Medicare health insurance is available in West Virginia when you turn 65 years old. It’s also available for some people who are under age 65 and meet certain eligibility criteria.
When you’re ready to enroll in Medicare, it’s important to understand the different plans available.
The Centers for Medicare & Medicaid Services (CMS) reported the following information on Medicare trends in West Virginia for the 2021 plan year:
- A total of 442,467 residents of West Virginia are enrolled in Medicare.
- The average Medicare Advantage monthly premium decreased in West Virginia compared to last year — from $36.81 in 2020 to $32.30 in 2021.
- There are 44 Medicare Advantage plans available in West Virginia for 2021, compared to 42 plans in 2020.
- All West Virginia residents with Medicare have access to buy a Medicare Advantage plan, including plans with $0 premiums.
- There are 12 different Medigap plans offered in West Virginia for 2021.
There are a few different parts that make up the Medicare program. We’ll go over some of these plan options next.
Part A (hospital insurance) covers:
- treatments and care in a hospital
- hospice care
- limited home healthcare
- limited stays in a skilled nursing facility
Part B (outpatient medical insurance) covers:
- doctors’ visits
- preventive care (annual wellness visits, screenings)
- counseling services
- lab tests and imaging
- certain durable medical equipment
With original Medicare, you can choose any provider or facility that accepts Medicare coverage.
Medicare Advantage in West Virginia
Medicare Advantage, or Part C, bundles Part A and Part B coverage into a single plan. Many Medicare Advantage plans include prescription drug coverage as well
There are many different carriers that offer Medicare Advantage plans in West Virginia, including:
Keep in mind, not every carrier offers plans throughout all areas of West Virginia. Your choices will vary depending on the county where you live.
Medicare supplement plans in West Virginia
Medicare supplemental insurance (also known as Medigap) is available through private companies to help pay out-of-pocket costs under original Medicare. Costs vary depending on which plan you choose.
Many companies offer Medigap plans in Nebraska. In 2021, some of the companies offering Medigap plans throughout the state include:
- AARP – UnitedHealthcare
- American Retirement
- Bankers Fidelity
- Garden State
- Great Southern
- Highmark Blue Cross Blue Shield West Virginia
- Medico Corp
- Reserve National
- State Farm
You can not purchase a Medigap plan if you have Medicare Advantage.
Medicare plans in West Virginia are available when you turn age 65 if you are one of the following:
- citizen of the United States, or
- legal resident for 5 or more years
You may be eligible before age 65 if you:
- have received Social Security Disability or Railroad Retirement benefits for 24 months
- have amyotrophic lateral sclerosis (ALS)
- have received a kidney transplant or have end stage renal disease (ESRD)
When can I enroll in Medicare?
There are certain times that you can enroll in Medicare and Medicare Advantage plans. We’ll discuss these different enrollment periods next.
Your initial enrollment period (IEP) starts 3 months before your 65th birthday, extends through your birthday month, and continues 3 months after you turn 65 years old. If you wait until your birthday month or later, the start date for your coverage will be later.
There are other enrollment periods that take place a certain times each year, including:
- Medicare open enrollment (October 15 to December 7) is when you can make changes to your original Medicare coverage or switch between Medicare Advantage and original Medicare plans.
- Medicare Advantage open enrollment (January 1 to March 31) is when you can make changes to your plan if you are already enrolled in Medicare Advantage. You can also drop your Medicare Advantage plan and switch back to original Medicare during this time.
- General enrollment period (January 1 to March 31) is when you can sign up for Part A and Part B if you didn’t sign up during your IEP. You may have to pay a late enrollment penalty if you missed your IEP.
Special enrollment periods allow you to enroll in Medicare outside of the usual enrollment periods if you lose coverage for a qualifying reason. You may have up to 8 months to enroll in coverage after the qualifying event.
Tips for enrolling in Medicare in West Virginia
The many choices for Medicare coverage can be overwhelming. Before you sign up it’s important to think about:
- plan costs and what each one covers
- whether the plan’s network includes your preferred doctors and hospitals
- if the plan is highly rated for quality and patient satisfaction using the CMS star ratings system (for Part C and prescription drug plans)
These resources can help you get more information about Medicare in West Viriginia:
- West Virginia Bureau of Senior Services (877-987-4463): information on Medicare, Medicare supplement, and other resources
- State Health Insurance Assistance Program (SHIP) (877) 987-3646): free counseling for Medicare questions
- WV Aging & Disability Resource Network (877-987-3646): local offices to connect seniors with services
- WV Department of Health & Human Services (800-642-8589)” provides a wide range of vital services to West Virginia residents
- PATH program: helps connect you with programs to help pay for Medicare
- Medicare (800-633-4227): visit the Medicare website to speak to someone who is trained to help you navigate Medicare.
- More than 400,000 West Virginia residents are enrolled in Medicare.
- There are several private insurance companies offering various types of Medicare Advantage and Medigap plans throughout the state.
- Overall, monthly premium costs have decreased for 2021 Medicare Advantage plans in West Virginia.
- There are also several Medigap plan options if you live in West Virginia and are looking for additional coverage.