Medicare Advantage Plans in West Virginia

Medicare Advantage plans in WV are private insurance policies that pay instead of Original Medicare for the calendar year that you enroll in them. All Medicare Advantage plans must include at least the same level of care you receive with Original Medicare. You won't lose coverage when you switch plans.

Remember, however, that you must pay your Part B premium if you want to enroll in a Medicare Advantage plan.

The standard monthly Medicare Part B premium for 2023 is $164.90.

The annual Part B deducible for 2023 is $226.

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Top rated Medicare Advantage Providers in West Virginia

  • Humana: Humana has enrolled 70 percent of the Medicare Advantage plans in West Virginia.
  • Blue Cross: The West Virginia BCBS company accounts for about five percent of the state's enrollment.
  • Coventry: Coventry offers PPOs that have earned high star ratings for quality in some West Virginia counties.
  • The Health Plan: A smaller company, The Health Plan, offers both HMOs and special needs HMOs that have earned good quality ratings.
  • Other Notable companies to look for in your area are Cigna and Aetna

Popular Medicare Advantage Plan Types in West Virginia

If you're searching for the best Medicare coverage in West Virginia for 2022, there are several types of plans that you can join. Each plan offers different benefits, from a larger service area to low monthly premiums.

Best Network Freedom: Medicare Advantage PPO

  • Premiums for PPO plans may cost you $0-$100 every month
  • PPO plan benefits include no referrals from primary care physicians and a broader network

Best for Lowest Out-of-Pocket: Medicare Advantage HMO Plan

  • Most HMO premiums are $0 per month
  • Reduced out-of-pocket expenses since you're required to visit in-network providers

Best for Low Income or Health Conditions: Medicare Advantage D-SNIP

  • Useful for people with low income or chronic health issues
  • Allows members to enter Medicaid and Medicare at the same time, which reduces out-of-pocket expenses for copays, coinsurance, and monthly premiums

Medicare Enrollment Facts:

Total number of people enrolled in West Virginia Medicare Advantage plan – 146,906

Number of people enrolled per Medicare Advantage plan –

Local HMO – 11,342

Local PPO – 97,236

PFFS: 3,649

Regional PPO – 4,588

Percentage of people enrolled in West Virginia Medicare Advantage – 33%

Number of people enrolled in Medicare Advantage across the nation – 29.5 million in 2022

Percentage of people enrolled in Medicare Advantage across the nation – 42%

How much does Medicare Advantage in West Virginia cost?

You should be able to find West Virginia HMO plans that come with no monthly premiums. It's also possible to find PPO plans with small premiums. The average monthly premium in West Virginia is $25.53. This plan type doesn't include the cost of prescription drug coverage – MAPD. The average premium for a plan providing prescription drugs would be $59.74.

How much do Advantage Plans cost in West Virginia?

PPO Plan $0.00 to $25.53

HMO Plan $0.00

When can I enroll in a Medicare Advantage plan?

When attempting to join Original Medicare or Medicare Advantage, several enrollment periods are available. The three most common enrollment periods to which you should have access include the initial enrollment period, the open enrollment period, and the Medicare Advantage open enrollment period. Consider speaking with an insurance agent if you're wondering when to enroll in a Medicare Advantage plan.

Initial Enrollment Period

  • The enrollment period extends seven months, including three months before and after your 65th birthday and your birthday month.
  • This period is only available to individuals who have yet to enroll in Medicare Part A or Part B.
  • You can only enroll in Medicare Part C after enrolling in Part B

Open Enrollment Period (Annual Election Period)

It begins on October 15 and remains open until December 7.

Also known as the Annual Election Period, the open enrollment period allows members to change, leave, or join various health plans. If you find that one plan's benefits are better than yours, you can switch to a new plan during this period. If you would like additional coverage with a Part D plan, one option available to you is to switch to a different Medicare Advantage plan that includes a prescription drug plan. These plans are known as MAPD plans.

Medicare Advantage Open Enrollment Period

It begins on January 1 and remains open until March 31.

You can use this open enrollment period to change from one Medicare Advantage plan to another. It's also possible to switch back to Original Medicare and consider your options for a Medicare Supplement plan and/or Part D plan.

Special Enrollment Periods – Special Circumstances

The exact circumstance dictates when the enrollment period is.

The three different special circumstances that may allow you to qualify for this enrollment period include:

  • A loss of coverage through an employer group plan or Medicaid
  • Your exact plan no longer being under contract with Medicare
  • Moving to a new location that falls outside of the network

5-Star Special Enrollment Period

It begins on December 8 and Ends on November 30.

During this special enrollment period, you can change your current plan and enroll in another plan with a star rating of 5.0. Medicare assigns ratings based on the performance and quality of the plan in question.

Special Enrollment Periods if You Get "Extra Help"

You can qualify for the "Extra Help" enrollment period if you have low resources or income. It's possible to qualify for this enrollment period based on one of three different criteria, which include:

  • Having eligibility for both Medicaid and Medicare
  • Having eligibility for Part D payment assistance
  • Losing eligibility or being enrolled in a State Pharmaceutical Assistance Program, which is also known as SPAP

For the first two qualifications, special enrollment can occur in three separate periods of the year, which extend from January to March, April to June, and July to September. You can drop, switch, or join a Medicare Advantage or Medicare Part D plan during these periods. As for the SPAP program, eligibility is possible once per year.

Medicare Advantage Highlights:

The primary advantages of choosing a Medicare Advantage plan include:

  • More and more Medicare beneficiaries are enrolling in Medicare Advantage every year
  • The insurance company delivers your benefits
  • Nearly all benefits and plans are connected to a defined network of hospitals, medical facilities, and doctors
  • Medicare Advantage Prescription Drug plans offer additional benefits in the form of comprehensive prescription drug coverage
  • You may gain access to extra benefits like medical appointment transportation, hearing, vision, and denta

Ready to Learn More?

We help educate Medicare beneficiaries on their Medicare Advantage options and help them go through the process of reviewing and comparing plans. We work with most of the nation's top-rated Medicare Advantage carriers. Call us today, or request a quote online to learn more about plan options.

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