Compare Medicare Advantage plans and quote side-by-side to get the best rate here.
Before choosing your health insurance coverage, it’s important to understand the options that are available to you. Read on for Benzinga’s guide to finding the best West Virginia Medicare insurance.
The Best Medicare in WV:
- Best Overall in WV: Humana
- Most Affordable in WV: Aetna
- Best for Low Copays: UnitedHealthcare
- Best for Unique Benefits: Highmark Inc.
- Best for Plans Without Drug Coverage: The Health Plan
What is Medicare?
Medicare is a health insurance program offered and regulated by the federal government. You may qualify for Medicare if you:
- Are 65 or older
- Have been diagnosed with a qualifying disability
- Need dialysis or a transplant due to end-stage renal disease
Medicare’s health insurance coverage is a bit different than your other options. There are a few parts of Medicare that you can choose from to customize your coverage options.
Part A: This part of Medicare is designed to cover your hospital-related needs. It covers in-patient hospital stays, hospice care and care in a skilled nursing facility. If you need home health care, you may be able to use this coverage for that as well.
Part B: Part B is what you will use for your other medical needs. It covers preventive care, outpatient care, medical supplies and other types of medical services.
Part C: Part C of Medicare offers an alternative where you can bundle the other parts of Medicare. These plans are referred to as Medicare Advantage plans.
Part D: Part D covers your prescription drugs. This is offered as a supplemental plan that you can add to your Original Medicare (Part A or Part B) policy. If you select a Medicare Advantage plan, it may already include Part D coverage.
Legalities of Medicare in West Virginia
Medicare is regulated by the federal government. If you enroll in an Original Medicare plan, you should be able to see any doctor that accepts Medicare insurance.
If you decide to choose a Medicare Advantage plan, you should be aware that these plans are not regulated by the government. Medicare Advantage plans are offered by private insurance companies. Each Medicare Advantage plan has to undergo approval from Medicare.
Medicare Advantage plans can restrict the doctors, specialists and hospitals that are covered by your health insurance policy. It may also require you to receive a referral from your primary care doctor before it will cover visits with a specialist.
Some Medicare Advantage plans may include Medicare Part D prescription drug coverage. These plans can restrict the drug coverage that you receive. Your Medicare Advantage plan may only cover generic drug treatments, for example.
If you have a Medicare Advantage plan, you will be unable to also carry a Medicare Supplemental Insurance plan.
Types of Medicare Advantage Plans
When you choose a health insurance plan, you should be familiar with the different types of plans. Like most types of health insurance, Medicare Advantage plans are available in many different plan types. Here’s a quick review of the 2 most common plan types.
HMO: Health maintenance organization (HMO) plans include both Part A and Part B of your Medicare insurance. Some HMO plans may also include Part D prescription drug coverage as well as vision, dental and hearing benefits.
If the health insurance company you select offers a Medicare Advantage HMO plan, it will come with its own network of providers. HMO plans only cover visits with in-network medical service providers. These plans may also require a referral from your in-network primary care doctor before it will extend coverage to a specialist visit.
PPO: Preferred provider organization (PPO) plans also include both Part A and Part B of Medicare. These plans may also include Part D of Medicare, vision, hearing and dental benefits.
PPO plans also come with a network of participating providers, however, you aren’t restricted to the providers within its network. The benefit of visiting an in-network provider with your PPO plan is that you will likely pay less than you would if you visit an out-of-network provider. PPO plans also typically do not require a referral from your primary care doctor before it offers coverage for a specialist visit.
When you compare Medicare Advantage plans, there are a few key terms that will help you understand the true cost of your insurance plan:
Deductible: Every health insurance plan comes with a deductible. The deductible is the amount of money you must pay for covered services out-of-pocket before your health insurance company will cover your medical bills.
Coinsurance: After you meet your deductible, you will still need to pay some amount out of pocket. If your plan requires coinsurance payments, this will be a percentage of each covered medical bill that you must pay. Since coinsurance is a percentage, the actual dollar amount you pay for your visits will depend on how much your provider charges. Your health insurance company will pay the provider the remaining percentage of your bill directly.
Copay: Some plans may require copays instead of coinsurance. Copays are a set dollar amount that you pay out of pocket for your covered medical services after you have met your deductible.
Premium: Your premium is the amount of money you must pay each month to keep your health insurance active.
Out-of-pocket maximum: Your plan will also list an out-of-pocket maximum. This is the maximum amount that the insurance company requires you to pay for your covered medical expenses. Each time you pay out-of-pocket for a covered service, it will count toward your out-of-pocket maximum. After you’ve met the maximum, your insurance company will pay 100% of your covered medical costs for the remainder of your plan year.
How to Sign Up for Medicare in WV
To sign up for Medicare Part A or Part B in West Virginia, you can:
- Enroll online.
- Call Social Security Monday through Friday from 7 a.m. to 7 p.m. at 800-772-1213.
- Enroll in person at your local Social Security office.
You will follow a different process if you choose to sign up for a Medicare Advantage plan. First, you’ll need to find the plans available in your area. Medicare Advantage plans vary by state and county, so you’ll want to be sure to put in your home ZIP code to find the ones available to you.
If you find a Medicare Advantage plan that you would like to enroll in, you can:
- Visit the insurance company’s website to see if you are able to enroll online.
- Request a paper enrollment form by contacting the insurance company.
- Enroll by phone by calling 800-MEDICARE (800-633-4227).
Average Cost of Medicare Advantage Plans
When you review your Medicare Advantage plan options, you’ll want to carefully consider all of the factors. Costs for Medicare Advantage plans can vary from company to company and plan to plan. To understand the true cost of each plan, pay close attention to the terms we reviewed above.
|Plan Name||Company||Plan Type||Health & Drug Costs|
|Aetna Medicare Advantage Credit Value||Aetna Medicare||PPO||$0|
|Humana Gold Plus H5619-113||Humana||HMO||$36|
|Freedom Blue PPO Distinct||Highmark Inc.||PPO||$300|
|AARP Medicare Advantage Choice Plan 1||UnitedHealthcare||PPO||$326|
|The Health Plan SecureCare Capitol Plan||The Health Plan||HMO||$468|
Best Medicare Insurance Providers in West Virginia
If you’re considering a Medicare plan, you’re probably wondering how Medicare Advantage insurance providers compare. Benzinga has put together quick overviews of some of the insurance providers available in West Virginia.
1. Best Overall in WV: Humana
Humana is one of our top choices for Medicare Advantage plans. This company has been offering Medicare Advantage plans since the Medicare program began. Over this time, Humana has built up a large network of reputable doctors and hospitals across the country.
Humana offers a few different plan types to fit your health insurance needs. Humana’s Medicare Advantage plans may also include additional benefits, such as telehealth services.
2. Most Affordable in WV: Aetna
Aetna offers a variety of affordable Medicare Advantage plans. Each plan can offer you affordable coverage in different ways, which allows you to select the option that best fits your needs. You may be able to choose from an Aetna plan with $0 health plan and drug deductibles.
This plan comes with a higher premium, but it can be a great choice for someone who regularly visits the doctor and would like to be able to avoid the out-of-pocket costs before meeting their deductible. Aetna also offers plans with $0 premiums. These plans come with drug deductibles but allows you to save on your monthly premium costs.
This can be a good option for someone who doesn’t need to visit the doctor often. Whatever your needs are, Aetna can likely offer you an affordable health insurance plan.
3. Best for Low Copays: UnitedHealthcare
If you visit your doctor’s office often, you’ll probably want to find a plan that will take the least amount of money out of your pocket. UnitedHealthcare offers Medicare Advantage plans with health plan deductibles as low as $0.
This means you will be able to skip the part where you pay for your medical visits completely out of pocket. It also offers copays as low as $0. While you will likely need to pay a higher monthly premium, you may be able to spend $0 out of pocket for each visit with your primary care doctor.
4. Best for Unique Benefits: Highmark Inc.
When choosing your health insurance plan, keep an eye out for the unique benefits that each insurance company can offer. Highmark Inc. offers the usual benefits with its Medicare Advantage plans — vision, hearing, dental coverage and even fitness benefits. These plans can also offer additional benefits that may come in handy.
One of the unique benefits Highmark Inc. offers is coverage for home safety device and modification. If you need to add safety devices to your home, this will help offset the costs of these modifications. Grab bars and wheelchair ramps are just some of the home safety devices you may be able to receive coverage for.
5. Best for Plans Without Drug Coverage: The Health Plan
Some people choose Medicare Advantage plans because they like to have their hospital insurance, medical insurance and drug coverage all rolled into one plan. But what if you don’t need Medicare Part D plans?
If you want to enroll in a Medicare Advantage plan but don’t need drug coverage, The Health Plan may be the company for you. It offers a Medicare Advantage option without drug coverage. This allows you to benefit from rolling your hospital and medical insurance together without the extra cost of drug coverage.
The Right Medicare Option
The best Medicare option is the one that offers the coverage you need. Consider the premium payments, deductibles and the networks each insurance provider offers. These factors can help you decide which plan is right for you.
Frequently Asked Questions
Medicare has 4 parts named Parts A, B, C, and D. Part A provides hospitalization coverage while Part B provides outpatient coverage, like doctor visits. Parts A and B make up Medicare’s core coverages. Part C is provides private-market Medicare plans, called Medicare Advantage Plans. Part C coverage often includes additional benefits. Medicare Part D provides coverage for prescription drugs. Get a Medicare Insurance Quote through the top providers here.
Because there are 4 parts to Medicare, there can be different cost structures. Most people won’t have to pay for Medicare Part A (hospitalization). Eligibility for premium-free Part A is based on your work history during which you paid Medicare taxes. Many people do pay a monthly premium for Medicare Part B, however, which covers outpatient medical services, like doctor visits. Deductibles also apply to services covered under Medicare Parts A and B, so you’ll pay a part of the annual cost.
Medicare Parts C and D are optional coverages and have premium costs of their own. Medicare Part C refers to Medicare Advantage Plans that offer additional coverage in exchange for a monthly premium. Part D, the prescription plan, reduces the cost of medications but also requires a monthly premium. Subsidies may be available for low income households to help reduce overall Medicare costs.
If you signed up for Social Security before age 65, you were enrolled in Medicare automatically but benefits will begin at age 65. In most cases, there are penalties for not enrolling at age 65, so it pays to sign up on time. Click here to get a medicare quote in minutes from the best providers.
If you have employer coverage, you may be able to delay Medicare coverage while your work plan is still in force. However, the size of the employer determines whether you’ll pay a penalty for not enrolling at age 65. Employees (and their spouses) of companies that offer group health insurance to 20 or more people are usually exempt from late sign-up penalties if they are covered by the employer’s plan.