Medicare in Virginia: 2025 Guide
Virginia is home to approximately 1.7 million Medicare beneficiaries and a large population of federal employees and retirees — particularly in Northern Virginia — for whom coordination between Medicare and the Federal Employees Health Benefits (FEHB) program is an important consideration. Virginia expanded Medicaid in 2019, improving access to cost-sharing assistance for lower-income Medicare enrollees. Medicare Advantage penetration sits at approximately 50%, with sharp differences between the well-served Northern Virginia and Hampton Roads metro areas and the more limited options available in rural southwest Virginia.
Virginia Medicare Quick Facts
| Medicare Enrollees | ~1.7 million |
| Medicare Advantage Penetration | ~50% |
| SHIP Program Name | VICAP (Virginia Insurance Counseling and Assistance Program) |
| VICAP Phone | 1-800-552-3402 |
| State Pharmaceutical Assistance | None; Medicare Extra Help available federally |
| Medicaid Program | Virginia Medicaid (expanded 2019, administered by DMAS) |
Medicare Advantage Plans in Virginia
Virginia's Medicare Advantage market reflects the state's geographic and demographic diversity. Northern Virginia — part of the Washington, D.C. metro area — is one of the most competitive MA markets in the country, with dozens of plans available from Anthem, UnitedHealthcare, Humana, Aetna, Kaiser Permanente Mid-Atlantic, and others. The Hampton Roads region (Virginia Beach, Norfolk, Chesapeake) similarly has strong plan availability.
Richmond and the Central Virginia corridor also offer robust MA options. However, the mountainous southwest Virginia counties and the rural Southside region have significantly fewer choices — in some counties, beneficiaries may find only two or three MA plans, and some may prefer Original Medicare combined with a Medigap supplement for broader provider access.
Virginia's large federal employee and retiree population requires special attention to FEHB-Medicare coordination. Many federal retirees keep their FEHB coverage when they turn 65 and must weigh whether to also enroll in Medicare Part B. VICAP counselors are trained to help federal retirees navigate this specific decision. Learn more about Medicare Advantage →
Medicare Savings Programs in Virginia
Virginia administers Medicare Savings Programs (MSPs) through the Department of Medical Assistance Services (DMAS). Since Medicaid expansion took effect in January 2019, more Virginians qualify for Medicaid and MSP assistance than before.
The four MSP tiers available in Virginia:
- Qualified Medicare Beneficiary (QMB): Pays Part A and B premiums, deductibles, and cost-sharing. Providers cannot bill QMB enrollees for Medicare cost-sharing.
- Specified Low-Income Medicare Beneficiary (SLMB): Pays the Part B premium ($185/month in 2025)
- Qualifying Individual (QI): Pays the Part B premium (limited enrollment, first-come first-served each year)
- Qualified Disabled and Working Individuals (QDWI): Pays Part A premium for certain disabled workers
To apply for an MSP in Virginia, contact DMAS or apply through your local Department of Social Services office. You can also call the Virginia Medicaid helpline or ask your VICAP counselor for assistance. Income and asset limits follow the federal minimums, but Virginia Medicaid expansion has made it easier for near-poverty beneficiaries to qualify for some form of assistance.
State Pharmaceutical Assistance in Virginia
Virginia does not operate a State Pharmaceutical Assistance Program (SPAP) for Medicare beneficiaries. However, several federal and community resources can help with prescription drug costs:
- Medicare Extra Help (Low Income Subsidy): Reduces Part D premiums, deductibles, and copays for qualifying beneficiaries. Apply at SSA.gov or call 1-800-772-1213. Many Virginians who qualify do not apply — a VICAP counselor can help you determine eligibility and complete the application.
- Virginia Medicaid: Dual-eligible beneficiaries who qualify for both Medicare and Virginia Medicaid receive prescription drug coverage coordination through the Medicaid program.
- Manufacturer Patient Assistance Programs: Pharmaceutical manufacturers offer free or reduced-cost programs for specific drugs. NeedyMeds.org and RxAssist.org are national directories.
- 340B Drug Pricing Program: Certain Virginia health centers and hospitals that participate in the 340B program offer reduced drug prices to eligible patients.
Getting Medicare Help in Virginia: VICAP
Virginia's State Health Insurance Assistance Program is called VICAP — the Virginia Insurance Counseling and Assistance Program. VICAP provides free, objective Medicare counseling to Virginia residents through a network of trained volunteer counselors operating through Area Agencies on Aging across the state.
VICAP counselors can help you:
- Compare Medicare Advantage, Part D, and Medigap plans for your county
- Understand Medicare-FEHB coordination for federal retirees
- Apply for Medicare Savings Programs and Medicare Extra Help
- Resolve Medicare billing problems and appeals
- Understand Original Medicare vs. Medicare Advantage trade-offs
Contact VICAP:
- Phone: 1-800-552-3402
- Website: vda.virginia.gov/vicap.htm
- Local offices: VICAP operates through Virginia's 25 Area Agencies on Aging statewide
Frequently Asked Questions: Medicare in Virginia
Plan availability in Virginia varies widely by location. Northern Virginia counties such as Fairfax, Arlington, and Loudoun may have 30 or more Medicare Advantage plans available, reflecting the competitive D.C.-metro market. Hampton Roads and Richmond-area beneficiaries typically have 15–25 options. Rural southwest Virginia counties may have only 3–8 choices. During Annual Open Enrollment (October 15 – December 7), enter your zip code at Medicare.gov's Plan Finder or call VICAP at 1-800-552-3402 to compare plans available in your specific area.
Virginia expanded Medicaid in January 2019, extending coverage to adults with incomes up to 138% of the federal poverty level. For Medicare beneficiaries, the most direct impact is on dual eligibility: more Virginians now qualify for both Medicare and Medicaid simultaneously, which means Virginia Medicaid can help cover costs Medicare doesn't pay — such as deductibles, copays, and Part B premiums through Medicare Savings Programs. If you have limited income and resources, it is worth applying for Medicaid through your local Department of Social Services or calling VICAP at 1-800-552-3402 to check eligibility.
This is one of the most common and consequential decisions for Virginia's large federal retiree population, and the answer depends on your specific FEHB plan, your health, and your budget. Generally, enrolling in Medicare Part B alongside FEHB provides strong coordination of benefits — Medicare pays first and FEHB wraps around it, often leaving you with little or no out-of-pocket cost. However, Part B costs $185/month (2025 standard premium), and some FEHB plans already provide generous coverage. VICAP counselors are specifically trained on FEHB-Medicare coordination and provide free guidance — call 1-800-552-3402 before making this decision.
Need Help with Medicare in Virginia?
Call VICAP at 1-800-552-3402 for free, unbiased Medicare counseling — or explore our national Medicare guides below.
Medicare Basics Guide → Medicare Advantage Guide