Medicare Advantage Plans in West Virginia

Medicare Advantage Plan Eligibility and Enrollment in West Virginia

If you’re eligible for Original Medicare, you’re eligible for Medicare Advantage in West Virginia.

To be eligible for Medicare you must be a U.S. citizen or permanent legal resident who has lived in the U.S. for at least five continuous years. Once you meet this requirement, you may qualify for Medicare if at least one of the following is true:

• You are 65 or older
• You have a disability
• You have amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease)
• You have end-stage renal disease (ESRD)

Most Medicare beneficiaries in West Virginia first become eligible when they turn 65. In addition to age, you must meet one of these requirements:

• You’re already receiving, or are eligible to receive, retirement benefits from either Social Security or the Railroad Retirement Board
• You or your spouse had Medicare-covered government employment

If you have a disability, you can get a Medicare Advantage plan in West Virginia no matter your age. As with Original Medicare, you may qualify for Part C before 65 if:

• You’ve been entitled to receive disability benefits from either Social Security or the Railroad Retirement Board for at least 24 months.
• You have ALS. Living with ALS typically means you can get Medicare starting the first month you receive disability benefits.
• You have ESRD; you can get Medicare if you’re currently on dialysis, or are a kidney transplant patient.

There are several enrollment periods in West Virginia when you can get a Medicare Advantage plan:

Initial Enrollment Period (IEP) – If you’re enrolling in Medicare due to age, the IEP is your first chance to sign up for Medicare. You can enroll at any time during the seven-month period that starts three months before you turn 65 and ends three months after.

If you have ALS, this period starts after 24 months of being eligible for, or having received, disability benefits from either Social Security or the Railroad Retirement Board.

If you have ESRD, this period can begin the first day of the fourth month that you start getting dialysis treatments. If you sign up later, your coverage may be retroactive.

Medicare Open Enrollment Period  – In West Virginia you can join, switch, or drop a plan during this time, also called the Annual Enrollment Period, which runs from October 15 to December 7 each year.

Medicare Advantage Open Enrollment Period – If you have already enrolled in a Medicare Advantage plan, you will be able to switch to a different Part C plan once during Medicare Advantage Open Enrollment.

During this enrollment period you can also choose to switch from a Medicare Advantage plan to Original Medicare, plus add a Medicare prescription drug (Part D) plan. It’s important to note that this process doesn’t work in reverse; if you have Original Medicare, you can’t switch to a Part C plan during this timeframe. Medicare Advantage Open Enrollment runs from January 1 to March 31 each year.

Special Enrollment Period – Special enrollment periods are triggered by events that affect your current health insurance. You can sign up for a Medicare Advantage plan if you lose your current insurance, or if you move and your current plan doesn’t provide coverage for your new location. In some instances your plan may no longer be available where you live. If this occurs, a special enrollment period will be triggered and you’ll be able to enroll in a Part C plan.