Comparing these benefits can help you see how a plan might be cheaper overall than combining Original Medicare with other standalone policies.

When Can You Enroll or Switch Plans?

Finally, it’s important to know when you can sign up for or change your plan. You can enroll in a Medicare Advantage plan when you first become eligible for Medicare. After that, your main opportunity to make changes is during the Annual Enrollment Period each fall. However, certain life events—like moving or losing other coverage—can qualify you for a Special Enrollment Period. Understanding these windows ensures you won’t miss your chance to get into a plan that’s a better fit for your needs.

Where to Find Help and Resources

Sorting through Medicare plans can feel like a monumental task, but you don’t have to do it alone. Virginia offers several reliable resources designed to give you clear, unbiased information. Whether you prefer attending a workshop, doing your own research online, or getting one-on-one advice, there are excellent support systems in place to help you make a confident decision about your healthcare coverage.

Connect with Virginia’s Insurance Counseling Program

If you’re looking for personalized, local assistance, a great place to start is the Virginia Insurance Counseling and Assistance Program (VICAP). This state-run program is dedicated to helping Virginians with Medicare. They offer free, confidential counseling to help you understand your benefits and options. VICAP also leads “Medicare 101 Workshops” for new beneficiaries and their family members, which are perfect for getting a solid overview of how everything works. It’s a fantastic resource for getting your specific questions answered by trained counselors who know the ins and outs of Virginia’s Medicare landscape.

Using Official Medicare Resources

For direct-from-the-source information, the official Medicare website is invaluable. It’s a comprehensive tool for learning about your different coverage choices. The site clearly explains that Medicare health plans, like Medicare Advantage, are another way to receive your Part A and Part B benefits outside of Original Medicare. You can use the website’s plan-finder tool to compare plans available in your area, check drug coverage, and see what your estimated costs might be. Taking some time to explore the site can help you feel more prepared and knowledgeable as you weigh your options.

Other Virginia State and Local Resources

Beyond counseling and online tools, Virginia also offers direct financial support for those who qualify. If you’re concerned about how healthcare costs will fit into your budget, it’s worth looking into the state’s Medicare Savings Programs (MSPs). These programs are designed to help individuals with limited income and resources pay for their Medicare costs. Depending on which program you qualify for, you could get help with your Part A and Part B premiums, and sometimes even your deductibles, coinsurance, and copayments. This assistance can make a huge difference in your monthly budget, so it’s always worth checking to see if you’re eligible. You can learn more about the specific income requirements for Virginia’s Medicare Savings Programs and how to apply.

Finding Free, Unbiased Assistance

In Virginia, you have access to several free assistance programs designed to help you understand your Medicare choices without any cost. VICAP is a primary example, and it works alongside the Senior Medicare Patrol to protect beneficiaries. Together, they work to “educate and empower beneficiaries to take an active role in detecting and preventing health care fraud and abuse.” Using these services not only helps you find the right plan but also equips you with the knowledge to be a savvy healthcare consumer, ensuring you can spot and report any potential issues with billing or services.

Should You Talk to a Licensed Agent?

For advice that’s tailored specifically to your health needs and financial situation, working with a licensed insurance agent can be incredibly helpful. Unlike general resources, an agent can sit down with you, listen to your priorities—like keeping your current doctors or managing prescription costs—and help you compare the specific plans available in your ZIP code. They do the heavy lifting of sifting through dozens of options to find the few that are a good fit for you. This one-on-one guidance can simplify the entire process and give you peace of mind that you’ve chosen a plan that truly works for you.

How to Manage Your Medicare Advantage Plan

Once you’ve enrolled in a Medicare Advantage plan, the work isn’t over. Think of your plan as something you actively manage, not just something you have. Your health needs can change, and so can the details of your plan. Staying on top of your coverage ensures it continues to serve you well year after year.

Managing your plan involves a few key steps. You’ll want to review it annually to catch any changes from the insurance company. It’s also important to know how and when you can make changes if the plan is no longer the right fit. Finally, a big part of managing your plan is simply using it to its full potential. This means taking advantage of all the preventive care and extra benefits it offers to stay as healthy as possible. By being proactive, you can make sure your healthcare coverage keeps up with your life.

Why an Annual Plan Review Is a Must

Every fall, your Medicare Advantage plan will send you an Annual Notice of Change (ANOC). This document is your roadmap for the upcoming year, and it’s essential to review it carefully. Insurance companies can change their offerings each year, which means your plan’s costs, benefits, and even its network of doctors and hospitals could be different.

Your own health needs might have changed, too. Perhaps you have a new diagnosis, need a new prescription, or want to see a specialist. An annual review is your chance to check if your current plan still aligns with your health and budget. This is the best way to avoid surprises and confirm you have the right coverage before the new year begins.

How to Switch Plans if Yours Isn’t Working

If your annual review reveals that your plan is no longer a good fit, you have options. The Medicare Annual Enrollment Period, which runs from October 15 to December 7, is your primary opportunity to switch to a different Medicare Advantage plan or return to Original Medicare.

Sometimes, life events give you a Special Enrollment Period to make changes outside of the standard window. For example, if you move out of your plan’s service area or if your plan stops participating in Medicare, you won’t be left without coverage. You’ll be given a special time frame to choose a new plan that better suits your new circumstances.

Don’t Miss Out on Preventive Care

One of the best features of Medicare Advantage plans is the focus on preventive health. These plans cover a wide range of services designed to keep you healthy and catch problems early. If you’ve had Medicare Part B for over a year, you’re eligible for a yearly “Wellness” visit. This isn’t a typical physical; it’s a conversation with your doctor to create a personalized prevention plan based on your health and risk factors.

Beyond the wellness visit, your plan likely covers screenings, vaccines, and other preventive services at no extra cost. Don’t let these benefits go to waste. Check your plan’s documents to see what’s included and schedule your appointments. Taking these small steps can have a big impact on your long-term health.

Tips for Maximizing Your Plan’s Value

To truly get the most from your plan, you need to understand its financial structure. Take time to review the monthly premium, annual deductible, and the copays or coinsurance you’ll owe for services. Knowing these figures helps you budget for your healthcare expenses and avoid unexpected bills.

Many Medicare Advantage plans also offer extra benefits not covered by Original Medicare, such as dental, vision, and hearing services, or even gym memberships. These perks can add significant value and support your overall well-being. Make a list of the extra benefits your plan provides and make a point to use them. You’re paying for this coverage, so it’s important to use all the features available to you.

Frequently Asked Questions

If I enroll in a Medicare Advantage plan, am I still covered by Medicare? Yes, you are absolutely still in the Medicare program. Think of a Medicare Advantage plan as a different way to receive your benefits. Instead of the government paying your claims directly, a private insurance company that is approved by Medicare manages your care. These plans are required by law to cover everything that Original Medicare (Parts A and B) covers, so you aren’t losing your core hospital and medical benefits.

Are the $0-premium plans actually free? While it’s true that many plans have a $0 monthly premium, that doesn’t mean all your healthcare will be free. You are still responsible for paying your monthly Medicare Part B premium to the government. Additionally, you will have out-of-pocket costs like deductibles, copayments, and coinsurance when you visit the doctor or receive services. It’s important to look at a plan’s total potential costs, not just the premium.

What if my favorite doctor isn’t in a plan’s network? This is a critical question to ask before you enroll. Most Medicare Advantage plans use a network of specific doctors and hospitals. If you choose an HMO plan, you generally must use providers within that network for your care to be covered. A PPO plan offers more flexibility to see out-of-network doctors, but you will almost always pay more for that visit. The best first step is to check the plan’s provider directory to see if your doctors are included.

Can I change my mind after I pick a plan? You are not locked into a plan forever. If you find that your plan isn’t working for you, you can make a change during the Annual Enrollment Period, which happens every fall from October 15 to December 7. During this time, you can switch to a different Medicare Advantage plan or return to Original Medicare. Certain life events, like moving, may also give you a Special Enrollment Period to change plans outside of that window.

Why do I need to review my plan every year if my health hasn’t changed? It’s a great habit to review your plan annually because insurance companies can, and often do, make changes each year. Your plan’s provider network, drug formulary, premiums, and copayments can all be different from one year to the next. Taking a little time to read the Annual Notice of Change document your plan sends you ensures you won’t be caught off guard by a change that could affect your costs or your care.

For more information on Medicare in Virginia, visit https://thebig65.com/virginia-medicare-insurance-broker/