TABLE OF CONTENTS
While the number of health insurance providers in West Virginia is relatively limited, the state offers many ways for individuals and families to obtain health care. After the state accepted the Affordable Care Act (ACA) Medicaid expansion in 2013, West Virginia has reduced its uninsured rate to one of the lowest in the nation.
This guide presents detailed information about your health care options in West Virginia and how you find the best plan for the lowest price.
West Virginians who wish to enroll in the state health marketplace should use Healthcare.gov. Once you create an account, you’ll be able to compare plans and see which offers you the best choices for copays, deductibles, and coinsurance. You’ll provide personal information, including your Social Security number and your household income. You’ll need this information for each member of your family you are enrolling.
Once you create your account, you’ll be able to see if you qualify for any premium subsidies or cost-sharing reductions. These will help you reduce your premiums and out-of-pocket expenses.
Small businesses in West Virginia will also see the lowest rates available via SHOP (Small Business Health Option Programs). Businesses that employ between one and 50 people can use SHOP to buy ACA-compliant health care for employees.
There are two plans available for individual health insurance in West Virginia. Both plans are available statewide.
When comparing plans for yourself or your family, there are questions that you need to answer.
These questions will help guide you while comparing your health insurance options.
When considering which individual plan to choose, it’s wise to consider your current health situation, usage level, and precise needs for health care coverage when selecting a plan. For example, if you plan to have a baby, look for plans with good maternity coverage and lower deductibles.
If you are generally healthy and don’t often use insurance, look for a balance of premiums and deductibles that you can afford. You may be better off with a plan that charges a higher premium, has a lower deductible and makes it easier to see out-of-network specialists if you have a chronic health problem.
There are different kinds of plans that may fit your needs.
Your considerations might be a little bit more complex when buying health care for your family. While you may be healthy, if your spouse has a severe health care condition, like prostate or breast cancer, it will impact the kind of health care choices you’ll make. Separate policies may be more cost-effective.
If your family is in relatively good health, an HMO plan with a lower monthly premium and higher deductibles may be a good option. Families with more complex health issues may need to pay a higher premium. If your family requires regular visits to the doctor or needs expensive prescriptions, you’ll want to consider a plan with a lower deductible.
When you buy a plan through the West Virginia Healthcare.gov marketplace, you’ll have an option of four levels of plans. Each level is associated with a different metal: Bronze, Silver, Gold, and Platinum. All ADA-compliant plans offer the same quality health care, regardless of the level.
Whichever plan you pick, you can use premium tax credits that lower your monthly premiums if your income is between 100% to 400% of the Federal Poverty Level. You may also be eligible for cost-sharing reductions (CSRs), which reduce your deductible. However, CSRs apply only to silver plans.
|Average premiums in West Virginia||2019||2020||2021||2022|
|Most affordable Bronze plan||$512||$552||$596||$621|
|Most affordable Silver plan||$584||$619||$635||$752|
|Most affordable Gold plan||$756||$804||$825||$839|
To be eligible for Medicaid in West Virginia, you need to be one of the following:
Under the expanded Medicare guidelines, any adult age 19 to 64 is eligible for Medicaid if they have a household income equivalent to 133% of the Federal Poverty Level.
Asset limits are $2,000 for an individual, $3,000 for a couple. The limit is based on income and property but does not include home, furnishings, appliances, and one vehicle.
CHIP provides quality and comprehensive health insurance to eligible children. It is a free or low-cost plan that covers children from birth to age 19. CHIP covers preventive care, immunizations, prescriptions, and well-child visits.
Your family can qualify for CHIP in West Virginia if you earn up to 300% of the federal poverty level. A family with one child cannot earn more than $32,200 a year, with two children $43,550 a year and three children $54,900 a year. Households with more than eight family members can add $11,350 per person to the income limit.
In September 2019, the West Virginia Legislature passed a law enabling pregnant women to receive maternity care under CHIP.
When you approach your 65th birthday, or if you have a qualifying disability, you’ll start to receive notices from the federal government that it’s time to sign up for Medicare. Medicare is the federal health insurance program designed for people aged 65 and older or who are disabled.
A Medicare Supplement Insurance plan fills in the gaps in coverage for Original Medicare. It covers deductibles, co-pays, and coinsurance and can provide you with coverage if you travel outside of the U.S. These plans do not work with Medicare Advantage Plans.
If you start receiving your Social Security or Railroad Retirement Board benefits at least four months before you turn 65, you’ll be automatically enrolled in Medicare. Otherwise, you must fill out an application online or contact your local Social Security office. You can enroll in Medicare during the following periods:
Seniors or their caregivers with questions about Medicare in West Virginia can get help from the West Virginia Office of The Insurance Commissioner, Consumer Services. Another option is the State Health Insurance Assistance Program (SHIP). SHIP counselors are trained volunteers who can help you navigate Medicare options and find the best solution for your situation with free, unbiased, and confidential counseling.
West Virginia has short-term health insurance plans that last for an initial term of up to 364 days. You can renew short-term health insurance for up to 36 months.
These plans are for emergency care if you’re unemployed and don’t qualify for Medicaid or missed open enrollment for a marketplace plan but want coverage for a defined short duration. Short-term plans do not cover pre-existing conditions. Renewal is not guaranteed if you develop a health condition while on the plan.
Some of the conditions not covered by short-term insurance include:
While the ACA requires health insurance, Congress removed the tax penalty in 2019. Some states have chosen to enact mandates, but West Virginia is not one of them.
No, there is an off-exchange plan available. Fortunately for West Virginians, both health care plans available on the marketplace and the one plan available off-exchange are ACA compliant.
Alternative health insurance plans are often faith-based plans. These plans are not considered health insurance by the state or the federal government and are not regulated. While cost-sharing plans may be more affordable than traditional insurance, these plans may not provide the health care coverage you need. Unlike ACA-compliant plans, these plans may have limited coverage and may not pay for pre-existing conditions.
In most cases, yes. Since West Virginia does not mandate that you have health care, you can remain uninsured and save enough money in an HSA or an FSA plan to cover your health costs. However, this is difficult, especially if you have an emergency health situation or a chronic long-term condition. These plans are good ideas but will not provide as much coverage as regular health insurance.
Perhaps. Short-term disability coverage provides payments for regular household expenses you incur while you are disabled. Health insurance will not pay for your mortgage or your groceries. If you’re at risk for an accident, short-term disability is a good idea.
Again, the answer is perhaps. Like short-term disability, long-term disability covers your household expenses when you’re disabled. If you have a dangerous job and injury is a concern, purchasing long-term disability insurance is a good idea.
West Virginia Chip is a comprehensive free or low-cost health insurance program covering low-income children from birth until age 19. It includes well-child visits, immunizations, prescriptions, and doctors’ visits.