Know your options for Medicare plans in West Virginia, whether you’re looking for Original Medicare or Medicare Advantage.
Medicare plan options include:
You may also elect to add a Medicare Supplement Plan (Medigap) to go along with Original Medicare to help with additional out-of-pocket expenses.
Before you pick a plan, learn about your costs, coverage, and choosing the best Medicare plan for your needs.
To qualify for Medicare, you must meet certain eligibility requirements. First, you must be a U.S. citizen or permanent resident. You must also be at least 65 years old or have a disability and receive Social Security Disability Insurance (SSDI) benefits for at least 24 months. You may qualify for Medicare at a younger age if you have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease).
If you start receiving your Social Security or Railroad Retirement Board (RRB) benefits at least four months before you turn 65, you’ll be enrolled in Medicare automatically. Otherwise, you must fill out an application online or contact your local Social Security office. You can enroll in Medicare during the following periods:
West Virginia has several Medicare options available to U.S. citizens or permanent residents at least age 65. You are eligible if under age 65 and you have ESRD, ALS, or have been disabled for at least 24 months and draw SSDI.
Original Medicare is the standard coverage for Medicare beneficiaries and has two parts: Part A (hospital insurance) and Part B (medical insurance). Here’s a look at the details about Original Medicare:
Who Original Medicare is best for: Original Medicare is a good option if you want more flexibility. It has a broad coverage area throughout the U.S. If you have several health conditions, you may want to pair your Medicare with a Medigap. Because Original Medicare does not cover prescriptions, enrolling in a stand-alone drug plan is important. If not paired with a Medigap, the out-of-pocket cost is a drawback to the plan.
|Part A premium||Standard Part B premium|
|Usually free||$170.10 per month|
An alternative to Original Medicare, Medicare Advantage Plans – also known as Part C – cover everything Part A and Part B do, but typically offer additional coverage.
West Virginia Medicare Advantage programs have networks and may only be available in certain areas of West Virginia. Plan options are based on ZIP code. These plans usually consist of copayments, deductibles, and out-of-pocket maximums that you are responsible for. However, plans can start at a $0 premium and go up from there. The average monthly premium in West Virginia is $8.54 (in 2022).
The West Virginia Medicare Advantage Program is made up of four types of plans:
The best Medicare Advantage Plan is the one that meets your individual needs and matches what is most important to you in terms of costs, choice of providers, and ease of access. West Virginia has 583 plans available in 2022. Medicare Advantage has continued to rise in popularity with West Virginians.
Who Medicare Advantage Plans are best for: This type of plan is best if you are on a fixed income or you are in good health and don’t want to overpay for coverage you don’t use very often. Having one card to use and the additional benefits bundled in the plan can be attractive. To be eligible, you need to be enrolled in Medicare Part A and Part B.
The downsides to Medicare Advantage Plans are mostly related to a limited choice of providers and service areas. Prior authorizations and referrals may also be necessary before receiving certain procedures.
|Medicare Advantage insurance company||Medicare rating||A.M. Best rating||Better Business Bureau (BBB) rating||National Committee for Quality Assurance (NCQA) rating||J.D. Power ranking|
|3.9 stars||A||A+||2.5 to 4.5 stars||Sixth out of 10|
|3.9 stars||A||F||Not rated||Fifth out of 10|
|3.9 stars||A||B||3 to 3.5 stars||Fifth out of 10|
|4 stars||A||Not rated||3.5 to 4 stars||Third out of 10|
|4.8 stars||A+||A-||3 to 3.5 stars||Second out of 10|
|4.2 stars||A-||A+||3.5 to 4 stars||Fourth out of 10|
|5 stars||A+||A-||4 to 4.5 stars||First out of 10|
|4 stars||A||B-||3 stars||Not ranked in the top 10|
|4.5 stars||Not rated||F||3 stars||Not ranked in the top 10|
|4.2 stars||A||Not rated||3.5 to 4 stars||Seventh out of 10|
|Plan name||Monthly premium||Yearly drug and premium cost||Deductibles|
|Capital Health Plan Silver Advantage (HMO)||$0||$0||Health: $0
|AARP Medicare Advantage (HMO-POS)||$0||$0||Health: $0
|Wellcare No Premium (HMO)||$0||$0||Health: $0
Plans calculated based on Charleston ZIP code 25301.
Medicare Part D is offered by private insurance but is regulated by Medicare. Part D can be purchased as a stand-alone PDP or as part of a Medicare Advantage Plan (MA-PD).
West Virginia Part D premiums start at $7.70 a month.
Currently, there are 22 stand-alone PDPs in West Virginia. Eight of the stand-alone plans and 244 Medicare Advantage Plans with prescription drug coverage participate in the Senior Savings Model, which lowers the cost of insulin out of pocket.
Who Part D plans are best for: PDPs are always best even if you don’t take any medications. If you do not enroll when becoming eligible, you will be penalized for every month you do not have one.
|Medicare Advantage insurance company||Medicare rating||A.M. Best rating||BBB rating||NCQA rating||J.D. Power ranking|
|3.8 stars||A||A+||2.5 to 4.5 stars||Sixth out of 10|
|4 stars||A||Not rated||2.5 to 3.5 stars||Third out of 10|
|4.2 stars||A||A+||2.5 to 4 stars||Seventh out of 10|
|3.7 stars||Not rated||A-||2.5 to 3.5 stars||Ninth out of 10|
|Plan name||Monthly premium||Yearly drug and premium cost||Deductible|
|SilverScript SmartRx (PDP)||$7.70||$53.90||$480|
|Wellcare Value Script||$12||$83||$480|
|Humana Walmart Value RX||$22.70||$158.90||$480|
Plans calculated based on Charleston ZIP code 25301.
Medigap plans are standardized plans sold by private insurance companies. These plans are designed to pick up costs where Original Medicare leaves off in coverage. There are 13 standardized plans available in West Virginia designated by different letters of the alphabet (A, B, C, D, F, G, K, L, M, and N). Plans C & F are only eligible to those who became eligible for Medicare prior to Jan. 1, 2020.
A Plan G for a 65-year-old nonsmoking female in Charleston ranges from $163 to $215 per month. You will also be responsible for the Part B deductible of $233.
Who Medigap plans are best for: Medigap is a good fit if you utilize benefits frequently, do not want to be restricted to a small coverage area, and prefer to choose your own provider. You should not choose a supplement if you cannot afford the monthly premium and you want extra benefits available with Medicare Advantage, such as having the PDP, dental, vision, and hearing benefits included.
If you are considering purchasing a supplement, always check to see if the company offers additional discounts for having people that live in your household or for nonsmoking.
|Plan name||Monthly premium range||Copays/coinsurance||Deductibles||Plan benefits|
|Plan F||$179 to $250||$0||$0 hospital (Part A)
$0 medical (Part B)
|Plan G||$163 to $215||$0||$0 hospital (Part A)
$233 medical (Part B)
|Plan N||$124 to $170||$0 Generally your cost for approved Part B services with some $20 and $50 copays||$0 hospital (Part A)
$233 medical (Part B)
Calculated based on a nonsmoking 65-year-old female in Charleston ZIP code 25301.
West Virginians have many plan options available. It is always good to make a list of pros and cons of the plans. Important things to consider are out-of-pocket costs, provider network, coverage area, insurance company ratings, and the overall ability of the plan to meet your specific need.
|People enrolled in Original Medicare||Average plan cost||Annual West Virginia spending per beneficiary||Spending per beneficiary compared to the national average|
|2,407,550||Part A: $0 to $499 per month*
Part B: $170.10 **
*Most people pay no premium but this can vary depending on how long they paid Medicare taxes.
**This is the average number but it can vary based on income.
Making Medicare decisions can be overwhelming at times. It is good to utilize the resources and tools available in West Virginia. The organizations have people knowledgeable in the programs specific to your state. Most of the services provided are free. An example is the West Virginia State Health Insurance Assistance Program (SHIP), which has dedicated counselors to help answer beneficiary questions.
Check out these West Virginia Medicare resources:
|Organization||How you can get help||Contact Information|
|West Virginia SHIP||West Virginia’s SHIP helps provide reliable and up-to-date information to Medicare beneficiaries and their caregivers. It offers resources on its website, or families can call with questions anytime.||Website | (877) 987-4463|
|West Virginia Bureau of Senior Services||The West Virginia Bureau of Senior Services helps connect seniors and their caregivers to programs and community-based services.||Website | (304) 558-3317|
|West Virginia Aging & Disability Resource Center (ADRC)||ADRC works with partner agencies to help assist older residents and their families with questions about long-term care and in-home support services.||Website | (866) 981-2372|
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.
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