West Virginia Health Insurance

Health insurance in West Virginia

● West Virginia has a partnership exchange: Residents enroll in health plans through the national exchange, HealthCare.gov and the state oversees plans that are being sold.

● Open enrollment for 2021 coverage in West Virginia runs from November 1 to December 15, 2020.

● Short-term plans in West Virginia can have initial terms of up to 364 days and can be renewable for a total duration of up to 36 months.

● Two carriers offer coverage for 2020 through the West Virginia exchange.

● The average premium increase in West Virginia was about 6.7% for 2020.

● West Virginia implemented the ACA's Medicaid expansion in 2014. As of May 2020, it benefited nearly 160,000 people enrolled in the expanded eligibility requirements.

● In 2019, 439,300 West Virginia residents were enrolled in Medicare coverage.

This page is dedicated to increasing health affordability by connecting west Virginia consumers who need health insurance coverage to useful resources. Use this page to get answers to your health insurance questions.

You'll find information about options for individual health insurance coverage, and you'll find links to help you sign up. You can find the basics of the West Virginia health insurance marketplace and the next open enrollment period; a brief overview of Medicaid expansion in West Virginia; a quick look at the availability of short-term health insurance in the state; statistics on state-specific Medicare rules; as well as a collection of health insurance resources for West Virginia residents.

The exchange, Medicare and Medicaid all include coverage for medical expenses and prescription drugs.

West Virginia's health insurance marketplace

West Virginia's health insurance marketplace is an exchange of partnerships, meaning residents (individuals or families) sign up for the plans through HealthCare.gov. The HealthCare.gov is run by the federal government, with the state governing the plans offered in West Virginia. The market, which is also called the health insurance exchange, was established by the Affordable Care Act. You can use the market to sign up for health care for you or your family, and to see if you're eligible for subsidies or cost-sharing reductions (CSR) to help you pay monthly premiums and other expensive out-of-pocket expenses (such as a deductible or copay). The health insurance marketplace is a good option for people who are self-employed or employed by a company or other organization that does not provide health insurance coverage.

Open enrollment period and dates in West Virginia

The open enrollment period for 2021 coverage in West Virginia will run out from November 1, 2020 to December 15, 2020. For 2020 health coverage, enrollment is only available to people with qualified events. Native Americans can sign up for the exchange year-round, as can anyone entitled to Medicaid or CHIP.

It is important that every consumer visits the exchange every year. Registration is not accompanied from one year to the next. The options available for the health plan offered on the market vary from year to year, and a change in income can affect qualification for subsidies or cost-sharing reductions.

West Virginia Exchange Health Plan Options

For 2020, the West Virginia health insurance marketplace has two carriers -- Highmark and CareSource -- that provide access to health insurance plans. Health Plan of West Virginia (Optum) also offers ACA-compliant coverage in the state, but only outside of the exchange (and their enrollment is very low).

In all three carriers, the average rate increase was 6.7% for 2020, compared to a national average of less than 0.2%. For 2021, CareSource proposed an average rate increase of 6.26%, while Highmark proposed an average rate increase of 4.34%.

Medicaid expansion in West Virginia

In general, Medicaid is a health insurance option for people without or very low income or with disabilities. Medicaid is jointly managed by the state and federal government; Medicaid is primarily funded by the federal government. Each state determines specific eligibility rules and manages the program within the general guidelines and requirements set by the federal government. Income restrictions for eligibility vary by state and for adults, children, pregnant women, and people with disabilities. Some people qualify for both Medicaid and Medicare.

West Virginia chose to expand Medicaid eligibility under the Affordable Care Act in 2014. Under the new eligibility guidelines, total West Virginia Medicaid/CHIP enrollment was 44% higher in April 2020 than in 2013, before Medicaid expansion.

As of May 2020, there were 162,169 residents enrolled in Medicaid plans through the expansion of West Virginia Medicaid. (Total Medicaid/CHIP enrollment, including people eligible under pre-ACA rules, was 510,167.)

West Virginia expanded CHIP in 2019 to include coverage for pregnant women.

Short-term health insurance in West Virginia

Starting in October, new federal short-term insurance rules allow plans to have an initial duration of up to 364 days, and renewals are allowed as long as the total duration of coverage does not exceed 36 months. Because West Virginia has no regulations regarding the maximum duration for short-term health plans, the state is not in compliance with federal rules.

How did Obamacare benefit West Virginians?

As a result of the Affordable Care Act, the uninsured rate in West Virginia fell from 14% in 2013 to just 5.3% in 2016, according to U.S. Census data. But it had grown to 6.4% by 2018, in line with a national trend of raising uninsured rates under the Trump administration. (Looking ahead, the average uninsured national rate in 2018 was 8.9 percent.) Much of this is due to the ACA's expansion of Medicaid, with nearly 160,000 people enrolled under expanded guidelines in West Virginia.

West Virginia and the Affordable Care Act

Joe Manchin is the only Democratic member of the West Virginia congressional delegation, and the only one who supports the ACA. Although Senator Shelly Capito took a more moderate stance than many of her fellow Republican senators, she ultimately voted in favor of the entire Better Care Reconciliation Act and "skinny repeal" in July 2017, even though she voted against the Obamacare Repeal Reconciliation Act. Capito voted in favor of the tax reform bill that passed the Senate at the beginning December 2017, which includes some of the provisions of the "skinny repeal" bill, including the repeal of the ACA's individual mandate.

In the House of Representatives, all west Virginia representatives are Republicans, and everyone is against the ACA.

Governor Jim Justice won the 2016 election in West Virginia. Justice has functioned as a Democrat (though conservative, intent on reviving the coal mining industry in West Virginia), and won despite the fact that the state voted overwhelmingly for Donald Trump as president. In August 2017, however, Justice announced that he was moving to the Republican party. Despite being a Democrat, the justices had expressed their opposition to U.S. House legislation that would repeal the ACA.

The previous governor, Democrat Earl Ray Tomblin, took office in 2010 (replacing Manchin, who left the governor's office for the Senate), and was generally in favor of the ACA. He chose to expand Medicaid, which had a huge impact on the uninsured rate in West Virginia in 2014. But Tomblin was limited to the end and could not try again in 2016.

West Virginia operates a partnership exchange with the federal government, using Healthcare.gov as a portal for residents to select plans. They opted for this path instead of managing their own exchange, because they felt they would take more money by expanding Medicaid and letting HHS handle the operational aspect of the exchange. The state has often been seen as an example of how successful Medicaid expansion can be if implemented well.

Does West Virginia have a high-risk pool?

From 2005 to 2014, West Virginia had a high-risk pool. Before Obamacare, in nearly every state, the medical history of claimants could prevent them from getting coverage in the private individual insurance market, or it could result in significantly higher premiums or exclusions of pre-existing conditions. Thirty-five states - including West Virginia - have taken responsibility for creating their own high-risk pools (not to be confused with PICP risk pools created by the ACA in 2010).

AccessWV was created in 2005 to offer people an alternative coverage option if they couldn't get individual health insurance because of their medical history. Now that all health insurance plans are guaranteed problem - thanks to the ACA - high-risk pools are largely outdated. AccessWV stopped accepting new members in November 2013, but continued to cover existing members until March 31, 2014. At that point, the program ceased operation.

Medicare coverage and enrollment in West Virginia

Medicare covers people over the age of 65, some people with disabilities, and people with end-stage kidney disease (ESRD).

Medicare terminology can be confused. Here's a simplified explanation of the difference between common Terms related to Medicare:

Medicare Part A covers hospital care.

Medicare Part B covers medical services.

Medicare Part D covers prescription drugs.

Original Medicare includes both Part A and Part B. Under original Medicare, the federal government pays directly for the services you receive.

Medicare Part C, also called Medicare Advantage, covers parts A, B, and, D. Through Medicare Advantage, you can choose between one of the many private health plans in your state, and the federal government pays for the plan for the services you receive

There were 441,672 West Virginia residents enrolled in Medicare plans as of June 2020. This is almost 25% of the state's total population. Nationally, the average Medicare enrollment is less than 19 percent.

The state has a relatively high percentage of individuals who are eligible for Medicare due to disability, at 21% (the other 79% are eligible because of at least 65 years). Only four states have a higher percentage of eligible beneficiaries due to disability and the national average is 15%.