Know your options for Medicare Advantage Plans in West Virginia and find out how to enroll.
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Medicare Advantage Plans provide the same benefits as Medicare Parts A and B but through a single, bundled plan offered by Medicare-approved private insurance companies. Many of these plans offer even more benefits than what is covered by Medicaid Part A and B, such as dental, hearing and vision coverage. They may even provide other benefits like discounted gym memberships or transportation assistance to doctor’s offices. Each Medicare Advantage insurance company determines what benefits the plan will provide and at what cost to beneficiaries so it’s important to compare your plan options before choosing a Medicare Advantage Plan in West Virginia.
This article discusses everything you need to know to choose the right Medicare Advantage Plan in West Virginia for you.
You have choices in Medicare coverage. While you can opt to stick with Original Medicare, a Medicare Advantage Plan – also known as Part C – may be a better alternative for you.
|Original Medicare||Medicare Advantage Plans|
|Original Medicare covers your Part A hospital insurance and Part B medical insurance.||Medicare Advantage Plans combine Part A, Part B, and additional benefits.|
|You can add Part D prescription drug coverage.||Prescription drug coverage is usually included.|
|You’re able to use any medical provider in the U.S. that accepts Medicare.||You’ll usually need to use doctors in your plan’s network.|
|You can buy supplemental coverage to manage out-of-pocket costs, including your coinsurance.||Your Medicare Advantage Plan may have lower out-of-pocket costs than Original Medicare.|
|Vision, hearing, dental, and other benefits aren’t covered.||Your plan may offer additional benefits, including vision, hearing, and dental.|
Medicare Advantage Plans cover benefits from Original Medicare Part A (hospital insurance), Part B (medical insurance), usually Part D (prescription drug coverage), and sometimes additional benefits that Original Medicare doesn’t cover. Each Medicare Advantage Plan insurer sets the rules about how you receive and pay for these benefits.
|Hospital and skilled nursing facility inpatient care||Home health care||Prescription drug coverage (if included in your plan)|
|Medically necessary outpatient services, such as:
||Preventive services, such as:
||Additional benefits (depending on your plan), such as:
With 53 Medicare Advantage Plans available in West Virginia, you likely have several options in your area. To help you choose the best plan for you, consider what is most important to you before selecting a plan. There are several factors to keep in mind:
There are 53 Medicare Advantage Plans offered in West Virginia. These plans include:
|Number of Medicare Advantage Plans available||Medicare Advantage Plan types available||Medicare Advantage Plans rated 3.5 or higher by NCQA|
In West Virginia, the most common Medicare Advantage plans available are HMOs or PPOs, although there are also a few SNPs and regional PFFS plans available. Seniors eligible for Medicare may choose from plans provided by multiple private insurers, although the choices available vary by county.
|HMOs||HMOs typically require that you receive all services from in network providers:
|PPOs||PPOs include a preferred network of providers, but you have the option of choosing doctors or hospitals from outside of the network for a higher cost.
|PFFS Plans||PFFS plans don’t require a primary care physician or referrals for specialists:
|SNPs||SNPs are only for people with specific conditions and characteristics, and include care coordination and targeted benefits tailored to meet your specific needs:
You’re eligible for Medicare when you turn 65 or if you’re younger and have a qualifying disability. A qualifying disability means at least one of the following applies:
When you become eligible for Medicare, you are also eligible for Medicare Advantage Plans. There are specific times of the year when you can enroll for the first time in a Medicare Advantage Plan: during your Initial Enrollment Period and the Open Enrollment Period.
Medicare Advantage Open Enrollment occurs between January 1 and March 31 of each year. This period is only for beneficiaries already in a Medicare Advantage Plan, and you can change plans or switch to Original Medicare. You cannot switch from Original Medicare to Medicare Advantage during Medicare Advantage Open Enrollment.
There are exceptions to these enrollment periods called Special Enrollment Periods. Certain events or circumstances may make you eligible to change your Medicare Advantage Plan outside of the open enrollment periods, such as if you move outside of your existing plan’s service area or to a location with new plan options you didn’t have before. If you think you may qualify for a Special Enrollment Period, call 1-800-MEDICARE and explain your situation.
|Enrollment period||When it happens||Medicare plans you can choose||What you can do|
|Initial Enrollment Period||Three months before you turn 65, the month you turn 65, and three months after||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Sign up for Medicare Part A and Part B. Complete your Part B enrollment to avoid a late enrollment penalty.|
|General Enrollment Period||January 1 – March 31||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan. If you enroll in Medicare during this period, your MAP enrollment is April through June.||Sign up for Medicare if you missed your IEP|
|Open Enrollment Period||October 15 – December 7||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Join, switch, or drop a plan|
|Medicare Advantage Open Enrollment Period||January 1 – March 31||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||If you’re enrolled in a Medicare Advantage Plan, you can change your plan or switch to Original Medicare|
|Special Enrollment Period||When you have a qualifying event||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Make changes to your plan|
Most Medicare Advantage HMO and PPO plans and all SNP plans provide prescription drug coverage like you would get from Medicare Part D. Some PFFS plans may provide prescription drug coverage, but not all do. Evaluate a plan’s prescription drug coverage when deciding which West Virginia Medicare Advantage Plan to use.
Prescription drug coverage may vary by cost, coverage, and convenience among Medicare Advantage Plans. Your monthly premium may include a premium for the drug coverage in the plan. There is usually a copayment or coinsurance amount that you have to pay for each prescription after you reach your annual deductible.
Some plans use different cost tiers with different costs for different drugs. For instance, you may pay less for generic drugs than brand-name drugs or less for brand-name drugs within different tiers. If your plan uses tiers, the formulary will list all covered drugs and their tiers. Verify your preferred or local pharmacies are included in the plan’s network.
|Resource||Contact||How they help|
|DARS Office for Aging Services||(804) 662-7000||The Division for Community Living fosters the independence and well-being of older Virginians and supports their caregivers through leadership, advocacy and oversight of state and community programs, and guides the Commonwealth in preparing for an aging population|
|West Virginia Bureau for Medical Services||(304) 558-1700||The West Virginia Department of Health and Human Resources (DHHR) provides a wide range of necessary and life-saving services to many West Virginia residents|
|West Virginia Bureau of Senior Services||(304) 558-3317||West Virginia Bureau of Senior Services is West Virginia’s premier advocate for the provision of in-home and community-based services for the state’s seniors and others served by our programs|
|West Virginia Department of Health and Human Resources||(304) 558-0684
|The West Virginia Department of Health and Human Resources (DHHR) provides a wide range of necessary and life-saving services to many West Virginia residents|
|West Virginia Offices of the Insurance Commissioner||(304) 558-3386
|The mission of the Offices of the Insurance Commissioner is to promote a competitive and solvent insurance market with adequate consumer protection by fairly and consistently administering the insurance laws of West Virginia|
|West Virginia State Medicaid Plan||(304) 558-1700||The West Virginia Medicaid State Plan is a comprehensive written document that describes he nature and scope of the Medicaid program|
|Resource||Contact||How they help|
|Appalachian Area Agency on Aging||(800) 473-1207||The AAAOA contracts with county aging programs to provide nutrition programs, transportation, and other social services|
|Central West Virginia Aging Services||(304) 472-0395||Central West Virginia Aging Services, Inc. provides in-home services to senior citizens including health care, personal care and coordination of government services|
|Northwestern West Virginia Area Agency on Aging||(304) 242-1800||The Northwestern Area Agency on Aging (NWAAA) was designated by the West Virginia Bureau of Senior Services, under the Older Americans Act, to administer funds to the service providers in the northwestern region of West Virginia|
|Upper Potomac Area Agency on Aging||(304) 257-1221
|The UPAAA will work through and in conjunction with locally-based county providers by keeping abreast of the community needs of the counties, assisting in development of programs geared to helping the elderly, especially the frail, economically needy and minority elderly, in the Region III area|
|Resource||Contact||How they help|
|CMS Medicare Managed Care Appeals & Grievances||(800) MEDICARE||Provided by the CMS, this page provides information related to dealing with Medicare managed care plan grievances and appeals|
|CMS Medicare Managed Care Eligibility and Enrollment||(800) MEDICARE||Provided by the Centers for Medicare & Medicaid Services (CMS), this page offers information for contacting MAP organizations plus other health plans and related aspects to Medicare health plan enrollment|
|CMS Medicare Prescription Drug Eligibility and Enrollment||(800) MEDICARE||Provided by the CMS, this page details prescription drug eligibility and enrollment as it relates to MAP|
|Medicare.gov||(800) MEDICARE||The homepage for the main Medicare website for the U.S|
Tammy Burns is an experienced health insurance advisor. She earned her nursing degree in 1990 from Jacksonville State University, obtained her insurance billing and coding certification in 1995, and holds a health and life insurance license in Alabama, Georgia, Iowa, Mississippi, and Tennessee. Burns is Affordable Care Act (ACA)-certified for health insurance and other ancillary, life, and annuity products. She maintains an active nursing license and practices private-duty nursing.
Burns’ background as a nurse, insurance biller and coder, and insurance consultant includes infectious disease, oncology, gynecology, phlebotomy, post operative, family medicine, geriatrics, home health, hospice, human resources, management, billing, coding, claims, fixed annuities, group and individual health and life products, and Medicare. She’s always been driven by a desire to help people, spending more than 25 years as a practicing nurse in hospitals, private doctors’ offices, home health, and hospice. As a nurse, Burns supported patients filing insurance claims with Medicare, Medicaid, and private insurance companies as well as responding to billing questions from confused patients.
Seeing firsthand how unsuspecting patients are frequently confused by an overly complex system they don’t understand led Burns to become an insurance agent and health care consultant, now helping people understand the medical system. Since becoming an insurance agent in 2013, she has worked with some of the largest and most reputable insurance carriers and agencies in the nation, and she has built a large and loyal clientele by way of her commitment to transparency and personalized service.