A Guide to Medicare in West Virginia

Over 15% of West Virginia’s population is 65 or older, which means that there are a lot of questions about how Medicare works in the state. Medicare is medical coverage that allows older Americans, and those with specific health conditions, to get help paying for their medical needs.

Understanding how to qualify for and enroll in Medicare is an important part of meeting your medical needs as you get older. This guide will help answer common questions about Medicare in West Virginia so you can get the coverage you need!

Does West Virginia Have Medicare?

Yes, because Medicare is a federal program, every state in the U.S. has Medicare. In West Virginia, 1.5 million people are enrolled in Medicare Advantage and over six hundred thousand people are enrolled in a prescription drug plan.
Medicare has several parts, all of which cover a different part of your medical needs. 

• Medicare Part A is inpatient hospital insurance, which helps pay for your care if you are admitted to the hospital. Most people do not pay a monthly premium for Medicare Part A, although there is a deductible and daily coinsurance if you use the coverage. 
• Medicare Part B is medical coverage that helps pay for doctor’s visits, preventive care, medical equipment, and more. Together, Medicare Parts A and B are known as Original Medicare. Medicare Part B has a monthly premium, and there is also a yearly deductible. After the deductible, you pay 20% of the Medicare-approved amount for your care, and Medicare pays the rest.
• Medicare Part D is prescription drug coverage and needs to be purchased separately from Original Medicare. Part D is offered by private insurance companies, and the costs and drugs included may vary from one plan to another. Be sure to compare plans to get the coverage you need.
• Medicare Part C is known as Medicare Advantage. This is a full replacement plan for Original Medicare and often includes drug coverage along with additional benefits. We’ll talk more about Medicare Advantage in West Virginia later in this guide.

Who Qualifies for Medicare in WV?

Medicare is intended to provide health coverage for those who are less likely to be able to get health insurance through their job. This includes older Americans as well as those with disabilities or specific health conditions. 

American citizens or permanent residents who have lived in the country for at least five years will qualify for Medicare, as long as at least one of the following also applies:

• You’re age 65 or older
• You’re under 65 but disabled and receiving disability benefits from Social Security or the Railroad Retirement Board
• You have end-stage renal disease (ESRD)
• You have Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease

Most people who qualify for Medicare are enrolled automatically in Original Medicare during their initial enrollment period. However, you still need to review your coverage to ensure it’s what you need. For example, you might want to add Medicare Part D for drug coverage or choose a Medicare Advantage Plan. 

In addition, if you want Original Medicare with a Medigap plan (Part F), you have guaranteed acceptance in Medigap during your initial enrollment period. After that time, you may not qualify for this important coverage that can help you cover out-of-pocket expenses.

What is the Income Limit to Qualify for Medicare in WV?

There is no upper-income limit that will cause you to not qualify for Medicare. However, if your income is above a certain threshold, you might pay more for your monthly premium. For example, those whose 2023 tax return shows an income of $91,000 or more for an individual, or $182,000 or more for a joint return, will pay a higher Medicare Part B and D premium in 2024.

If you have a lower income and assets, you may qualify for assistance paying for your Medicare costs. There are several Medicare Savings Programs available for West Virginia residents, and you may qualify for significant savings. 

For example, the Qualified Medicare Beneficiary program, allows individuals with income below $1,060 a month ($1,430 for couples), and assets below $7,730 ($11,600 for couples), to get assistance with monthly premiums, deductibles, copayments, and coinsurance. 

These amounts are slightly less, than last year, making them slightly more accessible for those who need the program.

Does West Virginia have Medicare Advantage Plans?

Medicare Advantage in West Virginia can give Medicare beneficiaries extra benefits, but there are some limitations on how you can use your coverage.

Medicare Advantage is a full replacement plan for Original Medicare and often includes drug coverage as well as benefits like vision, dental, and discounts on health programs. However, you generally will need to use the in-network medical providers anytime you need medical care. 

If you stay within your local area most of the time, that might not be an issue, but if you travel often it’s important to know that you generally won’t have medical coverage outside of an emergency at an out-of-network provider.

Some Medicare Advantage plans don’t cost anything above your normal Medicare Part B deductible. Others have an additional monthly premium. You’ll also want to compare the medical network to ensure your preferred doctors are included. By comparing the costs and benefits of different Medicare Advantage plans, you can get the coverage you need at a price that makes sense for you.

Contact Us to Learn More About Medicare in West Virginia

This guide answered many of the most common questions about Medicare in West Virginia, but it’s impossible to cover every possible concern in a single guide. That’s why we have licensed insurance agents available that can help you understand the best options for your unique situation.

If you’d like to compare Medicare Advantage plans or find out more about your Medicare options in West Virginia, contact us today!