Fifty-two percent of Virginia's Medicare beneficiaries have Part D.
Virginia had more than one million Medicare beneficiaries as of May 2010, according to the Kaiser Family Foundation. Medicare offers affordable health insurance for seniors and comes in four parts. Parts A and B, Original Medicare, are generally bought from the federal government, but Part C, also called Medicare Advantage, allows you to get your Part A and B benefits from private insurance companies. Part D only covers prescription drugs. The federal government controls Original Medicare but Virginia's Medicare Advantage and Part D plans are sold by local service areas and are overseen by the Virginia Bureau of Insurance.
Original Medicare
Original Medicare is standardized and offers the same benefits no matter where you live. Part A has benefits for home health services, hospice care and inpatient hospitalizations, while Part B covers outpatient services, vaccinations, doctor visits and preventive care. Part A is premium-free if you have paid 10 years of Medicare taxes, but does come with copays and deductibles. Part B does have monthly premiums as well as other out-of-pocket costs. Once they approach the age of 65, Virginia residents can sign up for Part A and/or Part B Medicare through their local Social Security Administration office. A list of Virginia Social Security offices is available at the Social Security Online website.
Medicare Advantage
Medicare Advantage, Part C Medicare, is sold in Virginia as private fee-for-services plans, HMO plans and PPO plans. PFFS policies work like traditional health insurance policies. You can see any doctor who takes your plan and usually have to submit your insurance claims yourself. Premiums are higher than for other Medicare Advantage plans but you have free choice of health care providers. HMO policies have lower copays and premiums, but you are required to choose a primary care physician and see only health care providers that are part of your insurance company's network. PPOs generally offer lower costs if you stay in their networks. You are allowed to go outside the network, but you will pay higher fees. Most Virginia MA policies are sold by county, but as of 2011, the Humana Choice PPO was available across the state.
Part D
Medicare Part D helps to cover the costs of prescription medications. But not all Part D plans cover the same prescriptions. Copays and monthly premiums differ by plan and by company. As of 2011, Virginia had 44 different Medicare Part D plans available to residents. These include the Humana Walmart-Preferred Rx, the AARP MedicareRx Preferred, the Bravo Rx and the Aetna Medicare Rx Premier.
Virginia Dual Eligibles
Low-income Medicare users may be able to receive help paying their out-of-pocket costs through Virginia's Medicare Savings Programs. Medicare users who meet certain income and asset limitations may receive help paying premiums, copays or deductibles, depending on which program they qualify for. There are three basic categories of Medicare Savings Programs in Virginia: Qualified Medicare Beneficiary, Specified Low-Income Beneficiary and Qualified Individual. Qualified Medicare Beneficiaries receive the most help but have the lowest maximum asset and income limits. Qualified Individuals have the highest income limit but receive help only for paying the Part B premium.
Tags: Medicare Advantage, Original Medicare, Virginia Medicare, Part Medicare, Part plans, receive help
