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From scenic mountain vistas to rich Appalachian heritage, West Virginia remains a desirable place to live — and understanding your health insurance options here is key to protecting your health and finances.
As of 2025, the uninsured rate in West Virginia reflects continued improvements due to Medicaid expansion and steady ACA Marketplace enrollment. If you’re currently without coverage, here’s what you need to know about getting insured in the Mountain State.
Health Insurance Options in West Virginia
West Virginia offers a range of health insurance options tailored to residents’ needs, depending on age, income, employment, and family size. Here are the most common coverage types available:
Employer-Sponsored Insurance
Many West Virginians receive health insurance through their employer. If your workplace offers coverage, this is usually the most cost-effective and convenient option.
ACA Marketplace Plans (Healthcare.gov)
The Affordable Care Act (ACA) allows individuals and families to buy health insurance through the federal Marketplace. These plans offer essential health benefits, free preventive care, and protection for preexisting conditions.
Individuals and families without employer coverage can shop for insurance through HealthCare.gov.
If you don’t have employer coverage, you may qualify for subsidies to lower your premiums. Use our ACA Subsidy Calculator to check your eligibility.
Starting this year, the Centers for Medicare & Medicaid Services (CMS) is requiring income verification to confirm eligibility for premium subsidies. As part of this effort, CMS will reduce the ACA subsidies by $5 per month for individuals who are automatically re-enrolled in fully subsidized plans without verified eligibility.
ACA Plan Types
ACA Marketplace plans come in Bronze, Silver, Gold, and Platinum tiers, each with different costs and coverage levels. Plans also vary by provider networks and out-of-pocket expenses, so compare carefully to find what fits your needs.
Marketplace Plans:
- Bronze: Low monthly premiums, higher out-of-pocket costs; ideal for minimal healthcare usage.
- Silver: Moderate costs; eligible for cost-sharing reductions (CSRs).
- Gold: Higher monthly premiums with lower out-of-pocket costs; best for frequent healthcare users.
- Platinum (if available): Highest premiums, lowest out-of-pocket costs.
Metal Tier Breakdown:
| Metal Tier | Insurance Company Pays | Consumer Pays |
|---|---|---|
| Bronze | 60% | 40% |
| Silver | 70% | 30% |
| Gold | 80% | 20% |
| Platinum | 90% | 10% |
Medicaid
West Virginia Medicaid provides free or low-cost health coverage for eligible low-income residents. Benefits typically include doctor visits, hospital care, prescription medications, mental health services, and more.
The state expanded its Medicaid program under the ACA, allowing more adults — including those without children — to qualify based on income.
Children’s Health Insurance Program (CHIP)
West Virginia’s CHIP program offers coverage to children and pregnant women in families that earn too much to qualify for Medicaid. Known for its tiered coverage options, CHIP provides essential care including routine check-ups, immunizations, and hospital services.
Student Health Insurance
College students in any state have multiple health insurance options, including staying on a parent’s plan until age 26, enrolling in a school-sponsored plan, or applying for coverage through the ACA Marketplace. Depending on your income and location, you may also qualify for Medicaid, CHIP, or low-cost catastrophic or short-term plans, making West Virginia student health insurance accessible and flexible for a wide range of needs.
Medicare
Medicare plans are available for residents aged 65+ and younger individuals with qualifying disabilities. Options include:
- Medicare Advantage (Part C)
- Medicare Advantage is an alternative to Original Medicare offered by private insurers to those enrolled in Parts A and B. These plans often include extra benefits and cost protections but typically require using a specific network of providers.
- Prescription Drug Plans (Part D)
- Medicare Part D provides prescription drug coverage for anyone with Medicare, helping pay for medications and many vaccines. Offered by private insurers, these plans vary in cost and coverage and can be joined during specific enrollment periods.
- Medicare Supplement (Medigap)
- Medicare Supplement plans, or Medigap policies, help cover the out-of-pocket costs that Medicare Part A and Part B don’t pay. Since Original Medicare (Parts A and B) lacks an out-of-pocket maximum, these plans can limit your expenses for medical services.
COBRA Coverage
If you’ve recently lost job-based insurance, COBRA allows you to temporarily continue your employer coverage. While typically more expensive, it can provide a bridge while you seek other options.
Short-Term Plans
Short-term medical (STM) plans offer flexible, low-cost coverage for up to four months, ideal for healthy individuals in transition. However, STM plans aren’t guaranteed issue, lack subsidies, and may exclude key benefits like maternity, mental health, and pre-existing conditions, making them less suitable for long-term or comprehensive needs.
Explore all non-ACA health plans that may fit your needs and lifestyle.
Enrollment Periods in West Virginia
Open Enrollment for 2026 Coverage:
November 1, 2025 – January 15, 2026
During this window, all eligible residents can apply for, renew, or change their marketplace health plans.
Special Enrollment Period:
Available year-round for those experiencing qualifying life events (QLE), such as:
- Job loss
- Marriage or divorce
- Birth/adoption of a child
- Relocation
- Change in income
You typically have 60 days from the event to enroll.
Health Insurance Providers in West Virginia
As of 2025, these insurers typically offer individual and family plans through the federal Marketplace:
Some carriers may also offer plans outside the Marketplace or standardized options if available.
Understanding Health Insurance Costs
When selecting a plan, be sure to understand these common cost terms:
- Premium: Monthly payment to maintain your plan.
- Deductible: What you pay before insurance covers services.
- Copayment (Copay): Fixed amount per visit or service.
- Coinsurance: Your share of costs after meeting the deductible.
- Out-of-Pocket Maximum: The yearly cap on your covered healthcare spending.
- In-Network vs. Out-of-Network: Using providers within your plan’s network reduces costs.
Understanding health insurance doesn’t have to be overwhelming. This glossary offers clear definitions of key terms—from agents to costs like copayments, coinsurance, and deductibles—to help you make confident coverage decisions.
Bottom Line
Health insurance in West Virginia comes with many choices—whether from your employer, through the ACA Marketplace, or public programs like Medicaid and Medicare. By staying informed and comparing plans during the appropriate enrollment periods, you can secure the coverage that fits your health needs and financial goals.
Need help choosing a plan? Use our ACA Subsidy Calculator to check your eligibility for savings or speak with a licensed insurance agent to explore your full range of options.
