What You Need to Know
In West Virginia, plans must last for less than 12 months. They can be renewed for up to 36 months in total.
Most plans premiums are $100 to $300 per month.
Short-term medical insurance plans aren’t required to cover essential benefits like prescriptions and maternity care.
What Is West Virginia Short-Term Health Insurance?
West Virginia short-term health insurance is major medical coverage that lasts for a limited time. The federal government has rules in place for this type of policy. Short-term health plans must last less than 12 months, and they can be renewed for up to a total of 36 months.1 Some states further restrict these policies, but West Virginia follows the federal rules.
Most plans cost $100 to $300 per month, and there are a few insurance companies selling these plans in Mountain State. Learn more about this coverage and whether it’s right for you.
One of the advantages of short-term health insurance is that there are no special enrollment periods, so you can sign up for a plan at any time.
Who Should Buy Short-Term Plans in West Virginia?
A West Virginia short-term plan might be a good fit if you:
- Need affordable coverage: The Affordable Care Act (ACA) established state Health Insurance Marketplaces, including West Virginia’s.2 If you don’t have other health insurance coverage, you can buy a plan through the Marketplace. You may receive subsidies that lower your premiums. Short-term plans are typically less expensive than unsubsidized coverage.
- Missed open enrollment: ACA-compliant plans only allow you to enroll at certain times. Employers also limit when you can enroll. You can enroll in West Virginia short-term plans at any time.
- Are relatively healthy: Short-term health plans can deny applications based on a person’s health status. This is called medical underwriting.3 Your chances of being accepted for a plan are better if you’re relatively healthy. These plans typically have high deductibles, so they’re best for people who don’t frequently use healthcare services.
- Are between health insurance plans: Short-term medical insurance plans are best used as a bridge between other health coverage options. For example, you might be waiting for insurance to start with a new employer, or you might be between jobs.
A short-term health plan might not be right for you if:
- You have preexisting conditions. If you have preexisting health conditions, you may not be approved for a short-term plan. If you are accepted, most plans don’t cover care for preexisting conditions.4 Let’s say you sprained your ankle before your short-term plan started. Once your plan starts, any care related to your ankle, like a follow-up doctor visit, would not be covered.
- You need essential benefits offered by ACA-compliant plans. Plans sold on the Marketplace are required to cover certain essential benefits, including prescriptions and maternity care.5 Short-term medical insurance plans aren’t required to cover those essential benefits.
|Pros of Short-Term Plans||Cons of Short-Term Plans|
|Affordable||Preexisting conditions typically aren’t covered|
|Flexible enrollment||Not required to cover essential benefits|
|Bridge gaps between other types of coverage||Typically have high deductibles|
Beyond the Premium
Keep in mind that short-term plans have additional costs, including deductibles, copays, and coinsurance.
How Much Are West Virginia Short-Term Plans?
There is more to pay for with a West Virginia short-term health insurance plan than just the monthly premium. Here are other costs to consider:
- Deductible: This is the amount you pay for covered services before your plan starts paying for care.6
- Coinsurance: This cost is a percentage of a covered item or service that you pay after you’ve paid your deductible.7
- Copayment: Copayments, or copays, are a set dollar amount you pay for an item or service.8
- Out-of-pocket maximum: This is the most you’ll pay out of pocket for covered healthcare services.9
- Maximum benefit: This is the most the plan will pay toward your care.10
Here are examples of how much plans cost in West Virginia. A 35-year-old, non-tobacco-using woman living in Morgantown, West Virginia, would pay:
- $126.03 for a plan from Pivot Health with a $5,000 deductible, a maximum benefit of $1 million, and no prescription coverage.
- $241.34 for a plan from Pivot Health with a $5,000 deductible, a maximum benefit of $1 million, and prescription coverage.
A 35-year-old, non-tobacco-using woman living in Charleston, West Virginia, would pay:
- $143.71 for a plan from Pivot Health with a $5,000 deductible, a maximum benefit of $1 million, and no prescription coverage.
- $278.24 for a plan from Pivot Health with a $5,000 deductible, a maximum benefit of $1 million, and prescription coverage.
Rates for men will be different.
What Rules Govern Short-Term Plans in West Virginia?
West Virginia follows the federal rules for short-term, temporary health insurance plans. According to federal law, plans must last for less than 12 months. They can be renewed for up to 36 months in total.
Federal law also requires plans to have clear, understandable language that lets consumers know these plans don’t cover the essential health benefits associated with ACA plans.11
Who Sells Short-Term Plans in West Virginia?
A few companies sell short-term health insurance plans in West Virginia. Here are the major carriers:
- Pivot Health: Pivot Health offers a variety of plans, including options that cover prescriptions. Deductibles range from $2,000 to $20,000 and maximum benefits range from $100,000 to $1,000,000.
- UnitedHealthcare/Golden Rule Insurance Company: These companies work together to provide a variety of short-term plans, some of which cover prescriptions. Their plans have deductibles ranging from $1,000 to $12,500 and maximum benefits of between $500,000 and $2 million.
- Independence American Insurance Company: This option offers limited coverage for preexisting conditions with some of its plans. Deductibles range from $2,500 to $10,000 and have up to $2 million in maximum benefits.
The first step in finding coverage is deciding whether a West Virginia short-term plan is the right fit for you and your family. If it is, get quotes from insurance companies and compare your coverage options. Be sure to look at more than the monthly premium. Plans vary in terms of out-of-pocket costs and benefits. Some plans cover prescription drugs, for example, while others don’t. Once you’re ready to sign up, most plans have a simple online application. They may also charge a small enrollment fee.