Get answers to the most common Medicare and insurance questions from Virginia residents. Our expert guidance helps you make informed decisions about your coverage.
Medicare is federal health insurance for people aged 65 and older, plus younger individuals with certain disabilities. Virginia residents qualify for Medicare if they're 65 or older and have worked at least 10 years (40 quarters) in Medicare-covered employment, or if they're under 65 with qualifying disabilities or End-Stage Renal Disease.
Medicare has four parts: Part A (hospital insurance) covers inpatient hospital stays, skilled nursing, hospice, and some home health care. Part B (medical insurance) covers doctor visits, outpatient care, and medical supplies. Part C (Medicare Advantage) is an alternative that combines Parts A, B, and usually D through private plans. Part D covers prescription drugs.
It depends on your situation. If you have employer insurance past age 65, you may be able to delay Medicare Part B without penalties. However, you should generally enroll in Medicare Part A at 65 since it's usually premium-free. If you have retiree health insurance, Medicare typically becomes your primary coverage. We recommend reviewing your specific situation with a Virginia Medicare specialist.
With Original Medicare (Parts A and B), you can see any doctor or visit any hospital in Virginia that accepts Medicare, which is most providers. With Medicare Advantage plans, you typically need to use doctors and hospitals in the plan's network, though emergency care is covered anywhere in the United States.
Your Initial Enrollment Period begins 3 months before your 65th birthday and ends 3 months after, giving you a 7-month window. If you're still working and have employer coverage, you may be able to delay enrollment without penalties. However, you should enroll in Medicare Part A at 65 since it's usually free for Virginia residents who worked and paid Medicare taxes.
Missing your Initial Enrollment Period can result in late enrollment penalties for Medicare Part B and Part D that last as long as you have Medicare. You'll also have to wait until the General Enrollment Period (January 1 - March 31) to enroll, with coverage starting July 1. There are some exceptions for those with qualifying employer coverage or other creditable coverage.
Yes, Virginia residents can change their Medicare plans during the Annual Open Enrollment Period (October 15 - December 7) each year. You can switch between Original Medicare and Medicare Advantage, change Medicare Advantage plans, or change Part D prescription drug plans. There's also a Medicare Advantage Open Enrollment Period from January 1 - March 31 for those already in Medicare Advantage plans.
You can enroll online at ssa.gov, call Social Security at 1-800-772-1213, visit a local Virginia Social Security office, or work with a licensed Medicare agent like Elite Care Advisors. If you're already receiving Social Security benefits, you'll be automatically enrolled in Medicare Parts A and B when you turn 65.
Medicare Part A is premium-free for most Virginia residents. In 2025, the standard Part B premium is $185 per month, though higher-income earners pay more through IRMAA (Income-Related Monthly Adjustment Amount). Medicare Advantage plans often have $0 premiums, while Medigap premiums vary by age, location in Virginia, and plan type. Part D premiums vary by plan.
In 2025, Medicare Part A has a $1,676 deductible per benefit period. Part B has a $240 annual deductible, then you typically pay 20% of Medicare-approved amounts. Medicare Advantage and Medigap plans have different cost-sharing structures. The specific amounts depend on which plan you choose and where you live in Virginia.
Yes, Virginia residents with higher incomes pay Income-Related Monthly Adjustment Amounts (IRMAA) for Medicare Parts B and D. In 2025, IRMAA applies to individuals with incomes over $106,000 and couples over $212,000. The surcharge is based on your income from two years prior, as reported on your tax return.
Original Medicare covers many medical services but has gaps, including most dental care, vision care, hearing aids, and long-term care. It also has no out-of-pocket maximum. Many Virginia residents choose Medicare Advantage plans or Medigap policies to fill these gaps. We can help you understand what's covered and recommend additional coverage if needed.
Medicare Advantage plans are offered by private companies and replace Original Medicare. They include everything Original Medicare covers plus usually prescription drug coverage (Part D) and often extra benefits like dental, vision, hearing aids, and wellness programs. However, Medicare Advantage plans typically have network restrictions, while Original Medicare allows you to see any provider that accepts Medicare.
Yes, Medicare Advantage plans are widely available across Virginia, though the specific plans and carriers vary by county. Urban areas like Virginia Beach, Norfolk, Richmond, and Northern Virginia typically have more plan choices than rural areas. Each plan has its own network of doctors and hospitals, so it's important to verify your providers are included.
Yes, Virginia residents can switch from Medicare Advantage back to Original Medicare during the Annual Open Enrollment Period (October 15 - December 7) or the Medicare Advantage Open Enrollment Period (January 1 - March 31). However, if you want Medigap coverage, you may have to go through medical underwriting unless you qualify for a guaranteed issue right.
Most Medicare Advantage plans in Virginia include prescription drug coverage (Part D), but not all. If your Medicare Advantage plan doesn't include drug coverage, you can enroll in a standalone Part D plan. However, you cannot have both a Medicare Advantage plan and a separate Medigap policy.
Medigap (Medicare Supplement) is insurance sold by private companies that helps pay some of the health care costs that Original Medicare doesn't cover, like copayments, coinsurance, and deductibles. Virginia residents with Original Medicare often choose Medigap to have predictable healthcare costs and the freedom to see any doctor who accepts Medicare.
The best time to buy Medigap in Virginia is during your 6-month Medigap Open Enrollment Period, which starts when you're 65 or older and enrolled in Medicare Part B. During this time, you have a guaranteed right to buy any Medigap policy sold in Virginia, regardless of health problems. Outside this period, you may have to go through medical underwriting.
The "best" Medigap plan depends on your individual needs and budget. Plan G is popular because it covers most out-of-pocket costs while having lower premiums than Plan F. Plan N offers lower premiums but requires small copayments for doctor visits and emergency room visits. High-deductible options like Plan G with a high deductible can work well for healthy individuals who want lower premiums.
You can apply to switch Medigap plans anytime in Virginia, but insurance companies can use medical underwriting to decide whether to accept you (except during certain guaranteed issue situations). This means they can deny coverage or charge higher premiums based on your health. It's generally best to choose carefully during your initial enrollment period.
A common guideline is 8-12 times your annual income, but your specific needs depend on factors like your mortgage, children's education costs, debts, and other financial obligations. Virginia residents should also consider the cost of living in their area - Northern Virginia has higher costs than rural areas. We can help you calculate the right amount based on your specific situation.
Term life insurance provides coverage for a specific period (10, 20, or 30 years) and is typically much less expensive. Whole life insurance provides permanent coverage with a savings component that builds cash value. Term is often best for young Virginia families who need maximum coverage at low cost, while whole life can be useful for estate planning and long-term financial goals.
Yes, many Virginia residents with health issues can still get life insurance. Options include simplified issue policies with limited health questions, guaranteed issue policies that accept everyone (usually with waiting periods), and working with companies that specialize in covering people with specific conditions like diabetes or heart disease.
It depends on your situation. If you have a spouse who depends on your Social Security or pension income, life insurance can help replace that income. Life insurance can also help with final expenses, pay off remaining debts, equalize inheritances among children, or provide a legacy for grandchildren or charities. Final expense insurance is a popular option for Virginia seniors.
Original Medicare generally doesn't cover routine dental care like cleanings, fillings, or dentures. Some Medicare Advantage plans in Virginia include dental benefits, but coverage varies by plan. Many Virginia seniors choose separate dental insurance or dental discount plans to help with dental costs.
Cancer insurance pays cash benefits directly to you when you're diagnosed with cancer, helping cover expenses like deductibles, copayments, travel to treatment centers, and income replacement. While your health insurance covers medical costs, cancer insurance helps with the indirect costs of cancer treatment. It can be valuable for Virginia residents with family history of cancer or those wanting extra financial protection.
Hospital indemnity insurance pays you a fixed daily amount for each day you're hospitalized, regardless of your actual medical expenses. For example, if your plan pays $200 per day and you're hospitalized for 5 days, you receive $1,000. This money can be used for any purpose - hospital deductibles, lost income, childcare, or other expenses while you're unable to work.
Specialty insurance can be valuable for filling gaps in your health coverage. Virginia residents might consider dental insurance if they don't have coverage through Medicare Advantage or employer plans, cancer insurance if they have family history or want extra protection, and hospital indemnity insurance to help with high-deductible health plans or to supplement Medicare coverage.
These FAQs cover the most common questions we receive from Virginia residents, but every situation is unique. If you don't see your specific question answered here, or if you need personalized guidance for your individual circumstances, our licensed insurance professionals are here to help.
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Social Security Questions
When should I start taking Social Security benefits in Virginia?
You can start as early as age 62, but your benefits will be permanently reduced. Your full retirement age is between 65-67 depending on when you were born. If you wait until age 70, your benefits increase by 8% per year after full retirement age. The best strategy depends on your health, financial needs, and whether you're married. Virginia residents should consider their complete financial picture when deciding.
How does working affect my Social Security benefits?
If you claim Social Security before your full retirement age and continue working, your benefits may be reduced if you earn over certain limits. In 2025, if you're under full retirement age, you can earn up to $23,400 without affecting benefits. Once you reach full retirement age, there's no limit on how much you can earn while receiving full Social Security benefits.
Can I get Social Security benefits based on my ex-spouse's record?
Yes, if you were married for at least 10 years, you're currently unmarried, and you're at least 62 years old. You can receive up to 50% of your ex-spouse's full retirement benefit if it's more than your own benefit. Your ex-spouse doesn't have to be retired or even know you're applying. This doesn't affect their benefits or their current spouse's benefits.
How do I coordinate Social Security with Medicare enrollment?
If you're receiving Social Security when you turn 65, you'll be automatically enrolled in Medicare Parts A and B. If you're not receiving Social Security, you need to actively enroll in Medicare. If you delay Social Security but are 65, you should still enroll in Medicare Part A (it's usually free) and decide about Part B based on whether you have other coverage.