Medicare Health Insurance

Original Medicare Eligibility for part A and part B

  • 65 or under with disabilities or health condition

  • disability benefits from social security for 24 months

  • ALS or ESRD

  • U.S resident & citizen or lawful permanent resident  for 5 yrs in Medicare

Individuals can enroll in Medicare 3 months prior to their 65 birthday, the month of their birthday, and 3 months after.

Original Medicare Part A:

  • Inpatient deductible $1676 for each benefits period (begins when admitted to hospital & ends when individual 60 days in a row)

  • 1-60 $0 after deductible 

  • 61-90- $419 copay per day

  • 91-150 $838 copay

Original Medicare Part B:

  • Annual $257 deductible

  • After deductible 20% coinsurance

  • Part B Premium for 2026 is $202.90

To enroll in Medicare call social security at 1-800-772-1213

Medicare Part C (Medicare Advantage plan)

  • Offers Part A, Part B and Part D (with MAPD plans) through commercial carriers

  • Plans typically include additional benefits such as dental, vision, and hearing coverage. Some plans also offer an Over-the-Counter (OTC) allowance that provides funds for approved items. Please note that benefits are based on the individual plan and may vary.

Part D  stand alone prescription drug plan (PDP)

  • Offered by commercial carriers- generally original medicare, MA MSA PFFS, or cost plan can enroll in standalone PDP

  • Initial phase pay 25% coinsurance ($615 deductible)

  • Out of pocket cost reaches $2100 beneficiary is through initial coverage phase and reaches catastrophic

Medicare supplemental Plans A-N (Medigap)

  • Medicare Supplement Insurance (Medigap) is extra insurance you can buy from a commercial health insurance carrier to help pay your share of out-of-pocket costs from Original Medicare in like copayments, coinsurance, and deductibles.

  • Part D PDP is often recommended with a Medicare Supplement plan because Original Medicare and Medigap plans do not include prescription drug coverage. A separate Part D plan helps cover the cost of covered prescription drugs and can help avoid a late enrollment penalty if you go without creditable drug coverage

Note: If Plan F costs more than $20/month over Plan G, Plan G may be better financial value since the Part B deductible is only $283

Virginia Medicare Supplement (Medigap) Birthday Rule

  • A new law effective July 1, 2025 that gives Virginia residents with Medigap plans an annual opportunity to switch insurance companies without medical underwriting

  • Who qualifies- Current Medigap policyholders (not for initial enrollment)

  • Starts on your birthday each year

  • It lasts 60 days after your birthday

  • Insurers cannot deny you or charge more due to pre-existing conditions

  • You can switch to any insurance company offering Medigap in Virginia

https://www.medicare.gov/

Medicare Helpline is 1-800-MEDICARE (1-800-633-4227)

For assistance with Medicare enrollment or to get free quote for Medicare advantage (Part C), Medicare PDP (Part D) or Medicare supplemental plans click Contact Us at the top of the page.

Contact Us For More Information

By providing your name and contact information, you are consenting to receive communications from a licensed insurance agent, which may include phone calls, text messages or E-mails. By providing your information, you understand that this is not a condition of purchase of any product or services, and carrier messaging and data rates may apply. We will not sell or share your phone number for marketing purposes. You may revoke consent for phone calls or texts by requesting revocation during a phone call. Privacy Policy