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Medicare Advantage Plans in West Virginia

Key Takeaways

  • Medicare Advantage
    Medicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D).
    plans must cover everything that Original Medicare Parts A and B
    Original Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance).
    cover.
  • Medicare Advantage also typically provides additional benefits, which can include prescription drug coverage, dental, hearing, and vision, among others.
  • Many Medicare Advantage plans in WV offer $0 monthly premiums.
  • Some plans have no-cost deductibles
    A deductible is an amount you pay out of pocket before your insurance company covers its portion of your medical bills. For example: If your deductible is $1,000, your insurance company will not cover any costs until you pay the first $1,000 yourself.
    for healthcare and for prescription drug coverage.

West Virginians have a variety of Medicare coverage options. In addition to Original Medicare, which is administered by the federal government, private insurers offer 58 Medicare Advantage plans across the state as of 2024.

A Medicare Advantage plan provides Original Medicare’s Part A and Part B benefits, but most include other features like prescription drug coverage (Part D), dental, vision and hearing. Medicare Advantage plan availability and costs vary across West Virginia, so you should explore your choices before deciding on a plan.

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West Virginia Medicare Advantage Plan Coverage

More than 445,000 West Virginians were enrolled in Medicare in 2023. Of those, 49% opted into a Medicare Advantage (Part C) plan .

Medicare Advantage is health insurance you buy from a private insurer. The companies that sell Medicare Advantage plans are licensed and approved by the federal government to do so.

Legally, Medicare Advantage plans must cover at least as much as Original Medicare (Parts A and B). Medicare Advantage plans also provide extra coverage that Original Medicare doesn’t. These extras vary by plan but can include prescription drugs, dental, vision, and hearing care coverage.

When you’re eligible for Medicare you have a choice about the type of plan you will choose. If you decide to stick with Original Medicare, you will most likely want to buy additional coverage for prescription drugs. This is known as a stand-alone Medicare Part D plan. You may also want to get a Medicare Supplement Insurance (Medigap) plan that will pay some out-of-pocket costs you’re responsible for with Original Medicare.

Medicare Advantage plans generally eliminate the need to buy a standalone Part D plan and a Medigap plan.

With a Medicare Advantage plan, you’ll have coverage for inpatient services such as hospitalizations, skilled nursing facility care, and hospice care. You’ll have coverage for outpatient services such as doctor’s appointments, specialists, preventive care, and ambulance services. You can also choose benefits that make medications and other healthcare needs more affordable.

WV Medicare Advantage Plan Costs

In 2024, the average monthly premium for Medicare Advantage plans in West Virginia was $20.90. No matter where you live in the state, you also have access to at least one Part C plan with a $0 monthly premium.

The Part B premium also applies. If you collect Social Security, the Part B premium will be automatically deducted from that amount. For most West Virginians, Part B costs $174.70 per month in 2024.

If you or your spouse worked and paid taxes for at least 10 years, you’re probably entitled to premium-free Part A.

There may be other costs associated with your Medicare Advantage plan. These vary from plan to plan and include copays, coinsurance, and deductibles. Many Part C plans in West Virginia have $0 deductibles for both healthcare and prescription drugs. Some have copays as low as $0 or $5 for primary care physician appointments.

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Medicare Advantage Plan Eligibility and Enrollment in West Virginia

If you’re eligible for Original Medicare, you’re eligible for Medicare Advantage in West Virginia.

To be eligible for Medicare you must be a U.S. citizen or permanent legal resident who has lived in the U.S. for at least five continuous years. Once you meet this requirement, you may qualify for Medicare if at least one of the following is true:

  • You are 65 or older
  • You have a disability
  • You have amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease)
  • You have end-stage renal disease (ESRD)
Most Medicare beneficiaries in West Virginia first become eligible when they turn 65. In addition to age, you must meet one of these requirements:
  • You’re already receiving, or are eligible to receive, retirement benefits from either Social Security or the Railroad Retirement Board
  • You or your spouse had Medicare-covered government employment
If you have a disability, you can get a Medicare Advantage plan in West Virginia no matter your age. As with Original Medicare, you may qualify for Part C before 65 if:
  • You’ve been entitled to receive disability benefits from either Social Security or the Railroad Retirement Board for at least 24 months.
  • You have ALS. Living with ALS typically means you can get Medicare starting the first month you receive disability benefits.
  • You have ESRD; you can get Medicare if you’re currently on dialysis, or are a kidney transplant patient.
There are several enrollment periods in West Virginia when you can get a Medicare Advantage plan:

Initial Enrollment Period (IEP) – If you’re enrolling in Medicare due to age, the IEP is your first chance to sign up for Medicare. You can enroll at any time during the seven-month period that starts three months before you turn 65 and ends three months after.

If you have ALS, this period starts after 24 months of being eligible for, or having received, disability benefits from either Social Security or the Railroad Retirement Board.

If you have ESRD, this period can begin the first day of the fourth month that you start getting dialysis treatments. If you sign up later, your coverage may be retroactive.

Medicare Open Enrollment Period  – In West Virginia you can join, switch, or drop a plan during this time, also called the Annual Enrollment Period, which runs from October 15 to December 7 each year.

Medicare Advantage Open Enrollment Period – If you have already enrolled in a Medicare Advantage plan, you will be able to switch to a different Part C plan once during Medicare Advantage Open Enrollment.

During this enrollment period you can also choose to switch from a Medicare Advantage plan to Original Medicare, plus add a Medicare prescription drug (Part D) plan. It’s important to note that this process doesn’t work in reverse; if you have Original Medicare, you can’t switch to a Part C plan during this timeframe. Medicare Advantage Open Enrollment runs from January 1 to March 31 each year.

Special Enrollment Period Special enrollment periods are triggered by events that affect your current health insurance. You can sign up for a Medicare Advantage plan if you lose your current insurance, or if you move and your current plan doesn’t provide coverage for your new location. In some instances your plan may no longer be available where you live. If this occurs, a special enrollment period will be triggered and you’ll be able to enroll in a Part C plan.

Are There West Virginia Medicare Advantage Plans With Prescription Drug Coverage?

In West Virginia there are many Medicare Advantage plans that include prescription drug coverage. Not every plan is available in every county, however.

Some plans have a no-cost monthly premium for prescription drug coverage.

A number of plans throughout the state also have a no-cost annual drug deductible. However, it’s not uncommon for Part D plans to have an annual drug deductible of $200 or more.

Make sure to thoroughly read what each plan offers. This will help you accurately gauge your budget for prescription drugs throughout the year. A licensed GoHealth insurance agent will be happy to guide you through your options. We’ll shop the different Medicare Advantage plans in WV and explain their fine print. The goal is to stop any unpleasant surprises before they happen. When it comes to Medicare Advantage plans in WV, we want to help find the coverage that’s right for you.

Medicare Learning Guides

Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.

 

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Sources

This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money.

Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.