Virginia Medicare beneficiaries have access to a range of coverage options, state-specific protections, and free counseling services. This comprehensive Virginia Medicare guide covers your SHIP office contacts, Medigap plan availability, birthday rule protections, Medicare Savings Program eligibility, Medicare Advantage options, and how to compare plans. Whether you are turning 65, helping a parent navigate Medicare, or re-evaluating your coverage, understanding Virginia Medicare rules is essential for making informed decisions.
All information in this guide has been verified against official state sources, CMS data, and NAIC reports as of April 2026.
In This Virginia Medicare Guide:
Virginia SHIP — Free Medicare Counseling
Every state has a State Health Insurance Assistance Program (SHIP) that provides free, unbiased Medicare counseling. Virginia’s SHIP program can help you understand your coverage options, compare plans, resolve billing issues, and navigate enrollment periods at no cost.
| SHIP Program | Virginia Insurance Counseling and Assistance Program (VICAP) |
| Phone | 1-800-552-3402 |
| Website | https://www.shiphelp.org/ships/virginia/ |
SHIP counselors are trained volunteers and staff who are not affiliated with any insurance company. They do not sell plans. Contact your Virginia SHIP office before making any major Medicare decisions.
Virginia Medigap (Medicare Supplement) Plans
Medigap plans in Virginia help cover out-of-pocket costs not paid by Original Medicare, including the Part A deductible, Part B coinsurance, and skilled nursing facility copays. Medigap plans are standardized by federal law, meaning Plan G from one carrier covers the same benefits as Plan G from another carrier. The difference is premium cost.
Plans available in Virginia: A, B, C, D, F, G, K, L, M, N
Most popular plan: Plan G (approximately 42 percent of all Medigap enrollees in Virginia) is the most popular Medigap plan in Virginia. Plan G covers all gaps in Original Medicare except the annual Part B deductible ($240 in 2026). Plan N is the most popular lower-premium alternative, with small copays for some doctor visits and ER visits.
Pricing method: Virginia uses community-rated Medigap pricing. This is the most favorable method for consumers because premiums are the same regardless of age. Your premium will not increase simply because you get older.
The average monthly Plan G premium for a 65-year-old in Virginia is approximately $236. Plan N averages approximately $188 per month. Actual premiums vary by carrier, age, gender, tobacco use, and zip code. Always compare quotes from at least three carriers.
Virginia Medigap Birthday Rule
Virginia is one of the few states with a Medigap birthday rule. Effective July 1 2025, Virginia law requires Medigap insurers to offer a 60-day open enrollment period starting on the enrollees birthday each year. During this window the enrollee may switch to any Medigap policy with the same or lesser benefits offered by any insurer in Virginia without health underwriting. Insurers cannot charge more based on health status. New coverage begins on the first of the month following application.
This annual switching window gives Virginia Medicare beneficiaries an opportunity to change Medigap plans without medical underwriting, potentially finding lower premiums or better coverage. Not all states offer this protection.
Virginia guaranteed issue protections: Virginia provides the standard federal 6-month Medigap OEP plus the annual birthday rule 60-day guaranteed issue window. Virginia also requires Medigap insurers to offer coverage to disabled individuals under 65 who are enrolled in Medicare Parts A and B on a guaranteed renewable basis.
Virginia Medicare Advantage (Part C)
Approximately 1712896 people in Virginia are enrolled in Medicare. About 38 percent of Virginia Medicare beneficiaries choose Medicare Advantage plans, with the remainder on Original Medicare with or without Medigap supplement coverage.
Medicare Advantage plans in Virginia are offered by private insurers as an alternative to Original Medicare. Most MA plans include prescription drug coverage (Part D) and often add dental, vision, and hearing benefits. However, MA plans use provider networks, which can limit your choice of doctors and hospitals.
Key Medicare Advantage considerations in Virginia:
- Networks matter: HMO plans require you to use in-network providers except in emergencies. PPO plans allow out-of-network care at higher cost.
- $0 premium plans: Many Virginia MA plans have $0 monthly premiums (you still pay your Part B premium).
- Maximum Out-of-Pocket (MOOP): MA plans cap your annual spending, unlike Original Medicare which has no cap.
- Star ratings: CMS rates MA plans 1-5 stars. Higher-rated plans often have lower costs and better coverage.
Top Medicare Advantage carriers in Virginia by enrollment:
- UnitedHealthcare
- Anthem Blue Cross Blue Shield
- Humana
- Aetna
- Kaiser Permanente
Virginia Medicare Financial Help Programs
Virginia offers Medicare Savings Programs (MSPs) that help low-income Medicare beneficiaries pay for premiums, deductibles, and copays. The four programs are:
- QMB (Qualified Medicare Beneficiary): Pays Part A and Part B premiums, deductibles, coinsurance, and copays.
- SLMB (Specified Low-Income Medicare Beneficiary): Pays Part B premiums only.
- QI (Qualifying Individual): Pays Part B premiums (limited funding, first-come first-served).
- QDWI (Qualified Disabled Working Individual): Pays Part A premiums for disabled workers.
Virginia MSP eligibility: QMB: 1325 per month single or 1783 per month married. SLMB: 1585 per month single or 2135 per month married. QI: 1781 per month single or 2400 per month married. Asset limits: 9660 single or 14470 married.
Apply through your local SHIP office or your state Medicaid agency for free help determining eligibility.
Top Medicare Insurance Companies in Virginia
Top Medigap carriers in Virginia:
- Anthem Blue Cross Blue Shield
- AARP/UnitedHealthcare
- Mutual of Omaha
- Cigna
- Aetna
When comparing carriers, focus on premium cost (for identical standardized Medigap plans, benefits are the same — only price differs), financial strength ratings from AM Best (A or higher), customer satisfaction ratings, and claims processing speed.
Virginia Medicare Enrollment Periods
Understanding Medicare enrollment deadlines prevents costly late enrollment penalties:
- Initial Enrollment Period (IEP): 7-month window around your 65th birthday (3 months before, birthday month, 3 months after). Enroll in Parts A and B during this period.
- Medigap Open Enrollment: Standard federal 6-month period beginning the first day of the month the beneficiary is both age 65 or older and enrolled in Medicare Part B. Virginia does not extend this initial OEP beyond the federal 6 months but supplements it with the annual birthday rule.. During this period, insurance companies cannot deny you Medigap coverage or charge higher premiums based on health conditions.
- Annual Enrollment Period (AEP): October 15 through December 7 each year. Switch between Original Medicare and Medicare Advantage, change MA plans, or add/change Part D drug plans.
- Medicare Advantage Open Enrollment Period (OEP): January 1 through March 31. Switch MA plans or return to Original Medicare (and add a Medigap plan, subject to underwriting).
- Special Enrollment Periods (SEP): Available when you lose employer coverage, move, or qualify for other life events.
Additional Virginia Medicare protections: Birthday rule providing annual 60-day guaranteed issue window effective July 2025. 30-day free-look return period on all Medigap policies with full premium refund. Mandatory Medigap coverage for disabled Medicare beneficiaries under age 65 on a guaranteed renewable basis. Insurers must offer Plan A and either Plan D or G if they sell any Medigap plan in Virginia.
Compare Virginia Medicare Plans
Ready to compare Medicare options in Virginia? Use the official Medicare Plan Finder or contact your local SHIP counselor for free, unbiased help.
Official Sources & Resources
- Medicare.gov: medicare.gov
- Virginia State Corporation Commission Bureau of Insurance: https://www.scc.virginia.gov/consumers/insurance/
- Virginia Insurance Counseling and Assistance Program (VICAP): https://www.shiphelp.org/ships/virginia/
- CMS.gov: cms.gov
- NAIC: naic.org
This Virginia Medicare guide was last verified against official sources in April 2026. If you notice outdated information, please contact us.