Medicare Part D in Virginia: Your Guide to Drug Plans in 2025
Choosing the right Medicare Part D plan in Virginia can feel like navigating a maze of premiums, deductibles, and formularies. But it doesn’t have to be overwhelming. With 16 different Medicare Part D Virginia plans available, finding one that fits your healthcare needs and budget is completely possible.
We're here to guide you through everything you need to know so you can make a confident, well-informed decision about your Medicare Part D coverage options.
Basic Medicare Part D Plans
Basic Medicare Part D plans offer essential drug coverage with lower premiums but may have higher out-of-pocket costs for certain medications. The following table links to all basic benefit Part D plans in Virginia.
| Plan Name | Premium/Mo | Deductible | Rating* | |
|---|---|---|---|---|
| AARP Medicare Rx Saver from UHC | $60 | $590 | ||
| Anthem MediBlue Rx Standard | $77 | $590 | ||
| Cigna Healthcare Assurance Rx | $90 | $590 | ||
| Clear Spring Health Value Rx | $6 | $590 | ||
| Humana Basic Rx Plan | $5 | $590 | ||
| SilverScript Choice | $28 | $590 | ||
| Wellcare Classic | $11 | $590 | ||
| * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. | ||||
- Essential Drug Coverage: Basic plans cover a narrower range of medications, focusing on essential, lower-cost drugs. Ensure that your prescriptions are included in the plan’s formulary, as Basic plans may exclude higher-cost or specialty medications.
- Lower Monthly Premiums: Basic plans typically offer lower monthly premiums, making them a cost-effective choice if your medication needs are minimal or if you are primarily taking generic drugs.
- Higher Deductibles and Cost-Sharing: Expect higher deductibles and out-of-pocket costs with Basic plans, especially for drugs not on the preferred list. If your medication needs increase, these costs could add up quickly.
Enhanced Medicare Part D Plans
Enhanced Medicare Part D plans provide broader drug coverage, often at a higher monthly premium. The following table links to all enhanced benefit Part D plans available in Virginia.
| Plan Name | Premium/Mo | Deductible | Rating* | |
|---|---|---|---|---|
| AARP Medicare Rx Preferred from UHC | $84 | $0 | ||
| Anthem MediBlue Rx Plus | $58 | $590 | ||
| Cigna Healthcare Extra Rx | $112 | $175 | ||
| Cigna Healthcare Saver Rx | $18 | $590 | ||
| Clear Spring Health Premier Rx | $73 | $590 | ||
| Humana Premier Rx Plan | $105 | $0 | ||
| Humana Value Rx Plan | $16 | $573 | ||
| Wellcare Medicare Rx Value Plus | $102 | $590 | ||
| Wellcare Value Script | $0 | $590 | ||
| * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. | ||||
- Broader Drug Coverage: Enhanced plans generally offer more extensive coverage, including a broader range of brand-name and specialty drugs. This can be crucial if you require medications not covered by Basic plans.
- Higher Monthly Premiums: Enhanced plans may have higher monthly premiums, reflecting the broader coverage and additional benefits. Ensure that the increased premium aligns with your medication needs and overall budget.
- Lower Out-of-Pocket Costs: Although the premiums are higher, Enhanced plans often offer lower deductibles and reduced copayments or coinsurance for certain drugs. This could lead to overall savings if you require several medications.
Extra Help Medicare Part D Plans
Extra Help Medicare Part D plans significantly reduce prescription costs for eligible beneficiaries, offering lower premiums, deductibles, and copayments. This program is not part of Medicare Advantage plans. The following table shows all Extra Help Part D plans available in Virginia.
| Plan Name | Premium/Mo | Deductible | Rating* | |
|---|---|---|---|---|
| AARP Medicare Rx Preferred from UHC | $84 | $0 | ||
| AARP Medicare Rx Saver from UHC | $60 | $590 | ||
| Anthem MediBlue Rx Plus | $58 | $590 | ||
| Anthem MediBlue Rx Standard | $77 | $590 | ||
| Cigna Healthcare Assurance Rx | $90 | $590 | ||
| Cigna Healthcare Extra Rx | $112 | $175 | ||
| Cigna Healthcare Saver Rx | $18 | $590 | ||
| Clear Spring Health Premier Rx | $73 | $590 | ||
| Clear Spring Health Value Rx | $6 | $590 | ||
| Humana Basic Rx Plan | $5 | $590 | ||
| Humana Premier Rx Plan | $105 | $0 | ||
| Humana Value Rx Plan | $16 | $573 | ||
| SilverScript Choice | $28 | $590 | ||
| Wellcare Classic | $11 | $590 | ||
| Wellcare Medicare Rx Value Plus | $102 | $590 | ||
| Wellcare Value Script | $0 | $590 | ||
| * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. | ||||
- Significant Cost Savings: Extra Help plans are designed to lower your prescription drug costs, including premiums, deductibles, and copayments. Compare how much you can save with each plan, as some might offer more substantial reductions based on your specific medications.
- Coverage During the Coverage Gap: With Extra Help, you might receive continued drug coverage through the coverage gap (donut hole). This means your out-of-pocket medication costs could remain consistent throughout the year, providing more predictable expenses.
- Formulary and Drug Tiers: Even with Extra Help, reviewing the plan's formulary and drug tiers is essential to ensure your medications are covered and to understand any potential out-of-pocket costs. LIS plans might still have variations in copayments depending on the tier of your medications.
- Pharmacy Network Access: Some plans may offer lower copayments at preferred pharmacies. Verify that your regular pharmacy is included in the plan's network, or consider switching to a preferred pharmacy to maximize your savings.
- Impact on Plan Choice: If you qualify for Extra Help, it might influence which plans are most beneficial for you. Plans with higher premiums or deductibles that may not be affordable without assistance could become viable options under LIS, offering more comprehensive coverage.
Medicare Part D Plans Explained
A Part D plan is the go-to coverage for helping you cover prescription drug costs if you're on Medicare. The main difference between this and Original Medicare is that private insurance companies run the show.
This year, you can expect to shell out an average of $489 for deductibles, but 2 plans offer a $0 deductible - music to the ears of those who have regular prescriptions.
How Medicare Part D Plans Work
Every Medicare Part D plan covers a wide range of drugs categorized into what’s known as a formulary. Formularies list all the medications covered by that specific plan. Each plan may have different formularies, which is why it’s essential to check and make sure yours includes the prescriptions you need.
Also, every formulary has different “tiers” which categorize medications based on cost. Generally, lower-tier drugs have lower copayments, while higher-tier medications will come with higher out-of-pocket costs.
For example, Tier 1 drugs might include generic medications and have the lowest copayments. Tier 2 might be preferred brand-name drugs and have slightly higher costs. Tiers 3, 4, and 5 might include specialty medications with higher price tags.
Your out-of-pocket costs can vary depending on factors like your chosen plan, the tier level of your medications, and which coverage phase you’re currently in (deductible phase or initial coverage phase, for example).
Key Factors to Consider When Before a Medicare Part D Plan
Finding a Medicare Part D in Virginia that aligns with your individual needs requires careful review of various factors. This ensures that your plan provides the right coverage while minimizing your out-of-pocket costs.Monthly Premium
This is the amount you pay each month for your Medicare Part D plan. Think of it like a subscription fee. While it’s tempting to go for the lowest possible premium, remember to factor in deductibles, copayments, and coverage details.
A lower monthly premium often means a higher deductible or more limited coverage. The goal is to find a good balance that won't result in unexpected expenses later.
Annual Deductible
Similar to deductibles with other types of insurance, this is the amount you need to pay out of pocket for covered medications before your Medicare Part D plan starts covering costs. It’s the amount you pay before your insurance kicks in.
If you regularly take prescription medications, opting for a plan with a lower deductible can often lead to greater savings. If you rarely need prescriptions, choosing a plan with a higher deductible might be a better option.
Drug Formulary
Carefully check the plan’s formulary (list of covered medications) to make sure the drugs you take are on it. Since plans often change their formularies throughout the year, it’s a good practice to review it during the Annual Enrollment Period to confirm your medications are still covered.
Pay special attention to your drug’s tier placement because this directly impacts how much you'll have to pay for it.
Pharmacy Network
Most plans have preferred pharmacy networks offering reduced medication prices, potentially saving you significant money. Check that the pharmacies you prefer are in the plan’s network and explore if mail-order pharmacy services are an option. This can be particularly beneficial for maintenance medications.
How Part D Plans Work with Other Parts of Medicare
Medicare Part D gives you prescription drug coverage, but you might wonder, "How does it fit in with my other Medicare coverage?" It's simpler than you think! Let's break it down:
Original Medicare (Parts A and B)
With Original Medicare, Part A covers hospital stays, while Part B handles doctor visits and other medical services, including medications administered by your doctor. Part D comes into play by helping cover the costs of the prescription drugs you take at home. Together, these parts provide comprehensive coverage for both medical care and prescriptions.
Medicare Supplement Insurance
Medicare Supplement plans, often referred to as Medigap, help pay for some of the healthcare costs that Original Medicare doesn’t cover, such as copays, coinsurance, and deductibles. However, Medigap plans don’t cover everything.
For example, Medicare Supplements don’t include prescription drug coverage. To get coverage for your medications, you'll need to enroll in a stand-alone Part D plan.
If you take multiple medications, having both a Medicare Supplement plan and a Part D plan can help you manage your costs. Although you’ll pay a monthly premium for each, the added security of comprehensive medical and drug coverage can be well worth it.
Medicare Advantage
Part D works differently if you have a Medicare Advantage plan, sometimes called Part C. Most Medicare Advantage plans include Part D prescription drug coverage. This means you get your medical and prescription drug coverage bundled together.
However, some Medicare Advantage plans don't include Part D, allowing you to choose a stand-alone Part D plan.
Whether you choose Original Medicare with a standalone Part D plan or a Medicare Advantage plan with drug coverage, the goal is to find what fits you best. Think about what prescriptions you take and your budget. This will help you make the best choice for your health needs.
Important Dates for Medicare Part D Enrollment
Medicare has specific timeframes for enrolling in or modifying your coverage. Here are the key enrollment periods to keep in mind:
- Initial Enrollment Period (IEP): This begins three months before your 65th birthday and lasts for a total of seven months.
- Annual Enrollment Period (AEP): Occurring each year from October 15th to December 7th, this period allows you to make changes to your coverage.
- Medicare Advantage Open Enrollment Period: Held annually from January 1st to March 31st, this period is for those who already have a Medicare Advantage plan.
For more details, be sure to checkout and bookmark our Medicare Enrollment Periods Guide.
Need Help Enrolling in a Virginia Prescription Drug Plan?
Sorting through Medicare Part D plans on your own can feel challenging, but you don’t have to do it alone. Our knowledgeable, licensed insurance agents are available to help by phone at 1-833-748-3201, seven days a week (Mon-Fri 5am-6pm, Sat 6am-5pm PST).
We’re here to answer your questions, compare plans, and assist you every step of the way through the enrollment process.
Plans Offered Through Medicare.org
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Baylor Scott & White Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, GlobalHealth, Health Care Service Corporation, Healthy Blue, HealthSun, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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