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Medicare Coverage Overview

Our Medicare Advantage Plans

Virginia Premier offers three Medicare Advantage plans, including Gold, Platinum and Elite to meet your benefit needs. 

Virginia Premier’s Medicare Advantage Gold (HMO) and Platinum (HMO) Plans

Gold Plan (HMO)
Platinum Plan (HMO)
Monthly Premium
$0
$29
Annual Deductible
$0
$0
Annual Out-of-pocket maximum
$5,900
$5,900
Primary Care Physician
$0 co-pay
$0 co-pay
*Specialist
$45 co-pay
$35 co-pay
Annual Exams
$0 co-pay in addition to annual wellness exam, get a $25 incentive for getting this exam
$0 co-pay in addition to annual wellness exam, get a $25 incentive for getting this exam
24-hour Nurse Advice Line
Included
Included
Gold Plan (HMO)
Platinum Plan (HMO)
Monthly Premium
$0
$29
Annual Deductible
$0
$0
Annual Out-of-pocket maximum
$5,900
$5,900
Primary Care Physician
$0 co-pay
$0 co-pay
*Specialist
$45 co-pay
$35 co-pay
Annual Exams
$0 co-pay in addition to annual wellness exam, get a $25 incentive for getting this exam
$0 co-pay in addition to annual wellness exam, get a $25 incentive for getting this exam
24-hour Nurse Advice Line
Included
Included
Additional Benefits You Get With Your Virginia Premier Medicare Advantage Plan
Gold Plan (HMO)
Platinum Plan (HMO)
Dental Preventative
$0 co-pay oral exams, cleanings, fluoride treatment and dental x-rays

New! Dental Restorative: $1,000 per year at 50 percent co-insurance for fillings, crowns, extractions and implants
$0 co-pay oral exams, cleanings, fluoride treatment and dental x-rays

New! Dental Restorative: $1,000 per year at 50 percent co-insurance for fillings, crowns, extractions and implants
Vision
$0 exam co-pay ; $150 eyewear allowance for frames and contacts per year
$0 exam co-pay ; $200 eyewear allowance for frames and contacts per year
Hearing Aid Benefit
One exam per year plus hearing aid benefits up to $750 every three years, discounts included for hearing aids
One exam per year plus hearing aid benefits up to $1000 every three years, discounts included for hearing aids
Fitness Benefit
$0 cost for participating fitness centers
$0 cost for participating fitness centers
Over-the-counter drug benefit
Up to $50 quarterly benefit ($200 annually)
Up to $60 quarterly benefit ($240 annually)
Gold Plan (HMO)
Platinum Plan (HMO)
Dental Preventative
$0 co-pay oral exams, cleanings, fluoride treatment and dental x-rays

New! Dental Restorative: $1,000 per year at 50 percent co-insurance for fillings, crowns, extractions and implants
$0 co-pay oral exams, cleanings, fluoride treatment and dental x-rays

New! Dental Restorative: $1,000 per year at 50 percent co-insurance for fillings, crowns, extractions and implants
Vision
$0 exam co-pay ; $150 eyewear allowance for frames and contacts per year
$0 exam co-pay ; $200 eyewear allowance for frames and contacts per year
Hearing Aid Benefit
One exam per year plus hearing aid benefits up to $750 every three years, discounts included for hearing aids
One exam per year plus hearing aid benefits up to $1000 every three years, discounts included for hearing aids
Fitness Benefit
$0 cost for participating fitness centers
$0 cost for participating fitness centers
Over-the-counter drug benefit
Up to $50 quarterly benefit ($200 annually)
Up to $60 quarterly benefit ($240 annually)

Virginia Premier’s Medicare Advantage Elite Plan (HMO SNP)

This plan is for individuals who are eligible for both Medicare and Medicaid

Elite Plan (HMO SNP)
Monthly Premium
$0
Annual Deductible
$0
Annual Out-of-pocket maximum
$3,400
Primary Care Physician
$0 co-pay
*Specialist
$0 co-pay
Annual Exams
$0 co-pay in addition to annual wellness exam Get a $25 incentive for getting this exam.

LIS Premium Summary

The LIS Premium Summary shows what you’ll 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 get: 100 percent, 75 percent, 50 percent or 25 percent.

Additional Benefits You Get With Your Virginia Premier Medicare Advantage Elite Plan
Elite Plan (HMO SNP)
Dental Preventative
$0 co-pay oral exams, cleanings, fluoride treatment and dental x-rays

New! Dental Restorative: $2,000 per year for fillings, crowns, extractions and implants
Vision
$200 eyewear allowance for frames and contacts per year
Hearing Aid Benefit
One exam per year plus hearing aid benefits up to $1250 every three years, discounts included for hearing aids
Fitness Benefit
$0 cost for participating fitness centers
Over-the-counter drug benefit
Up to $250 quarterly benefit ($1,000 annually)

Need Assistance?

Call a Licensed Sales Agent

1-833-270-2104, (TTY:711)

October 1st through March 31st the sales team's hours of operation are 8 am – 8 pm seven days a week.

April 1st through September 30th, we are open Monday through Friday 8 am – 8 pm.

Frequently Asked Questions

I’m 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’re 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’ll 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 lat e enrollment penalty. That penalty is 10% a year for late enrollment.

If I’m covered for Medicare, is my spouse automatically covered as well?
No. Medicare is an individual enrollment. Both you and your spouse must sign up for coverage and the policies are not related. There is no family coverage under Medicare.

If I enroll for 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 with 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. Or you may stay in Original Medicare and buy a Medicare Supplement plan and a Part D prescription drug plan.

Does all Medicare private coverage have annual open enrollment periods?
No. It’s important to know the difference before you enroll: For Medicare Advantage and Medicare Part D prescription drug plans, there’s an annual open enrollment period (October 15 to December 7, with enrollments effective January 1 of the coming year). During this time, you can switch to any other Medicare Advantage or Part D plan available in your area, regardless of your medical history.

There’s no annual open enrollment period for Medicare Supplement plans. You can apply for a Medicare Supplement plan anytime, but after your initial seven-month enrollment window has passed, the carrier can use your medical history to determine your eligibility and premium. However, states can impose their own regulations for Medigap plans. If you’re in good health, you’ll be able to switch to a different Medicare Supplement plan, but some Medicare Supplement plans are priced based on the enrollee’s age when the plan is issued, so they’ll be more expensive if you enroll later, even if you’re healthy

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, Virginia 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

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