Health insurance in WV
The West Virginia healthcare landscape is unique in many ways. As one of the states with the highest rates of the population with chronic disease and mental health challenges and with a nearly 16% poverty rate, having health insurance is crucial to ensuring access to quality medical care in WV. Due to the fact of Medicaid expansion in 2014, now the program covers around 36% of West Virginians and has become a critical source of healthcare coverage for residents. However, for those who are not eligible for any of the federal programs or don’t have employer-sponsored coverage – having access to healthcare services at affordable cost is still one of the top questions. Especially for those living in rural areas with a shortage of healthcare providers.
To understand your options, we want to provide some key information about when, how, and where you can obtain the best of all available health insurance in WV in your particular scenario.
Facts about the healthcare system and health insurance in WV
1. By the end of 2022, more than 638,000 residents in West Virginia had signed up for Medicaid and CHIP programs, including 223,000 through the Medicaid expansion.
2. West Virginia’s uninsured rate dropped from 14.9% in 2011 to 6.1% in 2021, according to the annual report of America’s Health Rankings.
3. The state has a shortage of healthcare providers, particularly in rural areas, which can make it challenging for residents to access healthcare services.
4. West Virginia has a high prevalence of chronic health conditions such as diabetes, heart disease, and obesity.
5. West Virginia has a relatively low rate of healthcare utilization, with residents using healthcare services at a lower rate than other states in the country.
6. State residents can buy short-term health insurance plans while experiencing a coverage gap. As of 2023, at least eight insurers are selling short-term health insurance policies in West Virginia with initial terms of up to 364 days with the option to renew for a total duration of up to 36 months.
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The enrollment period for individual and family insurance in West Virginia
Under the expanded eligibility guidelines, adults aged 19-64 are eligible for Medicaid with a household income up to 138% of the poverty level.
What comes to Medicare – West Virginia residents who are eligible for the program have two enrollment periods to keep in mind: initial and general. The initial enrollment period for Medicare starts three months before the month of their 65th birthday and continues until three months after their 65th birthday. To avoid potential late enrollment penalties – it’s important for those turning 65 to understand the initial enrollment period so they can enroll in Medicare on time. By enrolling during the initial enrollment period, they can ensure that their Medicare coverage starts as soon as they turn 65.
For those eligible due to disability, this period begins three months before their 25th month of disability payments, includes the 25th month, and ends 3 months after. Disabled individuals who have gotten disability benefits from Social Security for 24 months are automatically enrolled in Medicare.
Existing Medicare beneficiaries enrolled in Medicare Advantage or Original Medicare have the option to switch between plans during the annual fall enrollment period, which runs from October 15 through December 7. If a switch is made during this time, coverage is effective on January 1st. Additionally, there is a Medicare Advantage open enrollment period during the first quarter of the year (January 1 to March 31) where those already enrolled in Medicare Advantage can either switch to another Medicare Advantage plan or opt for Original Medicare instead. This gives beneficiaries the flexibility to reassess their healthcare needs annually and choose the Medicare plan that best fits their circumstances.