Medicare plays a key role in providing health and financial security to beneficiaries residing in West Virginia. With more than 441,300 West Virginia beneficiaries enrolled in Medicare, we’ll cover some very important information below about Medicare in West Virginia. We want to help you better understand your options and make the decision-process as seamless as possible once you’re ready to enroll in Medicare or discover different coverage options.

Who Qualifies for Medicare in West Virginia?

Medicare covers most West Virginia residents who are 65 or older, and it also covers disabled West Virginia residents. In general, Medicare enrollment in West Virginia works the same way as it does in the rest of the country. If you qualify for Original Medicare, also known as Part A and Part B, it will help cover 80% of your health care costs.

When you’re first eligible for Medicare, you have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B. If you’re eligible for Medicare when you turn 65, you can sign up during the 7-month period that:

  • Begins 3 months before the month you turn 65
  • Includes the month you turn 65
  • Ends 3 months after the month you turn 65

In most cases, if you don’t sign up for Part B when you’re first eligible, you’ll have to pay a late enrollment penalty. You’ll be responsible for paying this penalty for as long as you have Part B, and you could have a gap in your health coverage.

Once you reach Medicare eligibility, you can begin choosing additional coverage options to help pay for the remaining 20% of your medical expenses through Medicare Advantage (Part C), Medigap, and/or a Medicare Prescription Drug (Part D) plan.

Who Qualifies for Medicare

West Virginia Medicare Enrollments

274,972

Original Medicare Plans
(Part A and B)

166,367

Medicare Advantage & Other Health Plans

179,842

Stand-alone Medicare
Part D (Drug plans)

166,367

Total Medicare Beneficiaries
in West Virginia

West Virginia Medicare Advantage Plans (Part C)

More than 34% of West Virginia Medicare beneficiaries select Medicare Advantage plans.

Medicare Advantage plans are private, Medicare-approved insurance companies. They provide all of your Original Medicare benefits and often include extra benefits such as drug, dental, and vision coverage.

The Medicare Advantage Open Enrollment Period runs from January 1 to March 31. During this period, Medicare beneficiaries in West Virginia who already enrolled in a Medicare Advantage plan can switch to a different Medicare Advantage plan or drop their Medicare Advantage plan and enroll in Original Medicare.

According to the Centers for Medicare and Medicaid Services (CMS), as of May 2020, there are 166,367 beneficiaries enrolled in Medicare Advantage and other plans in West Virginia. More than 34% of West Virginia Medicare beneficiaries were enrolled in a private Medicare Advantage plan in 2019. 98% of people with Medicare have access to a Medicare Advantage plan.

As of 2020, 42 Medicare Advantage plans are available in West Virginia. The average monthly Medicare Advantage premium changed from $43.42 in 2019 to $40.76 in 2020. $0 is the lowest monthly premium for a Medicare Advantage plan in West Virginia. There is a substantial Medicare Advantage market in West Virginia. Depending on the county, Medicare Advantage plan availability ranges from 17 to 26 plans.

West Virginia Medicare Supplement (Medigap) Insurance Plans

West Virginia doesn’t guarantee access to Medigap plans if you’re under 65 and eligible for Medicare due to a disability.

Medigap plans are used to supplement Original Medicare, covering some or all of the out-of-pocket costs (for coinsurance and deductibles) that beneficiaries would otherwise incur if they only had Original Medicare on its own. Typically, Medigap plans are popular for those who want little to no copay when they access healthcare services. Unlike the majority of states, West Virginia doesn’t have rules in place to ensure at least some access to Medigap plans for enrollees under age 65. Moreover, the premiums for Medigap plans for people under age 65 are higher than the standard premiums for beneficiaries who are eligible for Medicare due to their age. For more information about West Virginia’s Medigap regulations, click here.

West Virginia Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t cover outpatient prescription drugs. However, Medicare beneficiaries can get prescription coverage via a Medicare Advantage plan, an employer-sponsored plan (offered by a current or former employer), or a stand-alone Part D plan. Medigap plans don’t cover prescription drugs unless they’re covered under Part B.

As of May 2020, There are 179,842 Medicare beneficiaries in West Virginia enrolled in stand-alone Part D prescription drug plans and 137,068 enrolled in Medicare Advantage Prescription Drug plans. For 2020 coverage, there are 31 stand-alone Part D plans available in West Virginia, with premiums ranging from about $13 to $168 per month. About 34% of people with a stand-alone Medicare prescription drug plan get Extra Help (also called the low-income subsidy, or LIS). When deciding on a Part D plan, it’s important to evaluate several factors such as each plan’s premium, formulary, and copays since every plan is different. Learn how you can save money on your out-of-pocket costs with a Medicare Advantage, Part D, or Medigap plan, fill out this form or give us a call.

Local Medicare Health Plan Resources in West Virginia

  • West Virginia’s State Health Insurance Assistance Program (WV SHIP) is a free, federally regulated service that helps seniors navigate their Medicare options. WV SHIP counselors can answer questions about:

    • Medicare Part A and Part B
    • Medicare Prescription Drug Coverage (Medicare Part D)
    • Medicare Supplement Insurance (Medigap)
    • Medicare Advantage Plans (HMOs and PPOs)
    • Long-term care insurance
    • Medicare Savings Programs (QMB, SLMB and QI)
    • Prescription drug assistance programs or drug discount cards offered by your state and pharmaceutical companies
    • Medicaid and other insurance programs (including free or reduced-fee health care programs)

    WV SHIP counselors can help you understand your Medicare benefits, identify and compare health insurance options, and protect you from paying too much on your medical care and prescription drugs.
    Contact: Call 877-987-4463, 304-558-3317, or use the search tool on West Virginia’s SHIP website.

  • West Virginia’s Senior Medicare Patrol is a volunteer-based, federally funded organization that works to raise awareness about Medicare fraud, misuse, and billing errors. SMP volunteers work in conjunction with SHIP counselors to deliver information to seniors through one-on-one sessions, public events, and community-based workshops.
    Contact: Call 855-254-1720

  • West Virginia Legal Aid provides free civil legal services and counsel to senior West Virginians age 60 and older, with a focus on economically or socially disadvantaged, disabled, and rural seniors. The statewide organization maintains a network of participating lawyers who can assist seniors, and also maintains a current library of plain-language resources that provide in-depth information on Medicare and other legal issues related to seniors.
    Contact: Call 1-800-229-5068

  • West Virginia Medicare Premium Assistance Programs: Seniors and qualified adults with disabilities who have difficulty paying their Medicare Part A and Part B premiums, co-pays, and deductibles may qualify for financial assistance through one of two West Virginia Medicare Premium Assistance Programs. Applicants may qualify for either the Qualified Medicare Beneficiary (QMB) or the Specified Low-Income Medicare Beneficiary (SLIMB) program.
    Contact: Call 304-558-0628

  • Barbour County Senior Center: Located in the City of Philippi, the Barbour County Senior Center offers a range of educational, support and advocacy services to older adults. Seniors can access State Health Insurance Assistance Program counselors at the center, speak with a social worker about local resources, and get referrals to low-cost legal services that specialize in Medicare Advantage issues. The center also hosts information workshops that help seniors understand their rights and responsibilities related to Medicare and Medicare Advantage plans.
    Contact: Call 304-457-4545

  • Kanawha Valley Senior Services is a non-profit organization that provides programs of service to individuals in the Kanawha Valley. The organization’s mission is to help seniors age successfully. Services for Medicaid and Veteran recipients may extend from 18 years and older. Kanawha Valley Senior Services, Inc. coordinates and cooperates with other county agencies to assure that health, educational, recreational, intergenerational, and economic benefits are readily available to senior citizens. Five KVSS representatives are available to provide seniors with unbiased information about Medicare, Medicare Advantage and Medicare Part D prescription drug plans
    Contact: Call 304-348-0707

The licensed agents that are partnered with Timefor65 can help you compare the availability, benefits, and costs of Medicare plans in your specific region of West Virginia. Our process makes it easier for you to access your Medicare eligibility in West Virginia so that you receive personalized, affordable, and easy-to-use coverage options and solutions. Fill out the form or give us a call at (866) 327‑0148 anytime to get a free quote or to ask any questions.

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