Medicare in West Virginia
Find affordable Medicare plans in West Virginia
Whether you’re turning age 65 and looking into Medicare, or already a Medicare beneficiary, you may be interested to know that 425,572 people in West Virginia had Medicare coverage as of January, 2017. That’s according to the Centers for Medicare & Medicaid Services (CMS), which reports that over 57 million people were enrolled in Medicare nationwide as of the same month. These Medicare beneficiaries chose their coverage from a variety of Medicare plan options that may be available to you as well.
Here’s an overview of the primary Medicare coverage options in West Virginia.
- Original Medicare: When you first become eligible for Medicare coverage, you’re usually automatically enrolled in Original Medicare, the federal program. Original Medicare consists of two parts – Part A (hospital insurance) and Part B (medical insurance). Medicare covered services under Part A generally include medically necessary treatment of conditions and injuries in the hospital, in skilled nursing facilities, and in certain circumstances at home (usually for a limited time if at all). Part B coverage may include certain preventive care benefits at no cost to you when provided by Medicare-assigned health professionals.
- If you’re already receiving Social Security or Railroad Retirement Board benefits when you become eligible for Medicare, in most cases you will be automatically enrolled in Original Medicare. If you or your spouse worked at least 10 years (40 quarters) while paying taxes, you typically pay no premium for Part A – but most people pay a monthly premium for Part B coverage. Typically you pay deductibles and coinsurance for Part A and Part B covered services.
- If you decide to stay with Original Medicare Part A and Part B coverage, you can apply for a Medicare Supplement (Medigap) plan to work alongside your Original Medicare coverage. Medicare Supplement plans are offered by private insurance companies and can help you pay for out-of-pocket costs for services covered under Medicare Part A and Part B. You typically pay a monthly premium for a Medicare Supplement plan, and must continue to pay your Part B premium.
- If you have Original Medicare Part A and/or Part B, you can enroll in a stand-alone Medicare Part D Prescription Drug Plan to help pay your prescription drug costs. Original Medicare provides coverage only for medications in very limited circumstances—medications provided as part of your inpatient hospital care, or physician-administered medications such as chemotherapy or infusions, for example. Twenty-four stand-alone Medicare Part D Prescription Drug Plans are available in West Virginia in 2017, reports the Center for Medicare & Medicaid Services (CMS). These Medicare Part D Prescription Drug Plans are offered by private insurance companies contracted with Medicare to provide prescription drug coverage to eligible Medicare beneficiaries who reside in the plan’s service area.
- You may prefer to receive your Medicare benefits from a private insurance company rather than the federal government-sponsored program. Medicare Advantage plans are offered by private insurance companies that contract with Medicare. Their benefits include all of your Medicare Part A and Part B benefits except hospice care, which Medicare Part A continues to cover. Many Medicare Advantage plans also include extra benefits such as routine dental, vision and fitness care. A number of Medicare Advantage plans provide prescription drug coverage as well, letting you get all of your Medicare benefits through a single plan.
- Medicare Advantage plans sometimes contract with local health-care providers to provide health services to members enrolled in their plans. Therefore, it is important that you understand whether the Medicare Advantage plan you are considering has a network of participating providers and if so, if your doctors and preferred hospitals are participating in the network. Premium costs vary among these plans and may be as low as $0. Remember, you will need to continue to pay your Medicare Part B premium as well as the Medicare Advantage plan premium, if any.
To identify the plans that are available in your area, you’re welcome to enter your zip code where indicated on this page to get started.
Medicare resources in West Virginia
To help West Virginia residents understand their Medicare options, the state offers a variety of free services and programs through local agencies such as:
West Virginia Bureau of Senior Services: provides information and resources from transportation to meals to exercise classes to in-home services.
West Virginia SHIP and SMP: SHIP stands for State Health Insurance Assistance Program and its goal is to provide reliable and up-to-date information to Medicare beneficiaries and their families. SMP stands for Senior Medicare Patrol and its goal is to provide outreach and education about how to detect and report Medicare fraud.
Medicare statistical trends in West Virginia
Here are some facts and trends regarding Medicare in West Virginia, according to the Centers for Medicare & Medicaid Services (CMS).
- Among West Virginians who had Medicare prescription drug coverage in 2016, 86% have access to a plan in 2017 that has a lower premium than the premium they paid in 2016. In 2017 the lowest premium for a Medicare Part D Prescription Drug Plan is $14.60.
- 298,703Medicare beneficiaries residing in West Virginia are enrolled in stand-alone Medicare Part D Prescription Drug Plans and Medicare Advantage Prescription Drug plans as of January 2017.
- 305,610 West Virginians were enrolled in Original Medicare in 2016; during the same year 117,211 people were enrolled in Medicare Advantage and other Medicare plans offered.
- Enrollment in Medicare Advantage plans increased by 5% from 2012 to 2016—from 23% of the total number of West Virginian Medicare beneficiaries. In 2017 100% of Medicare beneficiaries in West Virginia have access to at least 1 of the 24 Medicare Advantage plans available in the state.
- 68% of people with prescription drug coverage signed up with stand-alone Medicare Part D Prescription Drug Plans in 2016. 32% of people chose to receive their Part D prescription drug coverage through a Medicare Advantage Prescription Drug plan that combined medical and prescription drug coverage. Enrollment in Medicare Advantage Prescription Drug plans has increased steadily during the past five years.
Statistical data from the Centers for Medicare & Medicaid Services, “2016 MA Part D Landscape State-by-State Fact Sheet,“ September 22, 2016 and “Medicare Dashboard,“ Office of Enterprise Data & Analytics (OEDA), April 2017.
Data in this article was checked when the article was written and might not be updated as newer data becomes available.
This website and its contents are for informational purposes only. Nothing on the website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.
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