Medicare in West Virginia
Key Takeaways
- Original MedicareOriginal Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). in West Virginia features hospital (Part A) and medical (Part B) coverage with the option of adding drug and supplemental coverage.
- Most people are eligible at age 65, which opens the door to Medicare AdvantageMedicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). plans that replace Original Medicare while offering additional benefits like dental and vision.
- Medicaid in West Virginia covers similar benefits, but eligibility is based on need regardless of age.
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How Do I Apply for Medicare in West Virginia?
Your options for applying for Medicare in WV include:
- Enrolling online with the Social Security Administration.
- Visiting a local Social Security office.
- Enrolling over the phone at 1-800-772-1213 (TTY: 1-800-325-0778).
Once enrolled in Original Medicare, you have the option of switching to a Medicare Advantage (Part C) plan in West Virginia.
If you decide to stay enrolled in Parts A and B, you have the option to add Part D to cover your prescription expenses. You may also choose to add Medigap, (another name for Medicare Supplement insurance) that helps fill in the gaps in out-of-pocket costs like copays and coinsurance. Most Medicare Advantage plans also include drug and supplemental coverage.
Find the Medicare Plan that works for you.
Who Is Eligible for Medicare in West Virginia?
If you’re a U.S. citizen or permanent resident of at least five years and are age 65 or older, you qualify for Medicare in West Virginia. You’re also eligible regardless of your age if:
- You have end-stage renal disease or Lou Gehrig’s disease (also known as amyotrophic lateral sclerosis or ALS).
- You have received 24 monthly payments of Social Security Disability Insurance or Railroad Board benefits.
What Is the Income Limit to Receive Medicare?
Your income isn’t a factor in your ability to sign up for Medicare plans in West Virginia (it’s a different story with Medicaid).
If you or your spouse has worked at least 10 years, you don’t have to pay a monthly premium for Part A.
For Part B, higher-income earners may have to pay more than the standard premium. In 2025, the monthly premium for Part B is $185 for anyone with an individual income under $103,000 on their 2023 tax return.
Ready for a new Medicare Advantage plan?
Who Is Eligible for Medicaid in West Virginia?
Each state has its own policies for administering Medicaid, a federal/state program founded alongside Medicare in 1965 that helps those facing a financial need and/or disability regardless of age.
The state of West Virginia oversees the Medicaid program for the state’s residents, offering coverage to all individuals in need with some programs geared toward children and pregnant women. If you’re living with a limited income and have trouble affording healthcare, see if you qualify for Medicaid in West Virginia.
What Is the Average Cost of a Medicare Advantage Plan?
According to the Centers for Medicare & Medicaid Services, the average monthly premium for a Medicare Advantage plan in 2024 is $20.90.
Every Medicare Advantage plan in West Virginia must offer, at least, the same level of coverage as Original Medicare Parts A and B. Most people on Medicare Advantage plans won’t pay a monthly premium for Part A, but they will still be responsible for the standard monthly premium for Part B.
Medicare Advantage and Original Medicare have different coverage areas. You can use Original Medicare nationwide, but Medicare Advantage is limited to a provider network. The limited network allows Medicare Advantage in West Virginia to offer more affordable options.
What Is the Best Medicare Plan?
In the case of Original Medicare, there’s only one plan, Parts A and B, which does open the option to add Part D and Medigap coverage from private insurance companies.
In the case of Medicare Advantage in West Virginia, there are many plans.
- Some Medicare Advantage plans mirror Original Medicare but are more affordable.
- Some Medicare Advantage plans include options for dental, vision and hearing coverage.
- Some Medicare Advantage plans offer assistance with transportation costs or over-the-counter needs.
- Some may offer all of the above!
My Medicare coverage doesn’t address all of my needs.
Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 427,400 people are enrolled in Medicare Part A and B in West Virginia. The total number of beneficiaries enrolled in Medicare Advantage increased from 157,857 to 176,831 year over year. Medicare Advantage participation in West Virginia went from 37.30% to 41.37% year over year. If you’d like to dive deeper into how Medicare in West Virginia breaks down across the state, we provide a glance at who is using Medicare and how.
427,400 Beneficiaries with Part A & Part B
176,831 Medicare Advantage Beneficiaries
41.37% Medicare Advantage Participation Rate
52.41% Female
47.59% Male
95.27% Non-Hispanic White
2.55% African American
0.52% Hispanic
1.65% Other/Unknown
23.93% Eligible for Medicaid
1.01 Average HCC Score
$9,468.11 Actual Per Capita Costs
19.79% Hospital Readmission Rate
29.70% % of Beneficiaries with an Emergency Department Visit
157,857 Medicare Advantage Beneficiaries, Previous Year
Increased Medicare Advantage, Year over year
37.30% Medicare Advantage Participation Rate, Previous Year
Table reflects the latest Beneficiary Demographics Data: Medicare Geographic Variation – by National, State & County
Average HCC Score: The Hierarchical Condition Category score gauges a population’s overall health. The score is based on a value of 1.0. Populations with an HCC score of less than 1.0 are considered relatively healthy. The score can be used to estimate health costs.
WV SHIP AND SMP - Medicare Counseling
http://www.wvship.org/AboutWVSHIPandSMP/tabid/132/Default.aspx
What should I know about WV SHIP and SMP?
The State Health Insurance Assistance Program and the Senior Medicare Patrol offer free Medicare guidance and monitoring.
West Virginia Bureau for Children and Families
Phone lines open M-F, 8 a.m. to 5 p.m.
https://dhhr.wv.gov/bcf/Services/familyassistance/Pages/Medicare-Premium-Assistance-Programs.aspx
What should I know about the Bureau for Children and Families?
This department administers Medicare Premium Assistance Programs (aka Medicare Savings Programs) for West Virginia residents in need.
West Virginia Bureau of Senior Services
http://www.wvseniorservices.gov/
What should I know about the West Virginia Bureau of Senior Services?
From assistance with transportation to meals, the bureau aims to be “West Virginia’s premier advocate for seniors.”
West Virginia Bureau of Medical Services
https://dhhr.wv.gov/bms/Pages/default.aspx
What should I know about the West Virginia Bureau of Medical Services?
Administers the state’s Medicaid program for West Virginia residents.
Nationwide Resources
Speak with a GoHealth insurance agent that is licensed in West Virginia about your Medicare questions.
Mon – Fri, 8 a.m. – 6 p.m. CT
Centers for Medicare and Medicaid Services
You can reach the Social Security Administration by phone for general questions. Not all questions can be answered over the phone.
Also, SSA.gov provides online resources for the following: Review information, apply for benefits, or manage your account online
1-800-722-1213
TTY 1-800-325-0778
Speak to SSA Representative, Monday – Friday, 8 AM – 7 PM ET
Medicare Learning Guides
Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.
Before 65 Guide
Understanding health insurance before age 65, especially when considering early retirement
Medicare Plans Guide
Costs, coverage and enrollment details for each Medicare plan
Medicare Beneficiary Guide
For those currently enrolled in Medicare
Low Income and Medicare Guide
For individuals with a qualifying income status
A Caregiver's Guide
For individuals with a qualifying income status
Sources
- Apply for Benefits. SSA.gov.
- Social Security Office Locator. SSA.gov.
- Costs. Medicare.gov.
- Poverty Guidelines. HHS.gov.
This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money.
Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.