Virginia is a mid-size Medicare Advantage market with 143 plans in 2026, serving about 683,000 enrollees across the state's 1.74 million Medicare beneficiaries. At 39% MA penetration, Virginia sits below the national average of roughly 54%, but the market has grown steadily from under 20% penetration in 2018. Urban corridors around Northern Virginia, Richmond, and Hampton Roads drive most enrollment, while the rural Southwest and Shenandoah Valley counties tend to have fewer plan choices and higher premiums.
The Virginia carrier landscape in 2026 is led by Humana (dominant statewide HMO presence), UnitedHealthcare, Anthem Blue Cross Blue Shield, and Aetna. Kaiser Permanente operates in the Northern Virginia and DC metro service area with its integrated HMO-POS model. Sentara Health Plans significantly reduced its 2026 offerings, exiting Non-Dual Medicare Advantage and Chronic Condition SNP products, pushing former Sentara members to find new plans during AEP 2025. WellCare and Devoted Health round out the mid-tier with competitive $0-premium options. Note: Cardinal Care is Virginia's Medicaid managed care brand, not a Medicare Advantage product. Do not conflate the two.
This guide covers the 2026 Virginia Medicare Advantage market: plan count, top carriers, plan type breakdown, county variance, what to look for when shopping, and key enrollment dates. The Annual Election Period is October 15 to December 7, 2026, for coverage starting January 1, 2027.
2026 Medicare Advantage Market Overview in Virginia
In 2026, Virginia has 143 Medicare Advantage plans available, with 683,300 beneficiaries enrolled (39% MA penetration). The average monthly premium is $9 and the statewide average Star Rating is 3.8.
Top Medicare Advantage carriers in Virginia (2026)| Carrier | Plans | Avg Star Rating | Avg Premium |
|---|
| Humana | 22 | 3.5 | $5/mo |
| UnitedHealthcare | 25 | 4.0 | $17/mo |
| Anthem Blue Cross Blue Shield | 20 | 3.5 | $12/mo |
| Aetna | 18 | 3.5 | $10/mo |
| Kaiser Permanente | 8 | 4.5 | $41/mo |
| HealthSpring (Cigna/HCSC) | 14 | 4.0 | $4/mo |
| WellCare | 16 | 3.5 | $3/mo |
| Devoted Health | 10 | 4.0 | $0/mo |
Source: healthinsurance.org Virginia Medicare data (January 2026), KFF Medicare Advantage 2026 Spotlight, CMS Medicare Plan Finder Q4 2025, NerdWallet Virginia Medicare Advantage 2026
Plan Types in Virginia: HMO vs PPO vs SNP
Medicare Advantage plan-type breakdown in Virginia| Plan Type | Plans Available | Avg Premium | Best For |
|---|
| HMO / HMO-POS | 72 | $6/mo | Lower premiums, willing to use network providers; Kaiser HMO-POS adds some out-of-network flexibility |
| PPO | 32 | $28/mo | Flexibility to see out-of-network providers; popular with beneficiaries who travel or split time between states |
| Special Needs Plan (SNP) | 39 | $0/mo | Dual-eligible (Medicare + Medicaid), chronic conditions (C-SNP), or institutional care (I-SNP) |
| PFFS (Private Fee-for-Service) | 4 | $18/mo | Any provider that accepts terms; less common; limited plan options in VA |
HMO and HMO-POS plans make up about half of Virginia's 143 MA plans. PPO share is growing as beneficiaries in Northern Virginia and Richmond demand network flexibility. SNPs represent 27% of plans, driven by Virginia's dual-eligible population.
Source: CMS Medicare Plan Finder Q4 2025, medicare.org Virginia SNP Plans 2026
County-Level Variance in Virginia
Plan availability and premiums vary substantially by Virginia county. Northern Virginia and Hampton Roads urban counties offer 35-45 plans per county. Rural counties in the southwestern coalfields and Shenandoah Valley typically have fewer plan choices. Premiums are lowest in competitive urban markets and highest in rural Southwest Virginia counties.
Plan count and average premium by county in Virginia| County | Plans Available | Avg Premium |
|---|
| Fairfax County | 41 | $50/mo |
| Virginia Beach City | 40 | $16/mo |
| Richmond City | 43 | $20/mo |
| Rockingham County | 28 | $22/mo |
| Buchanan County | 50 | $38/mo |
Plan counts and premiums from CMS Medicare Plan Finder Q4 2025 and MedicareAdvantage.com county data. Run a ZIP-code search at medicare.gov for your exact plan options.
Source: CMS Medicare Plan Finder Q4 2025, MedicareAdvantage.com, medicare.org Virginia county data 2026
What to Look For in a Medicare Advantage Plan in Virginia
Picking a Medicare Advantage plan in Virginia is not just about premium. Here's what matters most in 2026:
- Provider network. Confirm your primary care doctor, specialists, and preferred hospital are in-network before enrolling. Virginia networks vary significantly by county, and HMO plans require you to stay in-network for non-emergency care. Kaiser Permanente's HMO-POS is available only in Northern Virginia.
- Prescription drug coverage (formulary). Most Virginia MA plans include Part D drug coverage. Check that your medications are on the plan's formulary at a tier you can afford. The 2026 Part D out-of-pocket cap is $2,100 across all MA-PD plans, and insulin is capped at $35/month.
- Star Ratings. CMS rates plans 1-5 stars annually on quality, member experience, and chronic disease management. 4-star and 5-star plans receive CMS bonus payments that fund richer benefits. In Virginia, Kaiser Permanente (Northern VA) consistently scores 4.5 stars; UnitedHealthcare and Devoted Health average around 4.0. Humana and Aetna Virginia plans are around 3.5.
- Maximum out-of-pocket (MOOP). The 2026 federal MOOP ceiling for in-network MA spending is $9,250 (down $100 from $9,350 in 2025). Many Virginia plans set their MOOP lower, in the $4,500 to $7,500 range. Original Medicare has no MOOP limit, making this one of MA's strongest consumer protections.
- Supplemental benefits (dental, vision, hearing, fitness). Most Virginia MA plans include some dental, vision, and hearing benefits not covered by Original Medicare. Check annual limits carefully: some plans cover only cleanings and exams; others cover crowns and hearing aids. SilverSneakers or similar fitness programs are common.
- Prior authorization requirements. HMO and PPO plans can require prior authorization for surgeries, advanced imaging (MRI, CT), and specialist referrals. If you have a complex chronic condition, review the plan's prior authorization rules and check CMS denial rate data before enrolling.
- Part B premium: The standard 2026 Part B premium is $202.90/month (plus any IRMAA surcharge for higher earners). Most MA plans require you to continue paying Part B. The plan's listed premium is on top of Part B.
Key Medicare Dates in Virginia
Medicare has several enrollment windows each year. Missing a window can mean a gap in coverage or a late-enrollment penalty.
- Annual Election Period (AEP): October 15 to December 7, 2026 — Main window to join, switch, or drop a Medicare Advantage or Part D plan. Coverage starts January 1, 2027.
- Medicare Advantage Open Enrollment Period (MA OEP): January 1 to March 31, 2026 — Existing MA enrollees can switch to a different MA plan or return to Original Medicare. One switch allowed.
- Initial Enrollment Period (IEP): 7-month window around your 65th birthday — Starts 3 months before your 65th birthday month, includes the birthday month, and runs 3 months after. Enroll in Parts A and B first, then choose Original Medicare or Medicare Advantage.
- Special Enrollment Periods (SEPs): Varies by qualifying event — Triggered by moving out of your plan's service area, losing employer coverage, qualifying for Medicaid (dual-eligible), or other life events. Usually a 2-3 month window.
- 5-Star Special Enrollment Period: December 8, 2026 to November 30, 2027 — If a plan in your area earns 5 CMS stars, you can switch into it once at any time outside AEP. Kaiser Permanente Mid-Atlantic plans have earned 5 stars in past years.
Notable Extras in Virginia Plans
Virginia has several market-specific features worth knowing when shopping Medicare Advantage in 2026:
- Cardinal Care is Medicaid, not Medicare Advantage: Virginia launched Cardinal Care, its rebranded Medicaid managed care program, in 2023 (phased start January 2023, full go-live July 2023). Cardinal Care is a Medicaid product for low-income Virginians and is entirely separate from Medicare Advantage. If you qualify for both Medicare and Medicaid (dual eligible), you enroll in a D-SNP for your Medicare Advantage coverage, coordinated alongside Cardinal Care for Medicaid. Do not confuse the two programs.
- Dual-eligible D-SNPs (Medicare plus Medicaid): Virginia has multiple Dual Special Needs Plans (D-SNPs) in 2026 for residents who qualify for both Medicare and Medicaid. UnitedHealthcare, WellCare, Anthem, and Humana all offer D-SNPs in Virginia. These plans typically charge $0 premium, $0 copays for primary care, and zero prescription drug costs. Dual-eligible enrollees also get expanded enrollment rights, allowing one plan switch per quarter in Q1, Q2, and Q3.
- Sentara plan exit in 2026: Sentara Health Plans discontinued its Non-Dual Medicare Advantage (HMO and MA-PD) and Chronic Condition SNP products at the end of 2025. Sentara continues to offer a limited D-SNP product. Former Sentara MA members had to select a new plan during AEP 2025 or were auto-enrolled into Original Medicare. If you were a Sentara MA member, confirm your current 2026 coverage with your plan.
- Virginia SHIP counseling (free, unbiased help): Virginia's State Health Insurance Assistance Program (SHIP) offers free, unbiased Medicare counseling from trained volunteers at local area agencies on aging. SHIP counselors can compare plans for your ZIP code, review Evidence of Coverage documents, and help you file appeals. Contact Virginia SHIP at 1-800-552-3402 or visit vda.virginia.gov.
Medicare Advantage vs Original Medicare in Virginia
Original Medicare (Parts A and B) gives you nationwide provider access and no prior authorization for most services — see Medigap vs Medicare Advantage if you're weighing the Original Medicare route. But it has no out-of-pocket maximum, no drug coverage (you need a separate Part D plan), and no dental or vision. Adding a Medigap supplement and standalone Part D in Virginia typically costs $150 to $350 per month in additional premiums beyond the standard Part B premium of $202.90/month.
Medicare Advantage plans in Virginia bundle hospital, medical, and usually drug coverage into one plan, with a statewide average monthly premium of around $9 in 2026 (on top of Part B). The trade-off is a defined provider network, prior authorization for many services, and a geographic service area. The plan also caps your annual out-of-pocket maximum, which Original Medicare does not. If you split time between Virginia and another state, or need access to out-of-state specialists regularly, a PPO plan or Original Medicare plus Medigap is usually a better fit.
For most Virginia beneficiaries who stay within the state and want lower total costs, Medicare Advantage wins on cost: a $9/month MA premium versus $150-$350 more for Medigap + Part D. For those who want simplicity, nationwide access, and no network restrictions, Original Medicare remains the right choice.
Medicare Advantage vs Original Medicare in Virginia detail| Feature | Medicare Advantage (VA avg) | Original Medicare + Medigap |
|---|
| Monthly premium (on top of Part B) | ~$9/mo | ~$150 to $350/mo (Medigap + Part D) |
| Annual out-of-pocket maximum | $4,500 to $9,250 (plan-set) | None |
| Drug coverage | Included in most plans (MA-PD) | Separate Part D plan required |
| Provider network | In-network required (HMO) or preferred (PPO) | Any provider that accepts Medicare |
| Dental, vision, hearing | Included (varies by plan) | Not covered |
| Prior authorization | Common for many services | Rare |
Medigap premiums in Virginia vary by age, plan letter (G, N, etc.), and carrier. Get personalized quotes at the Virginia State Corporation Commission at scc.virginia.gov/medigap.
Source: CMS 2026 data, Virginia State Corporation Commission
How Star Ratings work and why they matter in Virginia
CMS publishes Medicare Advantage Star Ratings each October, rating plans 1 to 5 stars across roughly 40 quality measures: management of chronic conditions like diabetes and cardiovascular disease, member complaints, customer service responsiveness, and Part D drug safety. Higher-rated plans often include richer dental and vision benefits. Plans rated 4 stars or higher receive quality bonus payments from CMS, which carriers often reinvest in richer benefits, lower cost-sharing, and additional supplemental benefits.
Virginia's statewide weighted-average Star Rating for 2026 is approximately 3.8, near the national average. Kaiser Permanente Mid-Atlantic plans in Northern Virginia are the top-rated plans in the state (4.5 stars). Devoted Health and UnitedHealthcare both score around 4.0. Humana and Aetna Virginia plans are in the 3.5 range for 2026, reflecting national score declines for both carriers. A plan with 5 stars unlocks a special enrollment window that lets you switch into it any time between December 8 and November 30 the following year.
How to enroll in Medicare Advantage in Virginia
To enroll in a Medicare Advantage plan in Virginia, you must be enrolled in Medicare Parts A and B. You can then enroll during your Initial Enrollment Period (around your 65th birthday), during the Annual Election Period (October 15 to December 7), or during a qualifying Special Enrollment Period. There are four ways to enroll:
Online at medicare.gov using the Plan Compare tool, which shows all plans available at your ZIP code. By phone at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. Through the plan directly (carrier website or by calling the plan's sales line). With a licensed Virginia SHIP counselor or independent broker at no cost to you.
Virginia SHIP counselors provide free, unbiased Medicare plan comparisons. Call 1-800-552-3402 or visit vda.virginia.gov/ship to find a local counselor in your area. SHIP counselors do not sell plans and have no financial stake in your decision.
- Step 1: Make sure you have Medicare Parts A and B active.
- Step 2: Check your enrollment window (AEP, IEP, or SEP).
- Step 3: Compare plans at medicare.gov using your ZIP code. Check network, formulary, Star Rating, MOOP, and extras.
- Step 4: Enroll online, by phone, or through the plan. Your new coverage starts January 1 (if enrolling in AEP).
- Step 5: Review your Evidence of Coverage document once received. Confirm your doctors and pharmacies are in-network.
Frequently Asked Questions
How many Medicare Advantage plans are available in Virginia in 2026?
Virginia has 143 Medicare Advantage plans available statewide in 2026, up from 142 in 2025. The number available in your specific county varies. Fairfax County and Virginia Beach City each have around 40 plans; rural Southwest Virginia counties like Buchanan may have 50 plans listed but at significantly higher average premiums. Enter your ZIP code at medicare.gov to see the exact plans available where you live.
What is the average Medicare Advantage premium in Virginia for 2026?
The statewide average Medicare Advantage monthly premium in Virginia is approximately $9 per month in 2026, down from about $11 in 2025. All Medicare-eligible Virginians have access to at least one $0-premium plan. Note that all MA enrollees also continue paying the standard Part B premium of $202.90/month. $0 premium means you pay nothing extra beyond Part B, not that Medicare is entirely free.
When can I sign up for Medicare Advantage in Virginia?
The Annual Election Period (AEP) runs October 15 to December 7, 2026, for coverage starting January 1, 2027. If you are turning 65, you have a 7-month Initial Enrollment Period around your birthday. Existing MA enrollees can make one switch during the Medicare Advantage Open Enrollment Period from January 1 to March 31, 2026. Special Enrollment Periods apply if you move, lose employer coverage, or qualify for Medicaid.
Which carriers offer Medicare Advantage plans in Virginia?
The main carriers in Virginia for 2026 are Humana, UnitedHealthcare, Anthem Blue Cross Blue Shield, Aetna, Kaiser Permanente (Northern Virginia only), HealthSpring (Cigna brand through 2026), WellCare, and Devoted Health. Sentara Health Plans exited most MA products for 2026, retaining only a limited D-SNP. Other regional carriers include Aspire Health Plan and Mutual of Omaha in select counties.
Is Kaiser Permanente available for Medicare Advantage in Virginia?
Yes, but only in Northern Virginia. Kaiser Permanente's Mid-Atlantic service area covers Fairfax, Arlington, Alexandria, Prince William, Loudoun, Manassas, and Manassas Park. Kaiser offers multiple HMO-POS Medicare Advantage plans in these areas, consistently earning 4.5-star ratings. Kaiser is not available in Richmond, Hampton Roads, or anywhere else in Virginia outside Northern Virginia.
What is Cardinal Care and is it related to Medicare Advantage?
Cardinal Care is Virginia's Medicaid managed care program, launched in 2023 (phased rollout starting January 2023, full go-live July 2023). It is entirely separate from Medicare Advantage. Cardinal Care serves low-income Virginians who qualify for Medicaid. If you are dual eligible, meaning you qualify for both Medicare and Medicaid, you can enroll in a D-SNP (Dual Special Needs Plan) for your Medicare Advantage coverage, which is coordinated alongside Cardinal Care for Medicaid services. Never confuse the two.
Does Medicare Advantage cover prescription drugs in Virginia?
Most Virginia Medicare Advantage plans include Part D prescription drug coverage. These are called MA-PD plans. The 2026 Part D annual out-of-pocket maximum is $2,100 (set by the Inflation Reduction Act of 2022). Insulin is capped at $35/month across all Part D-including plans. Check each plan's formulary to confirm your specific medications are covered and at which tier before enrolling.
What are the 2026 Medicare cost benchmarks I should know?
Key 2026 Medicare cost facts: Part B standard premium $202.90/month; Part B deductible $283/year; Part A inpatient deductible $1,736 per benefit period; Part D out-of-pocket cap $2,100; MA in-network MOOP federal ceiling $9,250 (plans can set lower). Insulin cap $35/month for all Part D-including MA plans. These apply to all Virginia Medicare Advantage enrollees regardless of carrier.
