Virginia may have the 8th highest median household income in the country, but a significant number of its residents can’t afford health insurance, which has an average premium of $475 per month. Fortunately for people 65 years and older and workers with specific disabilities, they may qualify for Medicare health insurance benefits at a much lower cost.
Virginia Medicare insurance is funded by the federal government, but the Virginia state government also offers several assistance programs for Medicare beneficiaries here.
Medicare starts with Original Medicare, which is made up of Part A and Part B. Premiums are much more affordable as Part A normally doesn’t require a premium from most beneficiaries. Part B may typically require a premium, but for beneficiaries with an annual income of less than $85,000, it’s just $134 a month. Part A and Part B also have deductibles, copays, and coinsurance costs that beneficiaries need to take care of.
In return, beneficiaries receive hospital insurance such as inpatient care from Part A. Medicare Part B covers medical insurance, such as preventive services, durable medical supplies, and outpatient care.
Some Medicare beneficiaries can buy Medicare supplemental plans for additional benefits not found in Original Medicare. The most popular plan is that one that covers the cost of Medicare prescription medication, referred to as Medicare Part D.
The plans can also cover healthcare services that are not covered by Part A and Part B. Some plans can also help pay for the out of pocket expenses of Part A and Part B, such as the deductibles, coinsurance, and copays.
The supplemental plans are available from Medicare-approved health insurance companies in Virginia. These will require a separate premium apart from the premiums required by Original Medicare.
Also known as Medicare Part C, a Medicare Advantage Plan can offer a comprehensive Medicare package that offers the coverage of Original Medicare plus many more benefits. These additional benefits can include Medicare Part D prescription drug coverage, and additional healthcare services that Original Medicare doesn’t cover can be added as well.
Again, these plans can be purchased only from the private carriers with Medicare approval.
Virginia still has an 11.8% poverty rate, and this is why many Medicare beneficiaries living here cannot easily afford a Medicare coverage. However, the state offers Medicare Savings Programs (MSPs) that can help cover at least some of the expenses. The level of financial assistance will depend on the income and assets of the beneficiaries.
The program for the Qualified Medicare Beneficiaries provides the most savings, as it pays for nearly all expenses associated with Original Medicare. The QMB program pays for the premiums of Part A (if necessary) and Part B, plus the deductibles, copays, and coinsurance. An individual can qualify with a monthly income of less than $1,032 while a married couple’s combined income has to be less than $1,392.
The next MSP is for the Specified Low Income Medicare Beneficiary. The SLMB program pays for just the Part B premiums, which still totals $1,608 a year. The beneficiary can also still enjoy Virginia Medicaid benefits while on the SLMB program. An individual can qualify with a monthly income of $1,234. A married couple’s income limit is $1,666 per month.
The MSP for Qualified Individuals (QI) also only pays for Part B premiums, but the beneficiary cannot enjoy Medicaid benefits while on the QI program. Applications for QI are also granted only on a first-come, first served basis due to limited funding. An individual can be a QI with an income of $1,386 per month, while the limit for a married couple is $1,872 per month.
These 3 MSPs also have an asset limit of $7,560 for an individual and $11,340 for a married couple.
The QMB, SLMB, and QI Medicare Savings Programs also enable the beneficiaries to qualify for the Low-Income Subsidy (“Extra Help”) to cover Medicare Part D costs. The percentage of Part D coverage will depend on the income and assets of the beneficiaries.
Virginia has the Virginia Insurance Counseling and Assistance Program or VICAP to help provide free and unbiased counseling to Medicare beneficiaries. You can call VICAP at 800-552-3402.