Medicare Advantage in Virginia: 2026 At a Glance
| Total MA Plans Available | 44 |
|---|---|
| Average Monthly Premium | $10.80/month |
| Average CMS Star Rating | 4.0 / 5.0 stars |
| Part D Plans (standalone) | 24 |
| Medicare Beneficiaries in State | 1,680,000 |
How Medicare Advantage Works in Virginia
Medicare Advantage (Part C) is an alternative to Original Medicare offered by private insurers approved by CMS. In Virginia, there are 44 Medicare Advantage plans available, with an average CMS star rating of 4.0 out of 5.0. Unlike Original Medicare, most MA plans include prescription drug coverage (MAPD), dental, vision, and hearing benefits, often at a lower out-of-pocket cost for people who stay in-network.
CMS Star Ratings for Virginia Medicare Advantage Plans
CMS evaluates every Medicare Advantage plan annually on 40+ quality measures and assigns a star rating from 1 to 5. Plans rated 4 stars or higher receive quality bonus payments, which insurers typically pass on to enrollees through lower premiums or richer benefits. The average MA plan in Virginia is rated 4.0 stars.
What CMS Star Ratings Measure
| Category | Weight | Examples |
|---|---|---|
| Managing Chronic Conditions | High | Diabetes control, blood pressure management, cholesterol screening |
| Member Experience | High | Getting needed care, getting appointments, customer service |
| Preventive Care | Medium | Flu shots, cancer screenings, medication adherence |
| Health Plan Administration | Medium | Appeals decisions, call center performance |
| Drug Plan Quality (if MAPD) | Medium | Drug pricing accuracy, formulary accuracy |
Types of Medicare Advantage Plans in Virginia
| Plan Type | Network | Referrals Required | Out-of-Network Coverage |
|---|---|---|---|
| HMO (Health Maintenance Organization) | Restricted network | Yes (for specialists) | Emergency only |
| PPO (Preferred Provider Organization) | Preferred + out-of-network | No | Yes (higher cost) |
| PFFS (Private Fee-for-Service) | Any provider accepting plan terms | No | Yes (if provider accepts) |
| SNP (Special Needs Plan) | Varies | Varies | Limited |
2026 Medicare Advantage Enrollment Periods in Virginia
| Period | Dates | What You Can Do |
|---|---|---|
| Annual Enrollment Period (AEP) | Oct 15 – Dec 7 | Switch plans, join, or drop MA |
| Medicare Advantage Open Enrollment | Jan 1 – Mar 31 | Switch MA plans or return to Original Medicare |
| Initial Enrollment Period | 3 months before to 3 months after turning 65 | First-time enrollment |
| Special Enrollment Period | Varies by qualifying event | Moving, losing other coverage, etc. |
Medicare Advantage vs. Original Medicare in Virginia
| Feature | Original Medicare | Medicare Advantage |
|---|---|---|
| Monthly premium | Part B: $185/month (2026) | $10.80/month (average in Virginia) |
| Annual out-of-pocket max | No limit | Capped (varies by plan) |
| Prescription drugs | Separate Part D plan required | Usually included (MAPD) |
| Dental/vision/hearing | Not covered | Usually included |
| Provider choice | Any Medicare provider nationwide | Network restrictions apply |
| Prior authorization | Rarely required | Common for specialist visits and procedures |
| Star rating | N/A | Average 4.0 stars in Virginia |
How to Choose a Medicare Advantage Plan in Virginia
When comparing Medicare Advantage plans in Virginia, prioritize these factors in order: (1) whether your current doctors and preferred hospitals are in-network, (2) whether your current prescriptions are on the plan formulary at a reasonable tier, (3) the plan’s CMS star rating — aim for 4 stars or higher, (4) the annual out-of-pocket maximum, and (5) any extra benefits like dental or vision that you’ll actually use. Use the Medicare Plan Finder at medicare.gov/plan-compare to compare all 44 plans available in your ZIP code.
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