Medicare in Virginia follows federal rules, with state-specific additions: free VICAP counseling, SCC-regulated Medigap, and DMAS-administered Medicare Savings Programs. This guide covers Medicare in Virginia for 2026: what each part costs, your plan choices, and how to get help paying.
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. Medicare costs change every year. For the most current figures, contact Medicare at 1-800-633-4227 (1-800-MEDICARE) or Virginia VICAP at 1-800-552-3402.
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.
| Cost | Amount |
|---|---|
| Monthly premium | $0 for most people (40+ quarters of work history) |
| Hospital deductible | $1,736 per benefit period |
| Hospital coinsurance, days 61-90 | $434 per day |
| Lifetime reserve days | $868 per day |
| SNF coinsurance, days 21-100 | $217 per day |
The hospital deductible applies per benefit period, not per calendar year. A benefit period starts when you're admitted and ends after 60 consecutive days out of the hospital and SNF. Multiple benefit periods can occur in one year, each with its own $1,736 deductible.
Part B (Medical Insurance)
Part B covers doctor visits, outpatient care, preventive services, durable medical equipment, and mental health services. It does not cover routine dental, vision, or hearing.
- Standard monthly premium: $202.90 (higher for those with 2024 income above $109,000 single / $218,000 married, under income-related adjustment)
- Annual deductible: $283
- After the deductible: 20% of the Medicare-approved amount for most services
Delayed Part B enrollment without other creditable coverage triggers a permanent late penalty of 10% added to the premium for every 12-month period you could have had it.
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. Plans must cover everything Original Medicare covers, except hospice, which Original Medicare keeps paying.
Virginia's geography creates real differences in plan availability. The Northern Virginia corridor bordering Washington, D.C., and suburbs like Arlington, Fairfax, and Loudoun counties, has a dense Medicare Advantage market with a wide range of plans. In rural southwest Virginia, including areas around Roanoke, the New River Valley, and the Appalachian coalfields, fewer plans typically serve each county and plan networks may be more limited.
How These Plans Work
- You keep paying the Part B premium ($202.90) on top of any plan-specific premium. The CMS average Medicare Advantage premium for 2026 is about $14 a month, and many plans charge $0 extra.
- Plans run on networks (HMO or PPO). Confirm that your doctors and the hospitals you use are in-network before enrolling.
- Plans typically require prior authorization for certain services, which Original Medicare generally does not.
- 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.
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. For 2026, Part D runs through three phases:
- Deductible: you pay full price until you meet your plan's deductible (up to $615 in 2026).
- Initial coverage: you pay copays or coinsurance while your plan and drug manufacturers cover the rest.
- Catastrophic: once your out-of-pocket spending reaches $2,100, you pay $0 for covered drugs for the rest of the year.
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 $46.50 a month, though plan premiums vary. 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. 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 work only with Original Medicare, not Medicare Advantage. You can't hold both.
In Virginia, Medigap is regulated by the Virginia State Corporation Commission (SCC). The federally standardized plan letters A through N are available, and Virginia follows federal benefit standardization, meaning Plan G from one insurer covers the same gaps as Plan G from another.
The Six-Month Open Enrollment Period
Your strongest window to buy Medigap is the federal Open Enrollment Period, the six months that begin when you are both 65 or older and enrolled in Part B. During that window an insurer must sell you any plan they offer at the standard rate, regardless of your health history. Outside that window, Virginia insurers may use medical underwriting, meaning they can review your health, charge more, or decline you.
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.
Plan G is the popular choice for newly eligible Virginians. It covers the Part A deductible, Part A and Part B coinsurance, and skilled nursing facility coinsurance, leaving only the $283 Part B deductible on you.
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 you get a 60-day period beginning on your birthday to switch to any Medigap policy with the same benefits as your current plan, from any insurer in the state, without medical underwriting or health-based rate increases. There is no age cap for this right. The one constraint is that "same benefits" means same plan letter (or equivalent); switching to a plan with more or fewer benefits still requires underwriting. The birthday rule is administered by the Virginia State Corporation Commission.
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 uses the standard federal income tiers and resource limits.
| Federal program | Income (individual) | Income (couple) | What it pays |
|---|---|---|---|
| QMB | Up to about $1,350 | Up to about $1,824 | Part A and B premiums plus all cost-sharing |
| SLMB | Up to about $1,616 | Up to about $2,184 | Part B premium |
| QI | Up to about $1,816 | Up to about $2,455 | Part B premium |
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. The 2026 resource limit for all three programs is $9,950 for one person and $14,910 for a couple. Income figures tie to the Federal Poverty Level and update each April.
Virginia residents apply through their local Department of Social Services or through Cover Virginia. Enrolling in any of the three programs automatically qualifies you for Extra Help with Part D costs.
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. 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
- Resource limits: $16,590 individual, $33,100 married couple
- Qualifying for any Medicare Savings Program triggers automatic Extra Help enrollment
Apply through Social Security at ssa.gov or call 1-800-772-1213.
Medicare Enrollment Periods
These windows are federal and identical in Virginia as everywhere else. Missing them can mean coverage gaps or permanent late penalties.
| Period | Dates | What you can do |
|---|---|---|
| Initial Enrollment | 7 months around your 65th birthday | Sign up for Parts A, B, D; choose MA or Medigap |
| Annual Open Enrollment | Oct 15 - Dec 7 | Switch MA plans, move between MA and Original Medicare, change Part D plan |
| MA Open Enrollment | Jan 1 - Mar 31 | Switch MA plans or drop MA for Original Medicare (if already in MA) |
| General Enrollment | Jan 1 - Mar 31 | Sign up for Part B if you missed your initial window |
| Medigap Open Enrollment | 6 months from age 65 + Part B | Buy any Medigap plan at the standard rate, no health screening |
Changes made during Annual Open Enrollment take effect January 1 of the following year. If you're already receiving Social Security before 65, you're enrolled in Parts A and B automatically. Otherwise, you sign up through Social Security.
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.
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.
Frequently Asked Questions
Most people pay $0 for Part A. The standard Part B premium is $202.90 a month with a $283 annual deductible. Part D standalone plan premiums average about $46.50, though actual amounts vary by plan. Many Medicare Advantage plans charge $0 above the Part B premium. Your total depends on the plan you pick and the care you use.
No state law in Virginia guarantees Medigap access for Medicare beneficiaries under 65. The federal Open Enrollment Period applies only at 65 when you first enroll in Part B. Before 65, Virginia Medigap insurers may decline to sell you a policy or charge more based on your health. If you're in that situation, a VICAP counselor can review what's available at your address and help you compare your options.
Apply through your local Virginia Department of Social Services (DSS) or through Cover Virginia. Virginia DMAS administers the programs using the standard federal income tiers. Income limits update each April. Enrolling in QMB, SLMB, or QI also qualifies you for Extra Help with Part D automatically.
Medicare Advantage bundles Parts A, B, and usually D through a private insurer with a provider network and an annual out-of-pocket cap (up to $9,250 in-network for 2026). Original Medicare lets you see any provider who accepts Medicare nationwide, with no cap but generally predictable costs that Medigap can cover. Neither is uniformly better; the right choice depends on your doctors, prescriptions, and how much you want to manage out-of-pocket risk. See our guide to Original Medicare vs. Medicare Advantage.
Call 1-800-552-3402 to reach the Virginia insurance helpline, which connects you to VICAP and your local Area Agency on Aging. VICAP counselors are free, unbiased, and don't sell insurance.
Learn More
- Medicare: The National Guide
- Original Medicare vs. Medicare Advantage
- How Medigap Works
- Medicare Part D Drug Coverage
- Medicare Enrollment Periods
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.