What does Virginia require for Medicare insurance? No optional plan is mandatory
Virginia Medicare insurance has 2 main coverage paths, but the Commonwealth does not require every beneficiary to buy Medicare Advantage, Part D, or Medigap. Medicare is a federal program, while Virginia regulates insurance products such as Medigap policies sold in the Commonwealth. The practical requirement is to choose how you will receive Medicare-covered services after you are eligible and enrolled in Parts A and B.
Medicare.gov identifies 2 main ways to receive coverage. Original Medicare includes Part A and Part B and can be paired with a separate Part D plan and optional Medigap coverage. Medicare Advantage is a Medicare-approved private-plan alternative that includes Part A and Part B and usually Part D.
Medicare.gov explains the parts of Medicare and the 2 main coverage paths .
What are the minimum Medicare coverage limits in Virginia?
Virginia does not set a personal minimum dollar limit for Medicare Advantage or Medigap shoppers. Medicare benefits, plan cost sharing, and standardized Medigap benefits are governed by federal and state rules and by the approved plan documents. The policy or evidence of coverage controls the benefits available to an enrollee.
Virginia Administrative Code 14VAC5-170 standardizes Medigap coverage so shoppers can compare the same lettered benefit design across insurers. A Plan G offers the standardized Plan G benefits regardless of the company, although premiums and underwriting outcomes can differ.
What happens if you go without optional Medicare coverage in Virginia?
There is no Virginia fine for declining Medigap or Medicare Advantage. The financial exposure depends on the path you choose. Original Medicare has no annual out-of-pocket maximum unless other coverage helps with cost sharing, while Medicare Advantage plans use plan-specific cost sharing and an annual limit for covered Part A and Part B services.
Part D has a separate late-enrollment rule. Medicare.gov states that a person may owe a Part D late-enrollment penalty after going 63 days or more without Part D or other creditable drug coverage after the eligible enrollment period. The rule is federal, not a Virginia penalty.
How much do Medicare insurance plans cost in Virginia? There is no single statewide average
A single statewide average cannot answer what a Virginia Medicare plan will cost. Medicare Advantage, Part D, and Medigap pricing depends on the product, ZIP code, eligibility, benefit design, insurer, and applicant details that law permits the insurer to use. This page therefore does not publish an invented statewide average.
Use Medicare Plan Compare for Medicare Advantage and Part D options available for the current plan year. For Medigap, the Virginia State Corporation Commission provides a Premium Finder that compares annual premiums and standardized benefits after the shopper supplies criteria such as age, ZIP code, and plan type.
Compare total expected spending, not premium alone. A complete review includes the Part B premium, any plan premium, medical deductibles and copayments, prescription costs, provider access, and travel needs. Current plan documents and official comparison tools are the sources of truth.
- Premiums — Compare the Part B premium you continue to pay, any Medicare Advantage or Part D premium, and any separate Medigap premium.
- Medical cost sharing — Compare deductibles, copayments, coinsurance, and the Medicare Advantage annual out-of-pocket limit.
- Prescription costs — Check every prescription against the plan formulary, tier, pharmacy network, and utilization rules.
- Provider access — Confirm that doctors, hospitals, pharmacies, and other providers are available under the plan's network rules.
Compare Medigap premiums with the Virginia SCC Medigap Premium Finder .
| Decision | Original Medicare path | Medicare Advantage path |
|---|---|---|
| Core coverage | Part A + Part B | Part A + Part B through the plan |
| Drug coverage | Add a separate Part D plan | Usually included in the plan |
| Supplemental coverage | Medigap may help with cost sharing | Medigap cannot be used |
| Provider access | Any provider that accepts Medicare | Plan network and authorization rules may apply |
Source: Medicare.gov, accessed August 21, 2026. Exact plan availability, networks, formularies, premiums, and cost sharing depend on ZIP code and the current plan year.
What makes Virginia different: 60-day birthday switching, disability access, and standardized Medigap plans
Virginia adds consumer protections to the federal Medicare framework through statutes and State Corporation Commission regulations governing Medicare Supplement insurance.
§ 38.2-3611 — a Medigap birthday window of at least 60 days
Virginia Code § 38.2-3611 requires issuers of individual Medigap coverage in the Commonwealth to offer a current policyholder an annual open enrollment period beginning on the policyholder's birthday and remaining open for at least 60 days. During that period, the policyholder may purchase a Medigap policy offered in Virginia with the same benefits as the current coverage.
The issuer cannot deny or condition the new policy or discriminate in price because of health status, claims history, receipt of health care, or medical condition during that window. The current issuer must send notice at least 15 days and no more than 30 days before the window starts.
§ 38.2-3610 — Medigap access for qualifying Virginians under 65
Virginia Code § 38.2-3610 requires an issuer that sells Medigap in the Commonwealth to offer at least one policy to a Virginia resident under age 65 who is eligible for Medicare because of disability and is enrolled, or will be enrolled, in Parts A and B by the effective date.
The statute includes a six-month enrollment period tied to disability eligibility and a 63-day opportunity after group health coverage ends. It also states that, effective January 1, 2024, an issuer cannot charge an eligible person under 65 a premium for the offered plan that exceeds the premium charged for that plan to people age 65.
14VAC5-170-100 — six-month Medigap open enrollment at age 65
Virginia Administrative Code 14VAC5-170-100 bars an issuer from denying, conditioning, or pricing a Medigap policy based on health status when an eligible application is submitted before or during the six-month period that begins when the applicant is both at least age 65 and enrolled in Medicare Part B.
The regulation also addresses how prior creditable coverage affects a preexisting-condition exclusion. The exact application date and prior coverage history matter, so a shopper should preserve enrollment and coverage records.
14VAC5-170-87 — Plans C and F are closed to newly eligible shoppers
Virginia Administrative Code 14VAC5-170-87 states that standardized Medigap Plans C, F, and high-deductible F may not be offered to people newly eligible for Medicare on or after January 1, 2020. Those plans cover the Part B deductible, which the regulation bars for newly eligible shoppers.
People eligible before January 1, 2020 may face different availability rules. Eligibility date, not the date someone begins shopping, controls this distinction.
Read the primary text for Virginia Code § 38.2-3611 , Virginia Code § 38.2-3610 , 14VAC5-170-100 , and 14VAC5-170-87 .
Which Virginia Medicare coverage options should you compare?
The central choice is not a ranking of insurers. The central choice is how you want Medicare-covered care, prescription coverage, provider access, and cost sharing organized.
- Original Medicare — federal Part A and Part B coverage with access to any provider that accepts Medicare
- Medicare Advantage — a Medicare-approved private plan that provides Part A and Part B benefits and usually includes Part D; networks and prior authorization may apply
- Part D — prescription drug coverage through a stand-alone plan with Original Medicare or, usually, inside a Medicare Advantage plan
- Medigap — standardized private coverage that helps pay certain Original Medicare cost sharing; Medigap cannot be paired with Medicare Advantage
- Other coverage — employer, retiree, union, Medicaid, military, or veterans' coverage may change which Medicare path is appropriate
What do Medicare plans cost in Virginia cities? Compare by ZIP code
Medicare plan availability and pricing are not reliably compared through a generic city average. Medicare Advantage and Part D options are service-area products, and the official Medicare Plan Compare tool starts with a ZIP code. Medigap premiums can also vary by the applicant criteria and rating method used by the insurer.
A Roanoke resident should compare plans using the residence ZIP code, current prescriptions, preferred pharmacies, doctors, and hospitals. A Richmond or Virginia Beach resident should repeat the same process for that ZIP code. Statewide marketing copy cannot substitute for a service-area comparison.
Epic Insurance Group serves Virginia clients from 3800 Electric Road, Suite 205, Roanoke, VA 24018. The agency can help organize a comparison, while Medicare.gov and the Virginia SCC remain the official sources for current plan and Medigap information.
How do you file a Medicare claim or appeal in Virginia?
The correct path depends on the coverage. Original Medicare claims and appeals follow Medicare's federal notices and appeal procedures. Medicare Advantage and Part D plans issue plan notices that explain appeal rights and deadlines. Medigap claims usually coordinate with Original Medicare after Medicare processes the covered service.
Start with the Medicare Summary Notice, Explanation of Benefits, denial notice, or plan document that identifies the decision and deadline. Keep the notice, provider records, prescription information, and every submission confirmation. Missing a stated deadline can affect the appeal.
For a dispute involving a Virginia-issued Medigap policy or a licensed insurer or agent, the Virginia State Corporation Commission Bureau of Insurance can review whether the company or agent followed Virginia law and the policy. The Bureau cannot act as a lawyer or force payment outside the contract.
How do you verify a license or file a complaint with the Virginia SCC?
Use the Virginia State Corporation Commission Bureau of Insurance for Virginia insurer and agent questions. The SCC's complaint page directs consumers to its online Insurance Complaint Portal or to a Life and Health Insurance Complaint/Appeal Form submitted by mail or fax. The SCC states that formal complaints are not accepted by phone or email.
The SCC lists 1-877-310-6560 for toll-free assistance and 804-371-9691 for Life and Health Consumer Services. Those numbers can help identify the right process, but the formal complaint still goes through the portal, mail, or fax.
For non-selling assistance, Medicare.gov directs beneficiaries to their local State Health Insurance Assistance Program. Medicare.gov states that SHIP counseling is not connected to an insurance company or health plan.
Start with the Virginia SCC insurance complaint page .
Which Medicare carriers does Epic Insurance Group represent in Virginia? Ask for the current appointment list
Epic Insurance Group does not publish a Medicare carrier list on this page because the profile does not contain verified Medicare carrier appointments. Naming or implying an appointment without a current record would be misleading.
Call (540) 269-1301 to ask Justin Miller which Medicare products and carriers the agency is currently authorized to discuss in your Virginia service area. Medicare.gov Plan Compare remains the source for the full set of Medicare Advantage and Part D options available by ZIP code.
Epic Insurance Group is compensated by commission when an enrolled product pays compensation. Product availability varies by service area, eligibility, and carrier authorization.
Virginia Medicare insurance FAQs
What are the 2 main ways to get Medicare coverage in Virginia?
Medicare.gov identifies Original Medicare and Medicare Advantage as the 2 main coverage paths. Original Medicare includes Part A and Part B and can add separate Part D and Medigap coverage. Medicare Advantage provides Part A and Part B through a Medicare-approved private plan and usually includes Part D.
Can I have Medigap and Medicare Advantage at the same time?
Medigap is designed to supplement Original Medicare, not Medicare Advantage. Medicare.gov states that Medigap helps pay a person's share of costs in Original Medicare. A Medicare Advantage enrollee cannot use a Medigap policy to pay the plan's copayments, coinsurance, or deductibles.
What is Virginia's Medigap Birthday Rule?
Virginia Code § 38.2-3611 gives a current Medigap policyholder an annual enrollment period beginning on the policyholder's birthday and lasting at least 60 days. During the window, the person can apply for a Medigap policy with the same benefits without health-status denial or health-based price discrimination.
Does Virginia offer Medigap to people under 65?
Virginia Code § 38.2-3610 requires an issuer selling Medigap in Virginia to offer at least one policy to a qualifying resident under 65 who has Medicare because of disability and is enrolled, or will be enrolled, in Parts A and B by the effective date. Timing requirements apply.
How do I compare Medicare plan costs in Roanoke?
Use Medicare.gov Plan Compare with the Roanoke residence ZIP code for current Medicare Advantage and Part D choices. Add prescriptions, pharmacies, and providers before comparing totals. For Medigap, use the Virginia SCC Premium Finder and compare the same lettered plan across insurers.
Does the lowest-premium Medicare plan always have the lowest total cost?
The lowest premium does not establish the lowest total cost. Total spending can include the Part B premium, plan premiums, deductibles, copayments, coinsurance, prescription tiers, pharmacy rules, and out-of-network exposure. Compare the care and medications you expect to use, not premium alone.
Will Epic Insurance Group show me every Medicare plan in Virginia?
This page does not claim that Epic Insurance Group represents every Medicare plan available in Virginia. Medicare.gov Plan Compare is the official source for the options available in a ZIP code. Ask Justin Miller which products and carriers the agency is currently authorized to discuss before relying on an agency comparison.
How do I complain about a Medigap insurer or agent in Virginia?
File a complaint with the Virginia State Corporation Commission Bureau of Insurance through its Insurance Complaint Portal or submit the Life and Health Insurance Complaint/Appeal Form by mail or fax. The SCC says formal complaints are not accepted by phone or email.
Disclaimer: This page has not been reviewed or endorsed by Medicare.gov or any member of the Centers for Medicare & Medicaid Services (CMS).
We are appointed with multiple carriers and are compensated by commission. We are paid the same regardless of which carrier you choose.
Sources
- Medicare.gov . “Parts of Medicare.” Accessed August 21, 2026.
- Medicare.gov . “Your coverage options.” Accessed August 21, 2026.
- Medicare.gov . “Medicare & You 2026.” Accessed August 21, 2026.
- Virginia Legislative Information System . “§ 38.2-3611. Annual open enrollment period.” Accessed August 21, 2026.
- Virginia Legislative Information System . “§ 38.2-3610. Medicare supplement policies for persons eligible by reason of disability.” Accessed August 21, 2026.
- Virginia Legislative Information System . “14VAC5-170-100. Open enrollment ages 65 years and older.” Accessed August 21, 2026.
- Virginia Legislative Information System . “14VAC5-170-87. Standard plans for people newly eligible on or after January 1, 2020.” Accessed August 21, 2026.
- Virginia State Corporation Commission, Bureau of Insurance . “Medigap Premium Finder.” Accessed August 21, 2026.
- Virginia State Corporation Commission, Bureau of Insurance . “File an Insurance Complaint.” Accessed August 21, 2026.