Medicare Coverage Overview - Virginia Premier

Medicare Coverage Overview

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

I am looking for a: 2022 Plan | 2021 Plan

This plan is for individuals who are eligible for both Medicare and Medicaid. Our Advantage Elite Plan benefits can be combined with any Virginia CCC Plus Plan at no cost.  Advantage Elite offers more benefits than Original Medicare.

2022 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

If you prefer, you may enroll in Virginia Premier Medicare Advantage Elite Plans through the CMS Online Environment Center at Medicare.gov.

2022 Added Benefits
Grocery Card
$75 monthly allowance

Members with chronic condition(s) that meet certain criteria may be eligible for this special supplemental benefit.
Dental Coverage – $0 copay
Preventive: oral exam, two cleanings, two fluoride treatments and two bitewing X-rays every 12 months.

Comprehensive: fillings, extractions and dentures up to $4,000 annual allowable.
Vision Services
$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.
Fitness – Covered
SilverSneakers® – $0 copay

Attend SilverSneakers LIVE™ online classes and workshops, view On-Demand workout videos or visit one of many fitness locations nationwide.
Over-the-Counter Product Allowance (OTC)
$350 allowance every three months for approved OTC products.
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 non-health-related locations such as a church or senior center. Members with chronic condition(s) that meet certain criteria may be eligible for this special supplemental benefit.
2021 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 in addition to annual wellness exam. Receive a $25 incentive for getting this exam.

If you prefer, you may enroll in Virginia Premier Medicare Advantage Elite Plans through the CMS Online Environment Center at Medicare.gov.

2021 Added Benefits
Dental Coverage – $0 copay
Preventive: One exam, cleaning and X-ray per year.

Comprehensive: $3,000 per year for fillings, extractions, crowns, dentures, implants and bridges.
Vision Services
Up to $250 allowance towards eyeglass frames, lenses or contact lenses annually.
Hearing Services – $0 Copay
Exams and hearing aid allowance up to $1,250 every three years.
Fitness – Covered
Paid in full participating fitness centers in addition to flexible in-home options.
Over-the-Counter Product Allowance (OTC)
$350.00 allowance per quarter ($1,400 yearly). Unused OTC amounts do not roll over from quarter to quarter.
Transportation – $0 copay
48 one-way trips to health-related locations including the dentist, eye exam provider and podiatrist.

Low Income Subsidy (LIS) Premium Summary

The LIS Premium Summary shows what you will pay each month depending on the plan you have and the level of Extra Help you get. To read these charts, you’ll need to know your plan name and what percentage of the Low Income Subsidy you receive: 100%, 75%, 50% or 25%.

Need Assistance?

Call a Licensed Plan Advisor

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

October 1–March 31, 7 days a week, 8 am to 8 pm.

April 1–September 30, Monday–Friday, 8 am to 8 pm.

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

No. Part D is not related to your Original Medicare coverage. It is additional coverage for prescription drugs your doctor prescribes. 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 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