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Medicare Part D in Virginia

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Medicare Part D is prescription drug coverage for Medicare beneficiaries. According to the Centers for Medicare and Medicaid Services (CMS) nearly a million (930,433) people are covered by Medicare Part D in Virginia in 2018. While this coverage is optional, many Medicare beneficiaries in Virginia chose Medicare Part D so they don’t have to pay all their prescription drug costs out of pocket. Original Medicare (Part A and Part B) generally doesn’t cover the prescription drugs you take at home. Although Part D coverage is optional, you may pay a late-enrollment penalty if you disenroll after the period that you’re initially eligible.

How can I get Medicare Part D in Virginia?

The first thing to decide is how you want to receive your Medicare Part A (hospital) and Medicare Part B (medical) insurance. If you chose to stay with Original Medicare, you can get a stand-alone Medicare Part D Prescription Drug Plan. According to CMS, about 74% of people with Part D in Virginia have stand-alone Medicare Part D prescription drug plans. There are 24 stand-alone Medicare Part D Prescription Drug Plans available in Virginia in 2018, according to CMS.

You also can chose to get your Medicare Part A and Part B benefits through Medicare Advantage. Medicare Advantage plans are offered by private insurance companies contracted with Medicare and must offer everything that Original Medicare offers (except hospice care which is still covered by Part A). Most Medicare Advantage plans in Virginia offer Part D coverage. This means with a Medicare Advantage plan you get hospital, medical, and prescription drug coverage all under one plan. Medicare Advantage plans also often offer extra benefits, such as routine vision, dental, and hearing. According to CMS, about 26% of Medicare beneficiaries in Virginia with Part D coverage have it through a Medicare Advantage Prescription Drug Plan. While not all plans are available in all areas, 100% of people with Medicare in Virginia have access to at least one Medicare Advantage plan.

What are the costs of Medicare Part D in Virginia?

Costs for Medicare Part D in Virginia include premiums, deductibles, and coinsurance/copayments.

  • A premium is the amount you pay monthly to have the plan. According to CMS, the lowest premium for a stand-alone Medicare Part D plan in Virginia in 2018 is $16.70
  • A deductible is the amount you pay out of pocket before the plan begins to pay. The deductible is regulated by Medicare and the maximum deductible in 2018 is $405. Some plans don’t have a deductible.
  • A copayment is a dollar amount, for example, $15, that you pay when you fill a prescription. A copayment is similar, but it’s a percentage, for example 10%. Part D plans often put prescription drugs on tiers. Prescription drugs on tier 1 (preferred generic) often cost less than prescription drugs on tier 2 (generic). Tier 3 (preferred brand) generally costs less than tier 4 (non-preferred). The most expensive tier is usually tier 5 (specialty drugs).

How do I enroll in Medicare Part D in Virginia?

 There are a number of times when beneficiaries may enroll in Medicare Part D coverage in Virginia. The first is the Initial Enrollment Period for Part D, which occurs when a beneficiary first becomes eligible for Medicare. The seven-month Initial Enrollment Period begins three months before the beneficiary becomes eligible for Medicare, includes the month of eligibility, and continues for three months afterward.

Beneficiaries may also enroll in or make changes to their Medicare prescription drug coverage during the Annual Election Period(AEP), also called Open Enrollment Period for Medicare Advantage and Medicare prescription drug coverage, which runs from October 15 to December 7 of each year. For beneficiaries who use the Medicare Advantage Open Enrollment Period (OEP) (January 1 to March 31) to disenroll from their Medicare Advantage plan , they will be returned to Original Medicare. They can also use this enrollment period to enroll in a stand-alone Medicare Prescription Drug Plan.

Beneficiaries may also be able make coverage changes outside of the regular periods with a Special Election Period, provided they have a qualifying situation, such as moving out of a plan’s service area.

To begin searching for Medicare prescription drug coverage in Virginia, type your zip code into the designated fields on this page.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply.

Benefits, premiums and/or copayments/co-insurance may change on January 1 of each year.

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