West Virginia Medicare Guide

Get personalized advice from Medicare advisors who put your interests first. We’ll help you get to know your options, compare pricing and benefits of available plans, and enroll in the best coverage for your needs. Get started by scheduling a free consultation with one of our West Virginia Medicare Advisors here or calling us at (888) 604-0055.

In this guide, we break down the basics of Medicare in West Virginia to help you decide when to enroll, which options are best for you, and how to get the best value from your Medicare.

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A Snapshot of Medicare in West Virginia

There are 444,000 West Virginia Medicare beneficiaries, which makes up 25% of the state’s total population. Most Medicare recipients in West Virginia are enrolled due to age, but about 18% are on Medicare due to disability. 19% of Medicare beneficiaries are also on Medicaid. We’ll dive into the details of how Medicaid helps low-income Medicare beneficiaries later on.

If you’ve started looking into Medicare or are already on it, you’ve probably heard of Original Medicare, Medigap, and Medicare Advantage. In West Virginia, 57% of those on Medicare have chosen to stay on Original (also called Traditional) Medicare. The other 43% are enrolled in a Medicare Advantage plan. Read on to learn about the differences so you can make an informed decision that fits your unique health and financial needs.

West Virginia Medicare Eligibility and Enrollment Steps

Every US citizen who meets one of the following criteria is eligible for Medicare:

You’re 65 or older
You have certain disabilities like ALS and End-Stage Kidney Disease

Medicare Enrollment Steps for West Virginia Residents

1. Enroll in Original Medicare (Part A & Part B)

Most people become eligible for Medicare when they turn 65. If you’re already drawing from Social Security, then you’ll be automatically enrolled in Original Medicare, which consists of Part A and Part B. If you aren’t automatically enrolled, then you can enroll during your Initial Enrollment Period (IEP). Your IEP is a seven-month window that starts three months before the month you turn 65 and ends three months after it.

Some people who are still working choose to delay Part B enrollment in favor of their employer coverage. We recommend comparing your work coverage to Medicare because in many cases, Medicare provides better value for older Americans. If you do choose to delay Part B enrollment, just be sure you’re eligible for the Part B Special Enrollment Period—or you may incur a late enrollment penalty!

2. Compare additional coverage options

Once you’re enrolled in Original Medicare, you have options. You can stay on Original Medicare or enroll in a Medicare Advantage plan. Note: You cannot be enrolled in both Original Medicare and Medicare Advantage. If you stay on Original Medicare, you can choose to also add a Medicare Supplement and/or prescription drug plan.

Both Original Medicare and Medicare Advantage have their pros and cons. The right decision for you may be different than your neighbor’s or best friend’s! We recommend working with an independent Medicare advisor to understand your options and choose the Medicare coverage that works best for you. Our agents are on-hand and can be reached at (888) 604-0055.

3. Get the best value from Medicare

Choosing the right Medicare insurance for your unique needs is step one to getting the best value from Medicare. Once you’re enrolled, be sure to use your coverage. Set up preventive appointments, like your annual wellness exam and share your new prescription drug plan information with your pharmacy to be sure you’re getting the best price.

Finally, you should use the Medicare Open Enrollment Period to review your coverage. The Open Enrollment Period occurs every year from Oct 15 - Dec 7. It’s an important time because Medicare plans can change each year, and your healthcare needs may too. Use this time to shop Medicare Advantage and prescription drug plans and switch plans without consequence. Watch the video below for a quick overview of this annual enrollment period:

West Virginia Medicare Advantage Plans

There are 41 Medicare Advantage plans available in West Virginia. Plan pricing and availability varies from county to county. For example, Berkeley County, WV has 33 Medicare Advantage plans and Hancock County has 25. Most of these plans have zero-dollar premiums, but that doesn’t make them free. If you enroll in a Medicare Advantage plan, you pay your Original Medicare premiums, plus the Medicare Advantage premium.

Medicare Advantage plans replace Original Medicare and are popular because they bundle together Part A, Part B, and usually Part D coverage. They also usually offer additional benefits, which may include:

Dental, vision, and hearing services
Over-the-counter flex cards
Meal services
Fitness perks
Transportation services

More benefits at no extra cost may sound too good to be true. Medicare Advantage plans come with their disadvantages, including:

Network limitations
Frequent preauthorization requirements
Higher out-of-pocket costs (compared Original Medicare + Medigap)

To hear about and compare pricing and benefits for Medicare Advantage plans available in your county, give us a call at (888) 604-0055 or schedule a free consultation with one of our licensed West Virginia Medicare Advisors.

West Virginia Medicare Supplement Plans

Original Medicare doesn’t cover about 20% of costs and doesn’t have an out-of-pocket maximum. This means that, for a surgery that costs $50,000, you’d be on the hook for $10,000. Many people enroll in Medicare Advantage plans, which often don’t reduce your out-of-pocket costs, but do have an out-of-pocket maximum, so your bills won’t be sky-high. Many other Medicare recipients choose to stay on Original Medicare and add a Medicare Supplement (also known as Medigap) plan to their coverage to cut their out-of-pocket spending.

Plans of the same letter (e.g., all Plan Gs) are legally required to have the same coverage, but pricing varies based on location and insurance carriers.Each of these plans significantly reduces your out-of-pocket costs, but Plan G is the most comprehensive. With a Plan G, you don’t owe anything for covered services after meeting your Part B deductible.

When compared to Medicare Advantage plans, Medigap plans have some key benefits:

You can see any doctor that accepts Medicare (about 90% of doctors nationwide)
You don’t need prior authorization for covered services
Your out-of-pocket costs are significantly reduced

The best time to enroll in a Medigap plan is during your Medigap Open Enrollment Period. This is a six-month period of time that occurs after your Part B effective date. The Medigap Open Enrollment Period is one of the Medigap guaranteed issue periods. If you’re within one of these periods, you’re guaranteed acceptance into any Medigap plan. Insurance carriers are not allowed to ask you questions about your health history and cannot deny your application. You are technically able to enroll in a Medigap plan at any point, but outside of a guaranteed issue period, insurance can ask about your health history and may reject your application.

West Virginia prescription drug (Part D) Plans

Medicare introduced Part D because Original Medicare does not provide prescription drug coverage. West Virginia Medicare beneficiaries can either receive Part D benefits through a Medicare Advantage plan that includes them or through a stand-alone Part D plan. There are 26 Part D plans available in West Virginia—the 3rd most available in the country.

We recommend getting Part D coverage even if you don’t need it when you first enroll in Medicare. This will help you avoid the Part D penalty if you do need prescription coverage later in life!

If you have questions about your Medicare options or want to compare plan benefits and pricing, schedule a free consultation with one of our licensed West Virginia Medicare Advisors or give us a call at (888) 604-0055.

Get help paying for Medicare in West Virginia

Healthcare costs can add up. To help low-income individuals receive the healthcare they need, the government has three programs that provide financial aid.

West Virginia Medicaid for Medicare beneficiaries

Each Medicaid program is jointly funded by the federal and state governments and run by the state. West Virginia Medicaid offers Medicare Savings Programs (also commonly referred to as Medicare Premium Assistance) for its low-income Medicare beneficiaries.

Qualified Medicare Beneficiaries (QMB) Program

You’re eligible for the QMB Program if your income is below 100% of the current federal poverty limit (FPL) and you meet the maximum asset requirements. If you’re eligible, Medicaid will pay for your Medicare Part A and B premiums, copayments, and deductibles.

Specified Low-Income Medicare Beneficiaries (SLIMB)

You’re eligible for the SLIMB Program if your income is below 120% of the FPL and you meet the maximum asset requirements. If you’re eligible, Medicaid will pay for your Part B premium.

Qualified Individual 1 (QI-1)

You’re eligible for the QI-1 Program if your income is above 120% and below 135% of the FPL and you meet the maximum asset requirements. If you’re eligible, Medicaid will pay for your Part B premium.

Qualified Disabled Working Individuals (QDWI)

You’re eligible for the QDWI Program if you’re a former recipient of Social Security Disability benefits and Medicare, have an income below 200% FPL, and meet the maximum asset requirements. If you’re eligible, Medicaid will pay for your Part A premium.

You can apply for Medicaid on the West Virginia Department of Health & Human Resources website. If you need help determining if you’re eligible or applying, reach out to one of our licensed West Virginia Medicare Advisors!

Medicare Extra Help

If you have limited income and resources, you may be eligible for Extra Help. Extra Help is a federal program that helps pay for costs associated with prescription drug coverage, including premiums, deductibles, and coinsurance.

You automatically qualify for Extra Help if you:

Receive full Medicaid coverage from West Virginia
West Virginia pays your Part B premium
Are eligible for Supplemental Security Income (SSI)

If you don’t automatically qualify for Extra Help, you can learn more about the program here or talk to one of our licensed West Virginia Medicare Advisors to get free support with your application.

Supplemental Security Income (SSI) Benefits

Eligible US citizens receive monthly payments from the SSI program. You’re considered eligible if you meet the following criteria:

You are 65 and older, blind, or have a disability
You have limited income and limited resources

You can apply for SSI Benefits online or by calling 1-800-772-1213 / TTY 1-800-325-0778.

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