The Mountain State has two carriers offering Marketplace plans for 2021. Residents who miss open enrollment can sign up if they qualifying life events.
West Virginia Health Insurance Overview
Most West Virginians with private health insurance get it through an employer. A small percentage have individual coverage through Marketplace plans. The majority of these enrollees get government subsidies to help with monthly premiums.
About half of West Virginia’s population has government-funded coverage through Medicaid and Medicare. Medicaid is for low-income residents, while Medicare is for seniors and adults under 65 with disabilities.
What You Need to Know
You can enroll in a 2021 coverage from November 1, 2020 through December 15, 2020.
Three health insurance companies offer plans for individuals and families for 2021.
Depending on your income, you could qualify for federal help paying for health insurance or enroll in Medicaid. Another option to bridge coverage gaps is short-term health insurance.
West Virginia and the Affordable Care
Roughly 243,000 West Virginians (14% of the population) lacked coverage in 2013 when the Affordable Care Act (or Obamacare) was implemented. Uninsured rates fell to single digits (9%) by 2014.1 This is also the same year West Virginia expanded its Medicaid program under the ACA.2
The expansion gave eligibility to low-income adults without children who wouldn’t have qualified otherwise. As of 2019, about 183,000 of this group gained Medicaid coverage.3
Medicaid expansion contributed to the state’s low uninsured population, which dropped to about 108,000 people by 2018. This group represents just 6% of West Virginia’s nearly 1.8 million residents.4
West Virginia Health Insurance for Individuals, Families, and Self-Employed Professionals
West Virginians can buy Obamacare plans through the federal Marketplace at healthcare.gov. Policies are available to individuals and families, which include self-employed professionals with no employees.
Obamacare plans provide comprehensive health benefits, such as hospitalization, prescription drug coverage, and free preventive care. You can’t be denied coverage due to health or preexisting conditions.
You can choose from bronze, silver, gold, and platinum plans. Platinum plans are rarely offered. These metal levels represent how much the plan pays toward your covered medical expenses. For instance, a bronze plan pays 60% of costs when you use your benefits. Platinum plans pay for the majority of your care at 90%.
West Virginia Health Insurance Marketplace Enrollment
West Virginia’s Open Enrollment Period (OEP) for 2020 Obamacare plans ended on December 18, 2019. Just over 20,000 residents signed up through the Marketplace (also called the exchange).5 This number is a slight decrease from nearly 22,600 residents who bought coverage the year before.6
The next Open Enrollment Period for the 2021 plan year starts on November 1. But if you have a qualifying life event (such as marriage or childbirth) before that date, you can still buy a 2020 plan.
Health Insurance Companies in West Virginia
For 2021, two health insurance companies offer Marketplace plans, and one only sells off the exchange:7
- CareSource West Virginia
- Highmark West Virginia
- The Health Plan of West Virginia (off exchange only)
West Virginia Health Insurance Costs
Health insurance premiums in West Virginia have increased slightly from 2019 to 2020. Below are the average monthly rates for Marketplace plans:
- Average lowest-cost bronze premium: $512 in 2019; $552 in 2020
- Average lowest-cost silver premium: $584 in 2019; $619 in 2020
- Average lowest-cost gold premium: $756 in 2019; $804 in $2020
Help With Marketplace Costs for Low-Income West Virginians
The federal government offers premium tax credits if you earn between 100% to 400% of the federal poverty level (FPL). This range stems from $12,760 to $51,040 for a single West Virginia resident in 2020.8 Subsidies lower monthly premiums on any Marketplace plan. About nine out of 10 of West Virginia enrollees received subsidies in 2019. The average amount was $768 per month.9
You may also qualify for cost-sharing reductions (CSRs) if you make up to 250% of the FPL, or $31,900 as a single adult.10 CSRs lower your out-of-pocket costs when you use your benefits. Savings only apply to silver plans. Among all enrollees in the state, half received CRSs.11
Word of Advice
West Virginia offers plenty of other options. Make sure the plan meets the needs and budget of you and your family.
Medicaid for Low-Income West Virginians
Medicaid enrolls close to half-million low-income West Virginians as of 2019.12 This group includes one in two children under 19 and one in four adults aged 19 to 64. Medicaid in West Virginia is also available to people 65 and older, blind individuals, adults with disabilities, needy families, and pregnant women.
Each group has income limits to qualify. For example, children aged 6 to 19 and adults under 65 can earn up to $23,352 (in 2019) for a family of two. Pregnant women and infants can earn up to $34,776 for a family of three.
West Virginia Children’s Health Insurance Program (CHIP)
CHIP in West Virginia covers kids from birth up until the month they turn 19. Children must be uninsured, legal residents, and not eligible for Medicaid to enroll. The program is also available to pregnant women over 19. About 34,000 residents enrolled in CHIP, as of November 2019.13
The Mountain State offers three levels of coverage for its CHIP program: Gold, Blue, and Premium. Each level has different income limits to qualify. Here are some examples of the maximum income limits for a family of two:
- Gold: $2,155 per month
- Blue: $3,032 per month
- Blue: $4,310 per month
Families pay a monthly premium of about $17 per month ($200 a year) for one child across all coverage levels. There are also copayments for certain services. For example, the copay for doctor visits ranges from $5 to $20, depending on the level of coverage. Pregnant women, Native American and Alaskan Native children are exempt from premiums and copays.14
West Virginia Medicare for Seniors and Younger Adults With Disabilities
Medicare is available to people 65 and older as well as adults under 65 with disabilities. The traditional program that’s run by the federal government is called Original Medicare. More than 326,000 West Virginians enrolled, as of 2018. Another 117,000 get coverage through an alternative program called Medicare Advantage. Private insurance companies contract with the federal government and sell the Medicare Advantage policies.15
Both options provide Part A hospital and Part B medical insurance. But Medicare Advantage offers benefits beyond Original Medicare. The majority of Medicare Advantage plans include Part D prescription drug coverage. People with Original Medicare only get limited drug coverage. So many buy individual Part D plans to access comprehensive drug benefits. Almost 200,000 West Virginians who qualify for Medicare have separate Part D plans.16
Original Medicare enrollees also have access to Medicare Supplement Insurance plans, also known as Medigap. These plans help pay for covered Part A and Part B out-of-pocket expenses. For example, you generally pay 20% of medical costs, or coinsurance, after you meet your deductible for Part B benefits. Most Medigap plans pay 100% of this amount. West Virginia (and most states) offers 10 standard Medigap plan options.
Buying Short-Term Health Insurance in West Virginia
Short-term or temporary health insurance provides coverage for a specific number of days. West Virginians can get short-term coverage for as long as 364 days. After that, you can renew the policy for up to 36 months. This coverage length is the maximum allowed by the federal government.
You may consider a short-term plan if you need basic health insurance to get you through a temporary situation. For example, if you’re in between jobs or waiting for benefits to start at a new job.
Short-term health plans don’t count as qualified coverage under the Affordable Care Act. Major medical benefits like maternity and mental health care, pediatric services, and prescription drug coverage are usually not covered. In most cases, you don’t get coverage for preexisting conditions.
Next Steps
West Virginia offers plenty of other options. So you should have no problem finding coverage to fit your needs. Make sure the plan meets the needs and budget of you and your family.
