Jane Dotson
Medicare provides health insurance for Americans aged 65 and older who have paid into the system through payroll tax. It also covers younger people with disabilities, end-stage renal disease, or amyotrophic lateral sclerosis (ALS). In Virginia, over 1.6 million residents are enrolled in Medicare, with more than one-third opting for Medicare Advantage Plans. To apply for Medicare, individuals should contact the Social Security Administration, preferably 3 months before their 65th birthday or within 3 months after, to avoid late enrollment penalties. Those under 65 and disabled should apply after receiving disability benefits for 24 months. In Virginia, Medicaid can assist low-income individuals with Medicare costs, and Medicare Advantage Plans may offer extra benefits like vision, hearing, and dental coverage.
| Characteristics | Values |
|---|---|
| Who is eligible for Medicare in VA? | Americans aged 65 and older who have worked and paid into the system through payroll tax. Younger people with a disability status as determined by the Social Security Administration, as well as people with end-stage renal disease and amyotrophic lateral sclerosis (ALS). |
| How to apply for Medicare in VA | Contact Social Security to enroll, preferably 3 months before your 65th birthday. You can call 1-800-MEDICARE (1-800-633-4227) for more information. You can also apply online at medicare.gov. |
| What does Medicare cover in VA? | Hospital insurance (Part A), medical insurance (Part B), and prescription drug coverage (Part D). Medicare Advantage Plans (Part C) are also available and may offer extra coverage such as vision, hearing, and dental. |
| What is the initial enrollment period for Medicare? | The 3 months before your birthday, the month of your birthday, and the 3 months after your birthday. Enrollment outside of this period may result in penalties. |
| Is Medicaid available in VA? | Yes, Medicaid is available and can coordinate with traditional Medicare or Medicare Advantage. Medicaid provides health care, behavioral health, and long-term services for people with limited incomes and assets who meet eligibility requirements. |
| What is a Medigap plan? | Medigap plans are sold by private insurers and provide additional coverage on top of original Medicare. As of 2022, 437,832 Medicare beneficiaries in Virginia had Medigap coverage. |
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What You'll Learn
Eligibility requirements for Medicare in VA
Medicare is a federal health insurance program for people aged 65 or older. However, eligibility requirements vary depending on individual circumstances. Here are the key eligibility requirements for Medicare in Virginia:
Age
Medicare is primarily designed for individuals aged 65 or older. The initial enrollment period for Medicare starts three months before your 65th birthday, includes the month of your birthday, and ends three months after you turn 65. A total of seven months. Enrolling outside this initial period may result in penalties.
Disability
Individuals under 65 with a disability may also be eligible for Medicare. This includes people with End-Stage Renal Disease (ESRD) or permanent kidney failure requiring dialysis or a transplant, as well as those with amyotrophic lateral sclerosis (ALS) or Lou Gehrig's disease.
Income and Assets
Medicare Savings Programs are available for individuals with limited incomes and assets. These programs can help with Medicare costs, including prescription drug costs through the Extra Help program.
Social Security Benefits
If you are already receiving Social Security retirement or disability benefits, you may be automatically enrolled in Medicare. If you start receiving these benefits at least four months before turning 65, you can sign up for Medicare at the same time.
Medicare Parts
Medicare has different parts that cover specific services. Part A covers hospitalisation, skilled nursing, and hospice care, while Part B covers medical insurance. Part C, also known as Medicare Advantage Plans, is a private insurance option. Part D covers prescription medications, and you must have Parts A and B to join a Medicare Prescription Drug Plan.
To learn more about your specific eligibility and coverage options, you can visit the official Medicare website or contact their support services.
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Medicare Advantage Plans
In Virginia, Medicare Advantage Plans are offered by various providers, including Anthem and UnitedHealthcare. These plans may vary by region or county and may include different benefits such as prescription drug coverage, dental, vision, and hearing. Some plans also offer a prepaid benefits card to help with the cost of utilities, groceries, and over-the-counter health items.
Before enrolling in a Medicare Advantage Plan, it is important to consider the potential impact on your existing coverage. Joining a Medicare Advantage Plan might cause you to lose your employer or union coverage, and this could extend to your spouse and dependents. It is recommended to speak with your employer, union, or benefits administrator about their rules before enrolling.
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Part A and Part B enrollment
Part A of Medicare, also known as hospital insurance, covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health care services. Most people over 65 are automatically enrolled in Part A without having to pay a monthly premium as they would have paid Medicare taxes while working. If you are not eligible for premium-free Part A, you may be able to buy it, but in most cases, if you buy Part A, you must also have Part B.
Part B of Medicare, also known as medical insurance, covers doctor's services, outpatient hospital care, durable medical equipment, laboratory tests, x-rays, and some home health care. Part B enrollment is voluntary, and you will be charged a monthly premium for this coverage. Your premium can vary based on your income and when you signed up for the coverage. If you are over 65 and still working, you can delay enrolling in Part B coverage without paying a penalty if you are covered under an employer's or spouse's health plan. You will have to contact the SSA and inform them that you want to waive your right to Part B coverage. You have eight months to notify Medicare and sign up for Part B without penalty after your job-related insurance coverage ends.
If you are under 65 and disabled, you will be eligible for Part A and Part B after receiving disability benefits from Social Security or certain RRB disability benefits for 24 months. If you are enrolled automatically, you will receive a Medicare card in the mail three months before your 65th birthday or your 25th month of disability benefits. You will be given instructions to decline Part B coverage if you do not want it. If you are not automatically enrolled, you will need to sign up for Part A and Part B benefits if you are 65 or older but not receiving Social Security or Railroad Retirement Board benefits.
The initial enrollment period for Medicare starts three months before your 65th birthday and ends three months after your birthday. The federal government advises signing up for Medicare three months before your birthday so that it is effective from your birthday month. If you fail to enroll during this seven-month eligibility period, you can enroll between January 1 and March 31 of any year after you become eligible, but you will have to pay a penalty for late enrollment. This penalty is 10% for every 12 months that you were eligible but did not sign up, and you will have to pay this extra amount for the rest of your life.
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Medicaid and Medicare coordination
In Virginia, Medicaid is a federal and state program that covers health care, behavioural health, and long-term services for people with limited incomes and assets who meet the eligibility requirements. Some individuals may qualify for both Medicare and Medicaid, and they are known as 'dual eligibles'. Medicare provides health insurance for Americans aged 65 and above who have paid into the system through payroll tax. It also covers younger people with disabilities, as determined by the Social Security Administration, as well as those with end-stage renal disease and amyotrophic lateral sclerosis (ALS).
Medicare is divided into several parts, each covering different aspects of healthcare:
- Part A (Hospital Insurance): Covers inpatient care in a hospital, skilled nursing facility, hospice care, and some home health care services. Most people over 65 automatically receive this coverage without paying a monthly premium as they have paid Medicare taxes while working.
- Part B (Medical Insurance): Covers doctor's services, outpatient hospital care, and some home health care. Part B is voluntary and requires a monthly premium, which can vary based on income and when you signed up.
- Part C (Medicare Advantage Plan): An alternative way to receive Medicare coverage. It requires having both Part A and Part B, and coverage is provided through a Medicare Advantage Plan, not Original Medicare. These plans may offer extra coverage, such as vision, hearing, and dental, and most include Medicare prescription drug coverage (Part D). There may be an additional monthly premium for this plan.
- Part D (Prescription Drug Coverage): Provided by insurance companies and private companies approved by Medicare. Part D is voluntary and requires a monthly premium, which can vary based on when you signed up.
Medicaid and Medicare can be coordinated to maximise benefits for individuals who qualify for both. Medicaid will always be the secondary insurance and can work in conjunction with either traditional Medicare or Medicare Advantage. Even if an individual enrolled in Medicare does not qualify for full-benefit Medicaid, they may still be enrolled in a Medicare Savings Program (MSP) where Medicaid will pay their Part B premium and, in some cases, share Medicare costs. Additionally, individuals in an MSP are also enrolled in the Medicare Part D Extra Help program, reducing prescription costs.
To apply for Medicare in Virginia, individuals can visit the Medicare website (medicare.gov) or call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. For Medicaid-specific information and application in Virginia, individuals can visit www.coverva.org or call 1-855-242-8282. They can also print and mail a paper application to their local Department of Social Services.
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Applying for Medicare online or over the phone
Applying for Medicare in Virginia can be done online or over the phone. The application process involves providing personal information, such as your full legal name, date of birth, Social Security Number, and Citizenship or Immigration Status. You may also need to provide tax filing information and details of your income.
If you are 65 or older, you can apply for Medicare Part A and Part B online at the Social Security website. Part A covers inpatient care in a hospital, skilled nursing facility, hospice care, and some home health care services. Most people over 65 are eligible for premium-free Part A if they or their spouse paid Medicare taxes while working. Part B covers medical insurance, including doctor's services, outpatient hospital care, and some home health care. There is a monthly premium for Part B, which can vary based on your income and when you signed up. You can choose to enrol in only Part A if you prefer.
If you are under 65, you may still be eligible for Medicare if you have a disability status recognised by the Social Security Administration, such as permanent kidney failure or end-stage renal disease (ESRD). In this case, you can call Social Security at 1-800-772-1213 to apply for Medicare Parts A and B, or Part A only. TTY users can call 1-800-325-0778. You can also apply online at medicare.gov. If you have ESRD, you may be eligible for the End Stage Renal Disease Program, which has special eligibility rules.
Additionally, you can apply for Medicare over the phone by calling Cover Virginia at 1-855-242-8282. This service is available Monday through Friday from 8:00 am to 7:00 pm and on Saturday from 9:00 am to 12:00 pm. You can also print out and complete a paper application, which can be mailed to your local Department of Social Services.
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Frequently asked questions
You can apply for Medicare by contacting the Social Security Administration. The initial enrollment period for Medicare is the 3 months before your 65th birthday, the month of your birthday, and the 3 months after your birthday. It is recommended that you apply at the earliest opportunity to ensure your coverage is in effect on time.
Medicare is divided into different parts, each covering specific services:
- Part A (Hospital Insurance) covers inpatient care in a hospital, skilled nursing facility, hospice care, and some home health care services.
- Part B (Medical Insurance) covers doctor's services, outpatient hospital care, and some home health care.
- Part D (Prescription Drug Coverage) helps cover the cost of prescription medications and is offered by insurance companies approved by Medicare.
Original Medicare is the traditional government-provided insurance that covers the services mentioned in Part A and Part B. Medicare Advantage Plans (MA) are offered by private companies and may offer additional benefits such as vision, hearing, and dental coverage. These plans may have different copays and eligibility standards compared to Original Medicare.
