Medicare Advantage Plans in West Virginia

The majestic Appalachians, rolling Shenandoah and greener-than-green high country are only a few reasons why West Virginia is almost heaven. West Virginia has the highest elevations of any state east of the Mississippi. It also has some of the savviest Medicare beneficiaries. If you’re a West Virginian considering your options, read on to learn all about Medicare Advantage plans in WV, and why they’re so popular in your state.

More than 440,000 West Virginians are currently enrolled in Medicare. Of those, more than a third have 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 the healthcare West Virginians know is so important. These include 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 will also have coverage for your medications and other extras that are important to you.

In 2022, the average monthly premium for Medicare Advantage plans in West Virginia is $25.53. No matter where you live in the state, you will 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 $170.10 per month in 2022.

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.

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.

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.