Medicare in Virginia

Key takeaways

More than 1.6 million residents are enrolled in Medicare in Virginia.¹
More than one-third of Virginia Medicare beneficiaries (38%) are enrolled in Medicare Advantage plans.¹
More than 1.2 million Virginia Medicare beneficiaries have Medicare Part D prescription drug coverage, either under stand-alone plans or as part of their Medicare Advantage coverage.¹
There are 16 stand-alone Medicare Part D prescription drug plans available in Virginia for 2025, with premiums starting at $0 per month.²

Virginia Medicare enrollment

1,687,566 residents were covered by Medicare in Virginia as of September 2024.¹ Most Americans become eligible for Medicare enrollment when they turn 65. But nationwide, there are over 7 million people under the age of 65 who have Medicare coverage.³ This is because Medicare eligibility is also triggered once a person has been receiving disability benefits for 24 months, or has kidney failure or amyotrophic lateral sclerosis (ALS). As of September 2024, more than 175,000 Medicare beneficiaries in Virginia were under the age of 65,¹ accounting for more than 11% of the state’s Medicare population.

The annual Medicare coverage enrollment window (Medicare Annual Election Period) runs from October 15 to December 7 each year, and allows Medicare beneficiaries the chance to switch between Medicare Advantage plan enrollment and Original Medicare, and the option to add, drop, or switch to a different Medicare Part D prescription drug plan. People who are already enrolled in Medicare Advantage also have the option to switch to a different Medicare Advantage plan or to Original Medicare during the Medicare Advantage open enrollment period, which runs from January 1 to March 31.

Read our guide to Medicare’s open enrollment.
Understand the difference between Medigap, Medicare Advantage, and Medicare Part D.
Learn about how Virginia’s Medicaid program can provide financial assistance to Medicare beneficiaries with limited financial means (income and assets).

Learn about Medicare plan options in Virginia by contacting a licensed agent.

Explore our other comprehensive guides to coverage in Virginia

Frequently asked questions about Medicare in Virginia

What is Medicare Advantage?

Medicare beneficiaries can choose to get their healthcare coverage through Medicare Advantage plans, or directly from the federal government via Original Medicare (which includes hospital coverage via Medicare Part A and outpatient/medical coverage via Medicare Part B).

Medicare Advantage plans include the same covered benefits of Medicare Part A and Part B, and most plans include Part D prescription drug coverage as well as additional benefits such as gym memberships, nurse hotlines, and dental and vision coverage, as well as various other supplemental benefits.

But provider networks may be smaller with Medicare Advantage plans, and although monthly plan premiums may tend to be lower than they’d be with Original Medicare plus Medicare Part D prescription drug plan plus a Medigap plan, out-of-pocket costs may tend to be higher if the person has just a Medicare Advantage plan. There are pros and cons to either option, and the right solution depends on each enrollee’s circumstances and preferences.

Medicare Advantage plans are offered by private insurers, so plan availability varies from one area to another. There are 147 Medicare Advantage plans offered in Virginia for 2025,² but plan availability varies by county.⁴

As of 2018, less than 20% of Virginia Medicare beneficiaries were enrolled in Medicare Advantage plans; nationwide, the average was more than 35% at that point. As of September 2024, total Medicare Advantage plan enrollment in Virginia stood at 648,595 people, amounting to about 38% of the state’s Medicare population.¹

Most of those enrollees had Medicare Advantage plans, but there are also some people in Virginia who have Medicare Cost plans, which are a type of Medicare coverage. The rest of Virginia’s Medicare beneficiaries, amounting to more than one million people, had Original Medicare as of late-2024.¹

Nationwide, enrollment in Medicare Advantage plans has been steadily growing, and had reached about 50% of all beneficiaries as of 2024.³

Infographic regarding Medicare Advantage in Virginia

Medigap enrollment and regulations in Virginia

According to AHIP, 429,467 Virginia residents had Medigap plans in 2023,⁵ supplementing their Original Medicare coverage.

Learn how Medigap plans are regulated and standardized.

The Virginia State Corporation Commission has a Medigap plan comparison tool that residents can use to see available plans and premiums.

Federal rules only provide a guaranteed-issue right to Medigap coverage during a person’s initial six-month enrollment window (starting when they’re at least 65 and enrolled in Medicare Part A and B), and during limited special enrollment periods. Federal rules do not provide any sort of annual Medigap enrollment window. Federal rules also do not ensure access to Medigap policies for beneficiaries under the age of 65.

Virginia’s Medigap birthday rule

But states can establish more enrollment and plan change opportunities. Quite a few states have implemented Medigap “birthday rules” to provide an annual plan change opportunity, and Virginia joined them in 2025.

Since July 2025, Virginia has allowed Medigap enrollees to switch to any other insurer’s version of the policy they already have, during a 60-day window that starts on the enrollee’s birthday.⁶ The new policy is guaranteed-issue (meaning medical underwriting is not used) as long as it offers the same benefits as the old policy. So for example, someone with Medigap Plan N can use their birthday window to switch to another insurer’s Plan N. Virginia’s birthday rule is due to legislation that the state enacted in 2025.⁷

Virginia Medigap access for beneficiaries under age 65

Virginia is also among the states where at least some Medigap plans are guaranteed-issue for beneficiaries under age 65.

Since 2021, Virginia has required all Medigap insurers to make at least one policy available to disabled Medicare beneficiaries under age 65, at the same premium charged for age-65 applicants. Almost all of the insurers choose to offer Medigap Plan A,⁸ which is the least-comprehensive policy.⁹ Virginia Medicare beneficiaries under age 65 have a six-month Medigap enrollment window that begins when they’re enrolled in Medicare Part A and Part B.

As of 2024, Virginia’s Medigap access rule was expanded to include beneficiaries with end-stage renal disease (ESRD/kidney failure).⁶

When enrollees turn 65, they qualify for the federally required Medigap open enrollment period, which allows them access to all Medigap plans (as opposed to Virginia’s rule for under-65 applicants, which only requires each insurer to make one plan available).

What is Medicare Part D?

Original Medicare does not provide coverage for outpatient prescription drugs. Nationwide, more than 80% of Original Medicare beneficiaries supplemental coverage,¹⁰ and if these plans are offered by a current or former employer, they often include prescription benefits.

But Medicare Part D, created under the Medicare Modernization Act of 2003, provides prescription drug coverage for Medicare beneficiaries who do not have another source of coverage for prescription costs (this includes beneficiaries who are dually-eligible for both Medicare and Medicaid; their prescription coverage is provided via Part D).

Medicare beneficiaries can enroll in Medicare Part D prescription drug plans on a stand-alone basis, or obtain Medicare Part D prescription drug coverage integrated with a Medicare Advantage plan (not all Medicare Advantage plans include Medicare Part D prescription drug benefits, but most do). Both options are available for purchase (or plan changes) during the Medicare Annual Election Period that runs from October 15 to December 7 each year, with the new coverage effective January 1 of the coming year.

There are 16 stand-alone Medicare Part D prescription drug plans in Virginia for 2025, with premiums that start at $0 per month.²

As of September 2024, there were 655,337 Virginia beneficiaries with stand-alone Medicare Part D prescription drug coverage, and another 587,925 with Medicare Advantage plans that included integrated Medicare Part D prescription drug coverage.¹

Medicare Part D prescription drug plan enrollment is available when a person is first eligible for Medicare, and during the Medicare Annual Enrollment Period each fall, from October 15 to December 7. Plan selections and changes made during this window take effect on January 1.

Infographic regarding Medicare Part D in Virginia

What additional resources are available for Medicare beneficiaries and their caregivers in Virginia?

You can contact VICAP (Virginia Insurance Counseling and Assistance Program), with questions related to Medicare eligibility, enrollment, and coverage in Virginia.

The Virginia State Corporation Commission/Bureau of Insurance website offers a variety of information and resources about Medicare Advantage, Medicare Part D, and Medigap plans that are sold in Virginia. They can provide customer service, answer questions, and address complaints about entities they regulate, including health insurance companies and the brokers/agents who sell policies in the state.

This guide to Medicaid assistance for Medicare beneficiaries in Virginia is a useful resource that explains the various programs available to people with low income and asset levels, and how to apply for assistance.

Medicare Rights Center is a nationwide service, with a website and call center, where Medicare beneficiaries can get answers to their questions and assistance with understanding the eligibility and enrollment process for Medicare.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org.