WV Medicare (West Virginia Medicare Program) Guide

Medicare is a healthcare program for seniors and certain disabled people. In West Virginia, there are hundreds of private plans available that provide great coverage at a low cost. Nearly a quarter of West Virginia residents are enrolled in a Medicare plan. Will you be one of them?

This WV Medicare Guide Includes:

Who is Eligible for Medicare in West Virginia?

Anyone who is age 65 or older, diagnosed with ALS or ESRD, or on Social Security Disability Insurance (SSDI) for at least 25 months can enroll in Medicare in West Virginia.

If you are eligible due to your age, your enrollment period begins three months before you turn 65 and ends three months after. If you are eligible due to having ALS, you can enroll once you have been receiving SSDI for five months. If you have ESRD, you can get Medicare after your fourth month of dialysis treatments. Finally, if you have another disability, you can enroll in Medicare after receiving SSDI for at least 25 months.

Outside of your initial enrollment period, you can also make changes to your healthcare coverage during the Annual Enrollment Period every fall. Most people are only eligible to change in the fall, but a special circumstance may leave you with a Special Enrollment Period during another time of the year.

Turning 65 and Medicare

What is the Cost of WV Medicare?

Your West Virginia Medicare costs will vary based on the plans you select. As long as you worked for most of your life, you will have premium-free Part A, but most people will have to pay a Part B premium between $135.50 and $460.50 (depending on your income). You may also have a small deductible (the amount you have to pay before coverage starts in – only $185 per year for Part B in 2019) and co-insurance/co-payments for some services. In most cases, Medicare will cover at least 80% of your costs.

What Does Medicare Cover in West Virginia?

Original Medicare is the same in all 50 states, but private Medicare plans are different in every single zip code. Even though private Medicare Advantage and Medicare Supplement plans can cover more than Original Medicare, they are required to cover everything that Original Medicare covers.

Original Medicare consists of Part A (hospital, hospice, and skilled nursing facilities) and Part B (doctor visits, mental health, lab tests/ x-rays, ambulance transportation, and durable medical equipment). Once you have Original Medicare, you can get prescription drug coverage through a Part D plan. Medicare Advantage and Medicare Supplement plans can cover additional costs and services (see below for more information).

What Medicare Plans are Available in West Virginia?

West Virginians can choose from Original Medicare, Original Medicare with Part D, Medicare Advantage, Medicare Advantage with prescription drug coverage, and Original Medicare plus a Medicare Supplement plan (with the option to add prescription drug coverage).

What is the Best Medicare Plan in West Virginia?

We recommend Medicare Advantage plans for most beneficiaries. Most people are able to save money by enrolling in Medicare Advantage because of all the additional benefits. In fact, some people may be eligible for a $0 premium Medicare Advantage plan! One of our agents can help you figure out which plan is best for you and your individual needs.

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West Virginia Medicare Advantage

West Virginia Medicare Advantage (MA) plans, also called Medicare Part C plans, are different in every county, so what is available to you may not be available to your friend in the next town over. Since MA plans are allowed to offer additional benefits outside of what Original Medicare offers, they often include items like dental, vision, hearing, physical fitness, non-emergency medical transportation, meal delivery, and additional home care.

West Virginia Medicare Supplements

West Virginia Medicare Supplement plans, also called “Medigap,” help you cover costs associated with Part A and Part B. Unlike other Medicare plans, some people may have a Medicare Supplement plan waiting period due to preexisting conditions (for up to six months).

There are ten types of Medigap plans in West Virginia: A, B, C, D, F, G, K, L, M, and N.* Plan F is currently the most popular option, but it will be going away in the year 2020. The closest to Plan F (and the second most popular option) is Plan G. Plan G will cover your Part A deductible, Parts A and B coinsurance, Part B co-payments, up to three pints of blood, hospice co-payments and coinsurance, and some other Part B costs. The only difference between Plans F and G is that Plan G does not cover the Part B deductible, so that will not be an available benefit after 2019.

*Be careful not to confuse Original Medicare Part A and Original Medicare Part B with Medicare Supplement Plan A and Medicare Supplement Plan B.


Can I have Medicare and Medicaid in West Virginia?

If you are eligible for West Virginia Medicare and also meet the income limits for West Virginia Medicaid, you can qualify for a dual eligible special needs plan! These are commonly called “DSNPs,” and they cover most of your healthcare costs. If you qualify for both programs, you can enroll in a DSNP plan during any time of the year. You do not have to wait for the Annual Enrollment Period.

The WV Medicare Savings Program

There are two types of savings programs that you may be eligible for based on your income level. One is LIS, or low-income subsidies. LIS is also called the “Extra Help” program, and it can help you cover your prescription drug costs. The average person with LIS is able to save about $4,000 per year on prescription drugs! Click here to find out if you are eligible. The other is the Medicare Savings Program (MSP), and it can help you cover your Part A and B costs. Click find out if you are eligible for an MSP.

How do I Sign up for WV Medicare?

To enroll in Original Medicare, visit your local Social Security office, call 800-772-1213, or enroll online by visiting the Social Security website. To get more coverage, enroll in a private plan by contacting Medicare Plan Finder at 844-431-1832.

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