Complete Guide to Virginia Medicare Part D Plans
Many of the plans featured here are available through our partner, HealthCompare, who may compensate us when you enroll. This does not influence our evaluations. Our opinions are our own, based on our independent research. Learn more about how we make money.
Welcome to our comprehensive guide on Medicare Part D plans in Virginia. As you explore your options, it's essential to understand the coverage available and how it can meet your prescription drug needs. With 16 plans to choose from, and an average premium of $52.88 per month, finding the right Medicare Part D plan can help you manage your healthcare costs effectively.
Our guide is designed to help you understand the essentials of Medicare Part D, including what’s covered and how to select the best plan for your situation. For a deeper dive into Medicare Part D, don't miss our comprehensive article on Medicare Part D.
Virginia Medicare Part D Plans
| Plan Name | Premium | Deduct. | Benefit | LIS | Rating |
|---|---|---|---|---|---|
| AARP Medicare Rx Preferred from UHC | $84.30 | $0 | {drug_benefit_category} | {lis} | |
| AARP Medicare Rx Saver from UHC | $59.50 | $590 | {drug_benefit_category} | {lis} | |
| Anthem MediBlue Rx Plus | $58.40 | $590 | {drug_benefit_category} | {lis} | |
| Anthem MediBlue Rx Standard | $76.80 | $590 | {drug_benefit_category} | {lis} | |
| Cigna Healthcare Assurance Rx | $89.70 | $590 | {drug_benefit_category} | {lis} | |
| Cigna Healthcare Extra Rx | $111.90 | $175 | {drug_benefit_category} | {lis} | |
| Cigna Healthcare Saver Rx | $17.80 | $590 | {drug_benefit_category} | {lis} | |
| Clear Spring Health Premier Rx | $73.40 | $590 | {drug_benefit_category} | {lis} | |
| Clear Spring Health Value Rx | $5.80 | $590 | {drug_benefit_category} | {lis} | |
| Humana Basic Rx Plan | $5.20 | $590 | {drug_benefit_category} | {lis} | |
| Humana Premier Rx Plan | $105.40 | $0 | {drug_benefit_category} | {lis} | |
| Humana Value Rx Plan | $16.00 | $573 | {drug_benefit_category} | {lis} | |
| SilverScript Choice | $28.20 | $590 | {drug_benefit_category} | {lis} | |
| Wellcare Classic | $11.30 | $590 | {drug_benefit_category} | {lis} | |
| Wellcare Medicare Rx Value Plus | $102.30 | $590 | {drug_benefit_category} | {lis} | |
| Wellcare Value Script | $0.00 | $590 | {drug_benefit_category} | {lis} |
Please note that 2025 Medicare Part D plan information for Virginia beneficiaries will not be available until early October.
Sign-Up for 2025 Medicare Part D Plan Notification
Key Information About Medicare Part D Plans
Medicare Part D, provided by private insurers, helps cover the cost of prescription drugs. These plans cover drugs across all essential categories, but it's important to check if your specific medications are included in the plan’s formulary. The formulary classifies drugs into different tiers, which determine the cost you’ll pay.
It's important to note that while Part D covers many prescriptions, it typically does not include medications administered during a doctor’s visit or hospital stay—these are covered under Medicare Part B. Your out-of-pocket costs will vary depending on the coverage phase you’re in, such as the deductible phase or the initial coverage phase.
Most Part D plans have preferred pharmacy networks that offer lower prices for medications. Make sure your preferred pharmacy is within the plan’s network to maximize savings. Also, keep in mind that Medicare Part D plans can change annually, so it’s important to review your plan during the Annual Enrollment Period (AEP) to ensure it continues to meet your healthcare needs.
Exploring Medicare Part D: Coverage and Costs in Virginia
Understanding Part D Costs
Medicare Part D plans come with various costs, including premiums, deductibles, and out-of-pocket expenses. It's important to understand these costs to choose a plan that fits your budget.
Monthly Premiums
Premiums for Medicare Part D plans vary depending on the plan and provider. In Virginia, the average premium is $52.88 per month, with some plans offering premiums as low as $0.00. Depending on your income, you may qualify for assistance to help pay your premiums.
Annual Deductibles
Deductibles are the amount you pay out-of-pocket before your Part D plan begins to cover the cost of your medications. In Virginia, the average deductible is $489, but there are 2 plans available that have a zero-dollar deductible.
Copayments and Coinsurance
Once you've met your deductible, you'll typically pay either a copayment or coinsurance for your medications. Copayments are a fixed amount, while coinsurance is a percentage of the drug's cost. These amounts vary by plan and the tier of the drug you're purchasing.
Formulary and Tiered Pricing
A formulary is a list of covered medications for each Medicare Part D plan. Drugs are often grouped into tiers, with each tier having different costs. Higher-tier drugs generally cost more, so it’s essential to review the formulary of each plan to ensure your medications are covered at a cost you can afford.
The Coverage Gap ("Donut Hole")
The coverage gap, also known as the "donut hole," is a temporary limit on what the drug plan will cover for prescription drugs. Once you and your plan have spent a certain amount on covered drugs, you enter the gap, where you might pay more out-of-pocket. However, there are 0 plans in Virginia that offer additional coverage during this phase.
Catastrophic Coverage
After your out-of-pocket costs reach a certain threshold, you enter the catastrophic coverage phase, where you’ll pay significantly lower copayments or coinsurance for the rest of the year. This phase ensures that your costs are kept manageable even if you have high prescription drug expenses.
Low-Income Subsidy (LIS)
The Low-Income Subsidy (LIS), or Extra Help, is a program that helps lower the cost of Medicare Part D for those who qualify. In Virginia, there are 0 plans that offer full LIS benefits, making medications more affordable for those with limited income and resources.
Making Informed Choices
When selecting a Medicare Part D plan, it’s important to consider both the costs and the coverage options. By understanding the premiums, deductibles, copayments, and other cost factors, you can choose a plan that aligns with your prescription needs and financial situation.
Tips for Choosing Your Best Medicare Part D Plan in Virginia
Medicare prescription drug plans are compatible with Medicare Parts A and B, all Medicare Supplement Plans (Medigap), and Medicare Advantage plans that do not include prescription drug coverage. However, you cannot enroll in a stand-alone Part D plan if you have a Medicare Advantage plan that includes prescription coverage as an extra benefit.
Choosing the best Medicare Part D plan can be challenging, especially with 16 plans available in Virginia. To simplify your decision, consider these essential factors:
1. Review the Plan’s Formulary
A formulary lists all the medications covered by a Medicare Part D plan. Make sure the plan you’re considering covers your prescriptions, and be aware of the drug tiers, as these will determine your out-of-pocket costs for each medication.
2. Consider Premiums and Deductibles
Medicare Part D plans come with different premiums and deductibles. Compare these costs to find a plan that fits your budget. Remember, lower premiums might come with higher deductibles or other out-of-pocket costs, so factor in your prescription needs when making a decision.
3. Check Preferred Pharmacy Networks
Using a pharmacy within your plan’s preferred network can lower your medication costs. Ensure your preferred pharmacy is in-network, and consider whether the plan provides a mail-order option, which can be a convenient and cost-effective choice.
4. Understand the Coverage Gap
Known as the "donut hole," the coverage gap is a phase where your medication costs may increase. Some plans offer extra coverage during this phase, which could save you money if you expect high prescription drug expenses.
5. Look at Star Ratings
Medicare assigns star ratings to Part D plans based on quality and customer satisfaction. Plans with higher star ratings are generally more reliable, so consider this when making your choice.
6. Explore Low-Income Subsidy (LIS) Options
If you qualify for the Low-Income Subsidy (LIS), certain plans can lower your costs, including premiums, deductibles, and copayments. These plans are designed to help make prescription drugs more affordable for those with limited income.
By following these steps, you can find a Medicare Part D plan that aligns with both your health needs and financial situation. Be sure to review your plan options each year, as benefits and costs can change.
How Creditable Coverage and Late Enrollment Penalties Affect Medicare Part D
Creditable coverage refers to prescription drug coverage that meets or exceeds the standards set by Medicare Part D. If you have creditable coverage through an employer or other source, you can delay enrolling in Part D without incurring a penalty. However, if you do not have creditable coverage and delay enrollment, you may receive a late enrollment penalty, which will increase your monthly premium.
Determining Creditable Coverage
Your plan should notify you each year if your coverage is creditable. It is important to keep this notification for your records. If you’re uncertain about your coverage status, contact your provider to confirm.
What Is the Late Enrollment Penalty?
The late enrollment penalty is calculated based on how many months you went without creditable coverage. It’s 1% of the national base beneficiary premium for each month you were without coverage and is added to your monthly premium. This penalty is permanent, so enrolling promptly when you lose creditable coverage is essential.
How to Enroll in a Medicare Part D Plan
Enrolling in Medicare Part D is essential to securing prescription drug coverage. The process is governed by specific enrollment periods, each designed to give you opportunities to join, switch, or update your plan. Knowing when and how to enroll can help you get the necessary coverage without delay.
Initial Enrollment Period (IEP)
The Initial Enrollment Period is a 7-month window that begins 3 months before the month you turn 65, includes your birthday month, and ends 3 months after your birthday month. During this time, you can enroll in a Medicare Part D plan for the first time.
Annual Enrollment Period (AEP)
The Annual Enrollment Period runs from October 15 to December 7 each year. During this period, you can enroll in a Part D plan, switch plans, or drop your current plan. Changes made during AEP take effect on January 1 of the following year.
Medicare Advantage Open Enrollment Period (OEP)
The Medicare Advantage Open Enrollment Period occurs from January 1 to March 31. If you’re enrolled in a Medicare Advantage plan, you can switch to a different Medicare Advantage plan or return to Original Medicare and enroll in a standalone Part D plan during this time.
Understanding these enrollment periods is vital to maintaining continuous Medicare Part D coverage. To learn more about when and how to enroll, check out our detailed article on Medicare Enrollment Periods.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Baylor Scott & White Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, GlobalHealth, Health Care Service Corporation, Healthy Blue, HealthSun, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
Citations & References
- Medicare.gov, "Your Guide to Medicare Drug Coverage", Last Accessed July 21, 2024
- Medicare.gov, "How Part D works with other insurance", Last Accessed July 14, 2024
- Medicare.gov, "Catastrophic coverage", Last Accessed June 13, 2024
- Medicare.gov, "Your coverage options", Last Accessed June 6, 2024
- SSA.gov, "Extra Help with Medicare Prescription Drug Plan Costs", Last Accessed June 1, 2024
- CMS.gov, "Landscape Source Files", Last Accessed January 15, 2024
- CMS.gov, "Medicare Part C & D Performance", Last Accessed January 15, 2024