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Medicare in West Virginia

GoHealth is here to simplify your journey to Medicare in West Virginia

Reviewed by: Selah Lee, Licensed Insurance Agent. Written by: Bryan Strickland.

Key Takeaways

  • Original MedicareOriginal 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). in West Virginia features hospital (Part A) and medical (Part B) coverage with the option of adding drug and supplemental coverage.

  • Most people are eligible at age 65, which opens the door to Medicare AdvantageMedicare 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 that replace Original Medicare while offering additional benefits like dental and vision.

  • Medicaid in West Virginia covers similar benefits, but eligibility is based on need regardless of age.

 

Do you know where to find the longest steel-arch bridge in the western hemisphere?

West Virginia.

The New River Gorge Bridge’s steel arch portion spans 1,700 feet, turning a treacherous one-hour drive through mountainous terrain into a picturesque one-minute drive.

Don’t take the circuitous route to Medicare in West Virginia. Let GoHealth help bridge the gap.

How do I Apply for Medicare in West Virginia?

Your options for applying for Medicare in WV include:

  • Enrolling online with the Social Security Administration. [1]
  • Visiting a local Social Security office. [2]
  • Enrolling over the phone at 1-800-772-1213 (TTY: 1-800-325-0778).

Medicare is a federal program that provides affordable healthcare for older Americans nearing retirement. At age 65, you can enroll in Part A (also known as “hospital insurance”), Part B (“medical insurance”) or both.

Once enrolled in Original Medicare, you have the option of enrolling into a Medicare Advantage (Part C) plan in West Virginia.

If you decide to stay enrolled in Parts A and B, you have the option to add Part D to cover your prescription expenses. You may also choose to add Medigap, (another name for Medicare Supplement insurance) that helps fill in the gaps in out-of-pocket costs like copays and coinsurance. Most Medicare Advantage plans also include drug and supplemental coverage.

Who is Eligible for Medicare in West Virginia?

If you’re a U.S. citizen and are age 65 or older, you qualify for Medicare in West Virginia. You’re also eligible regardless of your age if:

If you are receiving Social Security benefits before you turn 65, you may be automatically enrolled in Original Medicare. If not, you have to apply. Your first chance to sign up is during your Initial Enrollment Period, which starts three months before the month of your 65th birthday and ends three months after you turn 65.

What is the Income Limit to Receive Medicare?

Your income isn’t a factor in your ability to sign up for Medicare plans in West Virginia (it’s a different story with Medicaid).

When it comes to Part A of Original Medicare, earned income is a positive. If you or your spouse has worked at least 10 years, you don’t have to pay a monthly premium for Part A.

For Part B, higher-income earners may have to pay more than the standard premium. In 2021, the standard monthly premium for Part B was $148.50, and it increased only if your individual income on your 2020 tax return was more than $88,000. The Centers for Medicare & Medicaid Services estimates that only 7 percent of Medicare beneficiaries are impacted by this increase. [3]

Who is Eligible for Medicaid in West Virginia?

Each state has its plan for administering Medicaid, a federal/state program founded alongside Medicare in 1965 that helps those facing a financial need and/or disability regardless of age.

The state of West Virginia oversees the Medicaid program for the state’s residents, offering coverage to all individuals in need with some programs geared toward children and pregnant women. In 2020, assistance was available to West Virginians who earned up to 138% of the Federal Poverty Level [4] (ages 6-65) and in some cases earned up to 190% of the Federal Poverty Level (pregnant women and their children). [5]

What is the Average Cost of a Medicare Advantage plan?

According to the Centers for Medicare & Medicaid Services, the average monthly premium for a Medicare Advantage plan in 2020 was $23.63. [6]

Every Medicare Advantage plan in West Virginia must offer, at least, the same level of coverage as Original Medicare Parts A and B. In 2020, most people didn’t pay a monthly premium for Part A, while most people paid the standard monthly premium of $144.60 for Part B.

Medicare Advantage and Original Medicare have different coverage areas. You can use Original Medicare nationwide, but Medicare Advantage is limited to a provider network. The limited network allows Medicare Advantage in West Virginia to often offer more affordable options.

What is the Best Medicare Plan to Get?

In the case of Original Medicare in OK, there’s only one plan — Parts A and B, which does open the option to add Part D and Medigap coverage from private insurance companies.

In the case of Medicare Advantage in West Virginia, there are many plans.

  • Some Medicare Advantage plans mirror Original Medicare but are more affordable.
  • Some Medicare Advantage plans include options for dental, vision and hearing coverage.
  • Some Medicare Advantage plans offer assistance with transportation costs or over-the-counter needs.
  • Some may offer all of the above!

Medicare Advantage plans offer a variety of benefits that can be overwhelming. However, it’s simple for a licensed insurance agent at GoHealth to analyze your needs and figure out which plan option is the right fit for you.

Medicare in West Virginia by the Numbers

Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 419,259 people are enrolled in Medicare in West Virginia. The total number of beneficiaries enrolled in Medicare Advantage in West Virginia is 142,447. The previous year, 130,372 enrolled in Medicare Advantage. Medicare Advantage participation in West Virginia went from 31.45% to 33.98% year over year. If you’d like to dive deeper into how Medicare in West Virginia breaks down across the state, we provide a glance at who is using Medicare, and how.

Outline of West Virginia
419,259
Beneficiaries with Part A & Part B
142,447
Medicare Advantage Beneficiaries
33.98%
Medicare Advantage Participation Rate
52.69%
% Female
47.31%
% Male
1.01
Average HCC Score
$9,662.94
Actual Per Capita Costs
27.40%
% Eligible for Medicaid
35.48%
% of Beneficiaries with an Emergency Department Visit
19.66%
Hospital Readmission Rate
95.32%
% Non-Hispanic White
2.73%
% African American
0.50%
% Hispanic
1.45%
% Other/Unknown

Table reflects the latest Beneficiary Demographics data: 2018, All Beneficiaries by State, Centers of Medicare & Medicaid Services (CMS)

Average HCC Score: The Hierarchical Condition Category score gauges a population’s overall health. The score is based on a value of 1.0. Populations with an HCC score of less than 1.0 are considered relatively healthy. The score can be used to estimate health costs.

West Virginia Medicare Resources & Contacts

Beneficiaries spend an average of $9,662.94 each year on Medicare in West Virginia. To be certain you are not leaving anything on the table, let us help. A GoHealth licensed insurance agent can assess your coverage or explain which West Virginia-based resources, like these, may be able to help:

WV SHIP AND SMP - Medicare counseling

1-800-887-4304

http://www.wvship.org/AboutWVSHIPandSMP/tabid/132/Default.aspx

What should I know about WV SHIP and SMP?

The State Health Insurance Assistance Program and the Senior Medicare Patrol offer free Medicare guidance and monitoring.

West Virginia Bureau for Children and Families

1-304-558-0628
Phone lines open M-F, 8 a.m. to 5 p.m.

https://dhhr.wv.gov/bcf/Services/familyassistance/Pages/Medicare-Premium-Assistance-Programs.aspx

What should I know about the Bureau for Children and Families?

This department administers Medicare Premium Assistance Programs (aka Medicare Savings Programs) for West Virginia residents in need.

West Virginia Bureau of Senior Services

1-304-558-3317 or 1-877-987-3646

http://www.wvseniorservices.gov/

What should I know about the West Virginia Bureau of Senior Services?

From assistance with transportation to meals, the bureau aims to be “West Virginia’s premier advocate for seniors.”

West Virginia Bureau of Medical Services

1-304-558-1700

https://dhhr.wv.gov/bms/Pages/default.aspx

What should I know about the West Virginia Bureau of Medical Services?

Administers the state’s Medicaid program for West Virginia residents.

Nationwide Resources

Speak with an insurance agent that is licensed in West Virginia about your Medicare questions.

1-855-792-0088 TTY: 711

Monday - Friday, 8 AM - 9 PM CT

Medicare & Medicaid

If you have general questions about Medicare in WV, or need help with current Medicare benefits.

1-800-MEDICARE (1-800-633-4227)

Social Security Administration

You can reach the SSA by phone for general questions. Not all questions can be answered over the phone.

Also, SSA.gov provides online resources for the following: Review information, apply for benefits, or manage your account online

Speak to SSA Representative, Monday - Friday, 8 AM - 7 PM ET

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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Costs, coverage and enrollment details for each Medicare plan.

Low Income & Medicare Guide

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For those helping a loved one with Medicare.