Medicare Coverage Overview

Our Medicare Advantage Plan:
Virginia Premier Advantage Elite (HMO D-SNP)

This Dual Eligible Special Needs Plan (D-SNP) is a type of Medicare Advantage plan for individuals who are eligible for both Medicare and Medicaid. Our Advantage Elite plan benefits can be combined with any Virginia Medicaid CCC Plus plan at no cost.  Advantage Elite offers more benefits than Original Medicare.

Advantage Elite Benefits
Monthly Premium
$0
Annual Deductible
$0
Annual Out-of-Pocket Maximum
$7,550
Doctors and Specialists
$0 copay
No referral is required to see a specialist.
Annual Exams
$0 copay
Added Benefits
Dental Coverage – $0 copay
Preventive: oral exam, one cleaning, one fluoride treatment, two bitewing X-rays every 12 months, and one full-mouth X-ray every 36 months.

Comprehensive: fillings, extractions and dentures up to $4,000 allowed annually.
Vision Services – $0 copay
$0 copay for routine exam. Receive up to $300 allowance every 12 months for eyewear and/or contact lenses.
Hearing Services – $0 copay
$0 copay for routine hearing exam. $0 copay for one set of select hearing aids every 12 months to a max allowance of $2,000.
Grocery Card – $75 monthly allowance
Members receive a grocery card loaded with $75 each month to spend on healthy food products at Harris Teeter, Kroger, Rite Aid, Walgreens, or Walmart. Grocery items can also be ordered from NationsBenefits® by phone, online, or mail— with no additional cost for delivery. Unspent dollars do not carry over to the next month.
Fitness Program – $0 copay
SilverSneakers®: Attend online classes and workshops, view on-demand workout videos, or visit one of many fitness locations nationwide. Available to Virginia Premier Advantage Elite members of all ages.
Over-the-Counter (OTC) Product Allowance
$350 allowance every three months for approved OTC products. Amount does not carry over to the next quarter.
Transportation – $0 copay
Medical: $0 copay for 48 one-way trips every 12 months for health-related services.

Non-medical: $0 copay for 24 one-way trips every 12 months to approved locations such as grocery stores, church, or senior centers.

Align Your Medicare D-SNP and Medicaid CCC Plus Plans

If you are dual eligible for Medicare and Medicaid, you may choose Virginia Premier for both plans. See why you should align your Medicare D-SNP and Virginia Medicaid CCC Plus plans through Virginia Premier.

Questions?

Call a Licensed Plan Advisor

1-833-688-6701 (TTY: 711)

October 1 – March 31 | 7 days a week | 8:00 am – 8:00 pm

April 1 – September 30 | Monday – Friday | 8:00 am – 8:00 pm

Medicare Frequently Asked Questions

I am still working and on my employer’s health insurance plan. When I turn 65, do I need to sign up for Medicare Part B during my Initial Enrollment Period?

No. You can wait until you are ready to retire and move off your employer plan or your spouse’s insurance plan if that is an option. When you do so, you will be eligible for a Special Enrollment Period and have an eight-month window to sign up for Part B. The eight-month period begins when your employer or union coverage ends or when your employment ends, whichever is first. Be sure to elect Part B at that time so you don’t have to pay a late enrollment penalty. That penalty is 10% a year for late enrollment.

If I am covered by Medicare, is my spouse automatically covered as well?

No. Medicare is an individual enrollment. Both you and your spouse must sign up for separate coverage and the policies are not related. There is no family coverage under Medicare.

If I enroll in Medicare Part A and Part B with Social Security, do I also enroll for Part D prescription drug coverage?

No. Part D prescription drug coverage is not related to your Original Medicare coverage. It is additional coverage for prescription drugs. You must enroll with a private insurance plan that contracts with Medicare. You have two choices: You can take Original Medicare and then sign up for a separate Part D plan, or you could enroll in a Medicare Advantage Part C plan that has prescription drug and medical in an all-in-one plan.

When I decide to enroll in Medicare and choose a Medicare Advantage plan, do I need to stay with the same insurance company I had with my employer?

No. When you leave your employer and no longer have health insurance coverage, you can choose a Medicare Advantage plan from any company that offers service in your area. You also can stay in Original Medicare and buy a Medicare Supplement plan and a Part D prescription drug plan.

Do you have more questions?

If you have questions, check with your State Health Insurance Program — the Virginia Counseling and Assistance Program (VICAP). VICAP offers free unbiased, confidential counseling on health insurance, education and assistance to seniors and adults with disabilities and their families. This program can help in understanding Medicare and making decisions about prescription drug plans, Medicare Advantage plans, Medicare Supplement plans or long-term care insurance.

How can I reach VICAP?

Write to:
Virginia Division for the Aging (DARS)
1610 Forest Avenue, Suite 100
Richmond, VA 23229

Toll-Free: 1-800-552-3402 (Nationwide Voice/TTY)
Phone: 1-804-662-9333
Fax: 1-804-662-9354
E-mail: aging@vda.virginia.gov