Medicare in Virginia: Plans and Coverage (2026)

If you are turning 65 in Virginia or helping a parent choose coverage, Medicare works the same here as everywhere, with a few state-specific advantages worth using. Virginia adds free VICAP counseling, SCC-regulated Medigap with a new birthday rule, and DMAS-run Medicare Savings Programs that can lower your costs. This guide walks through what each part costs in 2026, how to choose among your plan options, and how to get help paying.1

In This Guide

• Key Takeaways
• Original Medicare: Parts A and B
• Medicare Advantage in Virginia (Part C)
• Medicare Part D: Prescription Drugs
• Medigap in Virginia
• Help Paying for Medicare in Virginia
• Medicare Enrollment Periods
• Free Medicare Help: Virginia VICAP
• Frequently Asked Questions

About these numbers: The premiums and deductibles below come from CMS for calendar year 2026, effective January 1 through December 31, 2026.2 Medicare costs change every year, so check the CMS fact sheet or medicare.gov for the figures that apply to the year you're in. To reach a person about your own coverage, call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048), open 24 hours a day, 7 days a week except some federal holidays.6 Virginia VICAP counselors will also go through your costs with you at no charge at 1-800-552-3402.1

Original Medicare: Parts A and B

Original Medicare is a federal program and operates the same in Virginia as in every other state. It comes in two parts.

Part A (Hospital Insurance)

Part A covers inpatient hospital stays, limited skilled nursing facility care, hospice, and some home health care.2

The hospital deductible applies per benefit period, not per calendar year. A benefit period starts when you're admitted and ends once you have not received inpatient hospital care or skilled care in a skilled nursing facility for 60 days in a row. That clock can run while you are still in a facility, so someone who drops from skilled to custodial care can begin a new benefit period without leaving. Multiple benefit periods can occur in one year, each with its own $1,736 deductible.2

Part B (Medical Insurance)

Part B covers doctor visits, outpatient care, preventive services, durable medical equipment, and mental health services. Original Medicare does not cover routine dental, vision, or hearing.2,7

• Standard monthly premium: $202.90 (higher for those with 2024 income above $109,000 single / $218,000 married, under income-related adjustment)2
• Annual deductible: $2832
• After the deductible: 20% of the Medicare-approved amount for most services2

Delayed Part B enrollment without a qualifying Special Enrollment Period or a Medicare Savings Program triggers a permanent late penalty of 10% added to the premium for every 12-month period you could have had it. Creditable drug coverage is the Part D exception, not the Part B one.8

Medicare Advantage in Virginia (Part C)

Medicare Advantage plans are sold by private insurers approved by Medicare. They bundle Part A and Part B coverage, and most include Part D drug coverage plus extras such as routine dental, vision, and hearing.7 Plans must cover every medically necessary Part A and Part B service Original Medicare covers, except hospice, some clinical-trial costs, and benefits that come from laws or Medicare policy decisions the plan doesn't cover. Original Medicare keeps paying for those.7

Because Medicare Advantage plans are built around provider networks, the plan that works well in the Northern Virginia suburbs is not necessarily the one that works in rural southwest Virginia.7 Check a plan's network against the doctors and hospitals you actually use, in the county where you live, before you enroll.

How These Plans Work

• You keep paying the Part B premium ($202.90) on top of any plan-specific premium.2 The CMS average Medicare Advantage premium for 2026 is about $14 a month, and many plans charge $0 extra. CMS also notes that some plans may help pay all or part of your Part B premium itself.7
• Plans run on networks (HMO or PPO). Confirm that your doctors and the hospitals you use are in-network before enrolling; emergency care, out-of-area urgent care, and temporary out-of-area dialysis are covered in or out of network.7
• Plans may require prior authorization (plan approval) before covering certain services or items, which Original Medicare generally does not.7
• Every plan caps your annual in-network out-of-pocket spending (federally limited to $9,250 in 2026; many plans set it lower). Original Medicare has no such cap of its own, and CMS names supplemental coverage as what bounds that spending: Medigap, Medicaid, employer, retiree, or union coverage.7

Use the Medicare Plan Finder at medicare.gov to compare plans by Virginia ZIP code. Enter your doctors and prescriptions and it shows which plans cover them along with estimated costs. Virginia VICAP counselors can walk through those results with you at no charge.

Medicare Part D: Prescription Drugs

Part D covers outpatient prescription drugs. It comes either as a standalone plan paired with Original Medicare, or built into a Medicare Advantage plan.

The Inflation Reduction Act eliminated the old coverage gap starting in 2025.3 For 2026, Part D runs through three phases:

1. Deductible: you pay full price until you meet your plan's deductible (up to $615 in 2026, though some plans charge none).9
2. Initial coverage: you pay copays or coinsurance while your plan and drug manufacturers cover the rest.
3. Catastrophic: once your out-of-pocket spending reaches $2,100, you pay $0 for covered drugs for the rest of the year.3

The $2,100 cap is new for 2026 (it was $2,000 in 2025, adjusted for drug-spending growth). The average standalone Part D premium for 2026 is about $34.50 a month, though plan premiums vary.2 Every Part D plan must also offer the Medicare Prescription Payment Plan, which lets you spread your annual out-of-pocket drug costs into capped monthly installments instead of paying in full at the pharmacy.3 People who qualify for Extra Help often pay much less.

For a full look at Part D rules, see our guide to Medicare Part D drug coverage.

Medigap in Virginia

Medigap policies supplement Original Medicare by covering some or all of the deductibles, coinsurance, and copays that Part A and Part B leave on you. They are built for Original Medicare: a Medigap policy can't be used to pay your Medicare Advantage copayments, coinsurance, deductibles, or premiums, and while you're enrolled in an Advantage plan CMS says it's illegal for anyone to sell you one unless you're switching back to Original Medicare. That isn't a permanent lock-out. If you joined a Medicare Advantage plan for the first time and you aren't happy with it, federal law gives you a trial right to buy a Medigap policy and a separate drug plan when you return to Original Medicare within 12 months of joining.7

In Virginia, Medigap is regulated by the Virginia State Corporation Commission (SCC). The federally standardized plan letters A-D, F, G, and K-N are available, and Virginia follows federal benefit standardization, meaning Plan G from one insurer covers the same gaps as Plan G from another.1

The Six-Month Open Enrollment Period

Your strongest window to buy Medigap is the federal Open Enrollment Period, the one-time six months that begin when you are both 65 or older and enrolled in Part B. During that window an insurer can't refuse to sell you any policy it offers, can't use medical underwriting to decide whether to accept you, and can't charge you more because you have health problems.10 Outside that window, Virginia insurers may use medical underwriting, meaning they can review your health, charge more, or decline you.

One limit applies even inside the window: an insurer may still refuse to cover your out-of-pocket costs for a pre-existing condition for up to six months, unless you had at least six months of continuous prior creditable coverage.10

Plans C and F are closed to anyone who first became Medicare-eligible on or after January 1, 2020, because they covered the Part B deductible, which the Medicare Access and CHIP Reauthorization Act prohibited for newly eligible beneficiaries. People who were eligible before that date may still keep or buy those plans.11

For Virginians who first became eligible on or after January 1, 2020, Plan G is the closest available equivalent to Plan F: it covers the same benefits except the annual Part B deductible. Plan G pays the Part A deductible, the Part A coinsurance and hospital costs for up to an additional 365 days, the Part B coinsurance, the first three pints of blood, the Part A hospice care coinsurance, skilled nursing facility care coinsurance, and Part B excess charges, and it covers foreign travel emergency care at 80% up to plan limits.10 The $283 Part B deductible stays with you.2

Virginia's Medigap Birthday Rule (effective July 1, 2025)

Starting July 1, 2025, Virginia added an annual birthday-rule window for Medigap policyholders. Each year, beginning on your birthday, you get a window of at least 60 days (the State Corporation Commission's consumer guide describes it as 60 days, so a birthday of August 10 runs through October 9) to switch to any Medigap policy with the same benefits as your current plan, from any insurer issuing Medigap policies in Virginia, without medical underwriting, waiting periods, or health-based rate increases. Two conditions qualify you: you live in Virginia, and you are currently covered by a Medigap policy issued by a licensed insurer, health services plan, or HMO in Virginia. Switching to a plan with more or fewer benefits still requires underwriting, though "innovative benefits" such as vision, hearing, or dental are not counted when comparing benefit levels. You must apply for the new policy during the window, and your current insurer must notify you 15 to 30 days before it opens.5 The Virginia State Corporation Commission publishes the consumer guide to the rule. For the full details, including the deductible-carryover caution and how to use your window, see our Virginia Medigap birthday rule guide.

For a deeper look at how Medigap works and how to compare plan letters, see our guide to how Medigap works.

Help Paying for Medicare in Virginia

If your income and resources are limited, two programs can reduce your Medicare costs considerably.

Medicare Savings Programs

Virginia administers its Medicare Savings Programs through the Virginia Department of Medical Assistance Services (DMAS), the state's Medicaid agency. Virginia's published income and resource limits match the federal standards for all states except Alaska and Hawaii. That match is Virginia's current published position, not a level federal law fixes for it: POMS records that states can effectively raise these limits by disregarding amounts or certain types of income and resources, and that some have used that authority to eliminate the resource test entirely.4

QMB is the most comprehensive: it pays your Part A and Part B premiums and all Medicare cost-sharing, and federal law bars providers from billing a QMB enrollee for that cost-sharing.4 For all three programs Virginia's flyer prints a resource limit of $9,950 for one person and $14,910 for a couple. The income tiers track the Federal Poverty Level, and Virginia publishes them as 2026 guidelines effective January 13, 2026 (March 1, 2026 for people who also receive SSI), so check the current year's figures before you rule yourself out.4 Neither the income nor the resource figure is a gross bank balance measured against a flat number, and reading them that way makes people disqualify themselves wrongly. Virginia's own flyer says the income limits already include the Federal Poverty Level amount plus a standard $20 unearned income disregard, and that additional income and resource disregards may apply depending on what you have. Not all resources are counted either: Virginia's handbook says you must report every vehicle you own, but one of them is not a countable resource. Do not assume your house is exempt, though: none of Virginia's published sources states a home exclusion, and its handbook counts real property such as a home or land among resources, so ask DSS how yours is treated. Either way, apply rather than rule yourself out. Note that these figures cover QMB, SLMB, and QI only; QDWI, the fourth tier, uses a far lower resource limit of $4,000 for one person and $6,000 for a couple.4 QI is also the one tier you must reapply for every year; qualifying once does not carry you into the next.4

Virginia residents apply through their local Department of Social Services or through Cover Virginia. Enrolling in QMB, SLMB, or QI automatically qualifies you for Extra Help with Part D costs; QDWI, the fourth savings program, does not.4

For a full breakdown, see our guide to Medicare Savings Programs.

Extra Help for Part D

Extra Help, also called the Low-Income Subsidy, pays Part D premiums, deductibles, and copays for people with limited income and resources.12 Since 2024 the partial-subsidy tier was eliminated, so everyone who qualifies gets the full subsidy.

• Income limit (2026): up to about $1,995 a month for an individual, $2,705 for a couple, in the 48 contiguous states and DC (Alaska and Hawaii run higher)12
• Resource limits: $16,590 individual, $33,100 married couple, or $18,090 and $36,100 if you tell SSA you expect to use some of your resources for burial expenses12
• Qualifying for QMB, SLMB, or QI triggers automatic Extra Help enrollment4

Apply through Social Security at ssa.gov.12 Social Security's national line is 1-800-772-1213 (TTY 1-800-325-0778), which SSA presents as a way to make an appointment.13

Medicare Enrollment Periods

These windows are federal and identical in Virginia as everywhere else. Missing them can mean coverage gaps or permanent late penalties.14

Changes made during Annual Open Enrollment take effect January 1 of the following year. If you start receiving Social Security or Railroad Retirement Board benefits at least four months before you turn 65, you're enrolled in Parts A and B automatically and your card arrives about three months before coverage starts. If you claim benefits later than that, or not yet at all, you sign up through Social Security yourself.14

If you or your spouse are still working past 65 with health coverage from that current employer, you can delay Part B without penalty and use an 8-month Special Enrollment Period to sign up, counted from the month that job or its coverage ends, whichever comes first. COBRA and retiree coverage do not count for this, so they do not extend the window. If you're self-employed, or your plan isn't available to everyone at the company, ask your insurer whether it counts as employer group health plan coverage before you delay; if it doesn't, sign up at 65. This Special Enrollment Period does not apply if you're eligible for Medicare based on End-Stage Renal Disease (ESRD).15

For a full breakdown of each window and what it lets you do, see our guide to Medicare enrollment periods.

Free Medicare Help: Virginia VICAP

You don't have to figure this out alone, and you don't have to pay anyone. The Virginia Insurance Counseling and Assistance Program (VICAP) is Virginia's version of the federal State Health Insurance Assistance Program (SHIP). It's run through the Virginia Department for Aging and Rehabilitative Services (DARS) and delivered locally through Area Agencies on Aging across the state.1

VICAP counselors are trained, unbiased, and do not sell insurance. The service is free and available to Medicare beneficiaries aged 60 and over, and to their families. A VICAP counselor can help you:

• Understand Original Medicare and what each part covers
• Compare Medicare Advantage and Part D plans side by side
• Evaluate Medigap plan letters and costs in your area
• Apply for Medicare Savings Programs and Extra Help
• Sort out claims, billing errors, and appeals

To reach VICAP, call 1-800-552-3402. That line connects you to the Virginia insurance helpline, which refers you to your local Area Agency on Aging and a VICAP counselor.1

Key Virginia Medicare Contacts

Learn More

Find personalized help comparing your Medicare plan options in Virginia at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.