Comparing Medicare plans in Virginia
Medicare is the foundation of healthcare for Americans aged 65 and older, but on its own, it leaves significant financial exposure. Original Medicare (Part A and Part B) does not feature an annual out-of-pocket maximum, meaning that if you face a severe illness or a prolonged hospital stay, your share of the medical bills can spiral out of control.
This is exactly the problem Medicare Supplement Insurance—universally known as Medigap—is designed to solve.
Medigap policies are private health insurance plans sold by commercial carriers that step in to pay the deductibles, coinsurance, and copayments that Original Medicare leaves behind. For Virginia residents approaching their 65th birthday or retiring from employer coverage, deciding whether to buy a Medigap policy, which lettered plan to choose, and which carrier to purchase it from is one of the most consequential financial decisions of retirement.
This comprehensive guide serves as the complete spine to understanding Medigap in Virginia. We will walk through exactly how these plans work, how they compare to the alternative (Medicare Advantage), the specifics of the different plan letters, and the critical rules regarding when and how you can enroll without being penalized for your health history.
To understand what Medigap does, you first have to understand the specific gaps in Original Medicare that make supplemental coverage a necessity rather than a luxury. Original Medicare is divided into two primary parts, and each comes with its own set of out-of-pocket costs.
Medicare Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. However, it is not free to use.
When you are admitted to a hospital under Part A, you are subject to the Part A deductible. Unlike standard private health insurance, where a deductible is an annual figure, the Medicare Part A deductible applies per benefit period. A benefit period begins the day you are admitted as an inpatient and ends when you have not received any inpatient hospital care (or skilled care in a SNF) for 60 consecutive days.
If you are hospitalized in February, discharged, and then hospitalized again for a different condition in October, you will pay that hefty Part A deductible twice in the same year. If your hospital stay extends beyond 60 days, you will also begin paying steep daily coinsurance amounts that quickly add up to thousands of dollars. Medigap policies step in to cover these catastrophic inpatient costs.
Medicare Part B covers outpatient care: doctor visits, specialist consultations, preventative services, outpatient surgeries, durable medical equipment, and ambulance services.
Part B comes with a relatively small annual deductible. However, once that deductible is met, Original Medicare typically pays 80% of the Medicare-approved amount for these services. You are responsible for the remaining 20% coinsurance.
A 20% coinsurance might sound manageable for a $150 doctor visit, where your share is $30. But if you need a $100,000 outpatient surgery, or you require expensive Part B-administered chemotherapy drugs that cost $10,000 a month, that 20% coinsurance becomes financially devastating. Because there is no cap on how much you can be charged for this 20% share in a given year, Original Medicare alone leaves your retirement savings vulnerable.
Medigap policies exist to pay that 20% coinsurance, effectively placing a firm ceiling on your medical liability and turning unpredictable healthcare costs into predictable monthly premiums.
Medicare Supplement Insurance is private coverage that explicitly acts as a secondary payer to Original Medicare. When you receive medical care, the doctor or hospital submits the bill to Medicare first. Medicare pays its approved share, and then Medicare automatically forwards the remaining balance to your Medigap insurance company, which pays the rest according to the terms of your policy.
There are three foundational characteristics of Medigap that differentiate it from other types of insurance:
Perhaps the most significant advantage of choosing Medigap over Medicare Advantage is the total absence of provider networks. Medigap policies do not have HMO or PPO networks.
If you have a Medigap plan, you can see any doctor, visit any specialist, or be admitted to any hospital in the United States that accepts Original Medicare. You do not need referrals from a primary care physician to see a specialist, and you do not have to worry about whether a world-renowned cancer center in another state is “in-network.” If they accept Medicare, they must accept your Medicare Supplement plan, regardless of which insurance company issued the policy.
Since 1992, the federal government has required that all Medigap plans be standardized and labeled by letters (e.g., Plan F, Plan G, Plan N).
Standardization means that the medical benefits of a specific letter plan are identical across all insurance carriers. A Plan G purchased from UnitedHealthcare offers the exact same core medical coverage as a Plan G purchased from Anthem Blue Cross and Blue Shield, Aetna Medicare, or Humana. The plans cover the exact same gaps, pay the exact same coinsurances, and offer the exact same freedom of doctors.
Because the benefits are standardized, you do not have to compare the fine print of the medical coverage between carriers. Your decision largely comes down to the monthly premium price, the carrier’s reputation for customer service, and the carrier’s history of rate increases over time.
All standardized Medigap policies are guaranteed renewable. This means that once you are enrolled in a policy, the insurance company can never cancel your coverage due to a decline in your health. As long as you continue to pay your monthly premium on time, your coverage remains locked in for life. Even if you develop a chronic, expensive condition that requires millions of dollars in care, your Medigap carrier must continue paying your claims.
When you turn 65 in Virginia, you face a fork in the road. You must choose between two distinct paths for your Medicare coverage: staying with Original Medicare and adding a Medigap policy, or leaving the traditional system to enroll in a Medicare Advantage (Part C) plan. You cannot have both at the same time.
It is crucial to understand the structural differences between these two paths.
Medicare Advantage plans are private health plans that replace Original Medicare. When you enroll in Advantage, you still pay your Part B premium to the government, but the private insurance company completely takes over administering your health benefits. These plans often feature $0 or very low monthly premiums and frequently bundle in extras like prescription drug coverage, basic dental, and vision. However, Advantage plans require you to use local HMO or PPO provider networks, mandate referrals to see specialists, and use prior authorization requirements where the insurance company must approve expensive procedures before you can receive them. Advantage plans have an annual out-of-pocket maximum, but you will pay copayments out of your own pocket as you receive care until you reach that maximum.
Medigap (Original Medicare) operates entirely differently. Original Medicare remains your primary insurance. You pay a monthly premium for the Medigap policy itself, which is generally higher than an Advantage premium. In exchange, you get comprehensive coverage with effectively no out-of-pocket costs for approved medical services (depending on the letter plan you choose). You have absolute freedom to see any doctor in the U.S. who accepts Medicare, without network restrictions or prior authorizations dictated by a private carrier. You will, however, need to purchase a separate Part D plan for your prescription medications, as Medigap strictly covers medical care.
In short: Medicare Advantage is a pay-as-you-go system with restricted local networks and lower upfront monthly premiums. Medigap is a pay-upfront system with higher monthly premiums, but it provides maximum geographic freedom, no managed care restrictions, and nearly 100% cost coverage at the point of service.
There are currently ten standardized Medigap plans available in most states, including Virginia: A, B, C, D, F, G, K, L, M, and N.
However, in the modern Medicare landscape, the vast majority of consumers focus their decision on just a few dominant plans. For those newly eligible for Medicare, the choice almost always comes down to Plan G or Plan N.
Below is an overview of the most prominent Medigap plans available today.
For anyone becoming eligible for Medicare after January 1, 2020, Plan G is the most comprehensive Medigap policy legally available for purchase.
Plan G leaves you with only one medical bill to worry about for the entire year: the Medicare Part B annual deductible. Once you pay that relatively small deductible out of pocket, Plan G steps in and covers 100% of all remaining Medicare-approved costs for the rest of the calendar year.
It covers your Part A hospital deductible, all hospital coinsurance, skilled nursing facility coinsurance, and all Part B 20% coinsurance. It also completely covers “Part B Excess Charges,” which occur in rare cases when a doctor who does not accept standard Medicare assignment legally charges up to 15% more than the Medicare-approved amount.
Plan G provides ultimate peace of mind. You pay your monthly premium, you pay your one small annual Part B deductible, and from that point forward, your medical care is completely covered.
Plan N has surged in popularity because it offers lower monthly premiums than Plan G, making it highly attractive for cost-conscious retirees who still want the broad network freedom of Original Medicare.
Plan N functions very similarly to Plan G, with three specific differences where you take on slightly more cost-sharing:
If you rarely visit the doctor and want a lower premium while still insulating yourself against catastrophic hospital bills, Plan N is an exceptional value.
| Feature / Gap | Medigap Plan G | Medigap Plan N | Notes |
|---|---|---|---|
| Part A Hospital Deductible | Covered 100% | Covered 100% | Covers the per-benefit-period fee. |
| Part A Hospital Coinsurance | Covered 100% | Covered 100% | For extended hospital stays past 60 days. |
| Part B Annual Deductible | You Pay | You Pay | No modern plan covers this for new enrollees. |
| Part B 20% Coinsurance | Covered 100% | Mostly Covered | Plan N requires up to $20 copays for office visits. |
| Emergency Room Copay | Covered 100% | You pay up to $50 | Waived on Plan N if admitted to the hospital. |
| Part B Excess Charges | Covered 100% | You Pay | Excess charges are rare but can occur with out-of-network specialists. |
You will frequently hear people talk about Medigap Plan F, as it was historically the most popular plan in the country. Plan F covers 100% of all Medicare-approved gaps, including the Part B annual deductible. With Plan F, you have literally zero out-of-pocket costs for covered medical services at the point of care.
However, under the Medicare Access and CHIP Reauthorization Act (MACRA), Congress changed the rules. Anyone who became eligible for Medicare on or after January 1, 2020, is legally barred from purchasing a Medigap policy that covers the Part B deductible. Therefore, Plan F (and Plan C) is no longer available to new Medicare beneficiaries.
If you were eligible for Medicare prior to January 1, 2020, you retain the right to purchase or keep a Plan F policy today. However, because no new, younger enrollees are entering the Plan F risk pool, premiums for Plan F are generally rising faster than premiums for Plan G.
For beneficiaries who want the lowest possible monthly premium but absolutely refuse to give up the geographic freedom of Original Medicare to join an Advantage plan, High-Deductible Medigap options exist.
High-Deductible Plan G (HDG) operates just like standard Plan G, but before the policy pays a single dime, you must first reach a significant annual out-of-pocket threshold (typically around $2,800 or more, adjusting annually). You pay for all your own outpatient and inpatient care out of pocket until you hit that high deductible, at which point the policy functions exactly like standard Plan G, covering 100% of remaining costs.
When it comes to Medicare Supplement Insurance, when you apply is just as important as what you apply for. Unlike Original Medicare itself, which is a federal right, Medigap policies are underwritten by private insurance companies that are legally allowed to discriminate based on your health history—except during specific, protected windows.
Your single most important window is the Medigap Open Enrollment Period. This is a one-time, six-month period that begins on the first day of the month in which you are both 65 or older and enrolled in Medicare Part B.
During these six months, you possess a federal right known as “Guaranteed Issue.” Under guaranteed issue rights, a Medigap carrier cannot:
During this window, medical underwriting is completely bypassed. Whether you are running marathons or currently receiving expensive cancer treatments, you will be approved for coverage at the exact same base rate.
This window only happens once. If you miss your Medigap OEP and try to apply for a policy later, the insurance company will put you through medical underwriting. They will review your medical records, examine your prescriptions, and ask detailed questions about your health history. If you have pre-existing conditions, they can legally deny your application entirely or charge you significantly higher premiums.
Outside of your initial six-month OEP, there are a few specific circumstances in Virginia where you can secure a Medigap policy with guaranteed issue rights (without medical underwriting). These situations typically occur when you lose coverage through no fault of your own.
Examples of situations that trigger guaranteed issue rights include:
If you qualify under one of these specific scenarios, you generally have a 63-day window to apply for a Medigap policy without being subjected to health questions.
If you meet any of the following criteria, you can secure a Medigap policy without facing medical underwriting or being denied for pre-existing conditions.
While the medical benefits of a Plan G are identical across all companies, the prices absolutely are not. Insurance companies use different methodologies to price their policies, and understanding these structures is vital to determining not just what a policy costs today, but what it will cost a decade from now.
In Virginia, insurance carriers generally use one of three pricing structures for Medigap policies:
When evaluating a quote, it is critical to ask how the policy is rated. An attained-age policy might look aggressively cheap when you are 65, but by the time you are 80 and living on a fixed income, the age-based increases can make it difficult to afford.
In addition to rating methodologies, carriers also apply various discounts. Many offer “household discounts” if two spouses (or sometimes just two adults living at the same address) both enroll in Medigap policies through the same company. These discounts can range from 5% to 12% and significantly alter the math of which carrier provides the best long-term value.
Virginia has a robust, competitive Medicare Supplement market. Because the plans are strictly standardized, carriers compete fiercely on premium price, historical rate stability, and customer service.
While the availability of specific carriers can vary slightly depending on your exact county, the major health insurance companies operating in Virginia’s Medicare space include:
When selecting a carrier, do not simply choose the brand name you recognize most from television commercials. A lesser-known, highly rated mutual insurance company might offer the exact same Plan G at a lower monthly premium with a stronger history of keeping inflation-based rate increases small over time.
Choosing your Medicare path is not a one-size-fits-all endeavor. The right decision depends entirely on your health needs, your budget, and your lifestyle. Here is a decision map to help you contextualize your options.
If you travel frequently, split your time between states, or live in an RV: You strongly need Medigap over Medicare Advantage. Advantage plans feature localized networks that will not cover non-emergency routine care when you are traveling out of state. Medigap provides seamless, nationwide coverage wherever Original Medicare is accepted. Plan G is highly recommended here to ensure seamless, predictable care anywhere in the country.
If you have complex, chronic health conditions and see multiple specialists: Medigap is the safer financial choice. Advantage plans require you to navigate HMO/PPO networks and often demand referrals to see specialists. If your specialist drops out of the network mid-year, you lose access to them. With Medigap Plan G, you bypass networks entirely. You control your care, and your maximum out-of-pocket exposure is strictly limited to the Part B deductible.
If you are healthy, rarely see the doctor, but want catastrophic protection without restrictive networks: Medigap Plan N is likely your strongest option. You save substantially on monthly premiums compared to Plan G. In exchange, you take on small $20 copays for the rare times you do see a doctor. You retain the full geographic freedom of Original Medicare, protecting you from massive hospital bills while keeping upfront costs low.
If you want all your benefits bundled into one card and prefer lower monthly premiums over geographic freedom: You are the target audience for Medicare Advantage. Just be fully aware of the trade-offs: localized networks, out-of-pocket copays for services up to a high maximum, and the potential need for prior authorizations.
Navigating Medicare requires precision. If you decide that Medigap is the correct path for your healthcare needs, follow this procedural roadmap to ensure a smooth transition into your coverage.
Step 1: Enroll in Original Medicare (Part A and Part B). You cannot purchase a Medigap policy until you are actively enrolled in both Part A and Part B. If you are already collecting Social Security, this will happen automatically. If not, you must proactively apply through the Social Security Administration about three months before your 65th birthday or your retirement date.
Step 2: Compare Lettered Plans. Decide the level of coverage you need based on your budget and risk tolerance. Choose between the comprehensive coverage of Plan G, the value-driven structure of Plan N, or a High-Deductible option. Remember, the letter you choose dictates your medical benefits perfectly.
Step 3: Compare Carrier Rates in Your Virginia Zip Code. Because benefits are standardized, you are comparing prices and rate-increase histories. Look at premiums from Anthem, Humana, UnitedHealthcare, Aetna, and others. Ensure you factor in any available household discounts and understand whether the policy is attained-age or issue-age rated.
Step 4: Submit Your Medigap Application. If you are in your six-month Open Enrollment Period, your acceptance is guaranteed. Work with a licensed agent or apply directly with the carrier. The policy will be linked to your Medicare Number, allowing the automatic secondary payer system to function seamlessly when you visit the doctor.
Step 5: Purchase a Standalone Part D Prescription Drug Plan. Medigap only covers medical care. You must purchase a separate Medicare Part D plan to cover your pharmacy prescriptions. If you fail to enroll in Part D when you are first eligible and do not have creditable drug coverage elsewhere, you will face permanent late enrollment penalties if you try to buy it later.
Speak with a licensed producer to compare standardized Medigap rates, verify your enrollment windows, and find the right coverage for your retirement.
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