It’s no secret that keeping up with health and wellness visits to the doctor improves your quality of life. Whether you’re employed, self-employed or between employment, you can get health insurance in West Virginia. The first thing you need to do is understand health insurance.
Get Health Insurance in WV
Tip: compare 2-3 providers
The Best Health Insurance in WV
- Best Overall in WV: Highmark BCBS West Virginia
- Most Affordable in West Virginia: CareSource Health Insurance
- Best Customer Service: Golden Rule Insurance Company
- Best for Claims: AgileHealthInsurance
- Best for Veterans: National General
- The Best Health Insurance in WV
- What is Health Insurance?
- Average Cost of Health Insurance in West Virginia
- Types of Health Coverage
- What Does Health Insurance Cover?
- What Does Health Insurance not Cover?
- 5 Best Health Insurance Providers in WV
- Get the Best Health Insurance in WV
- Frequently Asked questions
What is Health Insurance?
Insurance is all about absorbing risk. For instance, health insurance takes on your risk if you fall and break your arm as you hike in the Appalachians or if you come down with the flu. It covers your costs if these things do happen. Health insurance also offers preventive care — which can help you avoid disease or illness.
For example, let’s say you’re at your annual exam and your doctor finds that your cholesterol is high. The doctor might recommend that you do certain things to help lower your cholesterol to prevent heart disease. Immunizations, such as the flu vaccine, are also considered preventive care.
You pay a monthly amount as well as certain deductibles and copays for medical services and visits. Ultimately, you’re not on the hook for the entire bill — for surgery, hospital stays, medications and follow-up visits.
Average Cost of Health Insurance in West Virginia
The average premiums in West Virginia for 2019 is $937 per month, according to HealthInsurance.org. However, depending on your yearly income, you can qualify for subsidies. Those subsidies bring the cost down to an average of $768 per month. Even if you don’t qualify for subsidies, you can still get the best cheap health insurance. Let’s get to know the types of health insurance.
Types of Health Coverage
There are 2 kinds of health insurance providers: Private insurance and government-subsidized providers. You can choose from many types of plans. Let’s take a look so you understand the type of coverage you can get with the 3 best health insurance companies.
- Health maintenance organizations (HMOs): The main factor in an HMO is that you choose a primary care physician (PCP). HMOs usually fund treatment referred by your PCP if you need specialized care. Fees are negotiated upfront to keep costs low.
- Preferred provider organizations (PPOs): PPOs are more flexible than HMOs. You can visit any doctor you prefer. PPOs negotiate costs with a network of approved providers. You’ll pay less for treatment if you use an in-network provider but you can still use an out-of-network provider. You don’t need a referral from your PCP to visit a specialist.
- Exclusive provider organization (EPO): An EPO is more restrictive than an HMO or PPO because you’re confined to one network. You must use doctors and hospitals within that network for coverage. Going outside of the network for care means you won’t be able to use your benefits.
- Point-of-service (POS) plans: A POS plan is a mix of HMO and PPO plans. You choose an in-network physician to be your PCP. You can choose to go out of network, but your costs will increase. However, you won’t pay extra if your PCP refers you to a provider that’s outside the network.
- Managed care plan: The insurance company contracts with a network of health care providers to give you access to lower-cost medical care. Choosing out-of-network hospitals and clinics results in penalties and added fees to your plan.
- Indemnity or fee-for-service plan: You choose your place of treatment with a fee-for-service plan. Expect to pay about 20% of your health-related costs.
What Does Health Insurance Cover?
In the United States, health insurance providers must follow a minimum standard of coverage. Here is a list of care and service elements that all health insurance providers must cover.
- Outpatient care
- Emergency services
- Hospitalization and surgery
- Pregnancy, maternity and newborn care
- Psychotherapy and substance abuse services
- Prescription drugs
- Rehabilitative services
- Preventive and wellness care
- Full pediatric services
What Does Health Insurance not Cover?
Not every medical-related item falls under health insurance coverage mandates. Some plans do include these in their coverage, though many do not. If you know that you need these services, you’ll want to look into supplemental insurance. Services health insurance typically doesn’t cover include:
- Adult dental
- Adult vision
- Pain management
- Long-term care
- Alternative medicine
- Cosmetic procedures
- Weight-loss surgery
- Infertility treatments
- Private nursing
5 Best Health Insurance Providers in WV
Now that you know more about the types of plans and what health insurance covers and doesn’t cover, it’s time to review the best health insurance providers in West Virginia. Highmark, Caresource and UnitedHealthcare are the 3 largest providers in West Virginia, according to the Kaiser Family Foundation.
Provider size does matter because it’s indicative of your ability to easily access quality care. Here are the 5 best companies for health insurance in WV.
1. Highmark BCBS West Virginia
At 68% market share, Highmark Blue Cross and Blue Shield is the largest health insurance provider in West Virginia. Highmark offers health insurance through an EPO, which means that you must stay in-network for care.
Plans for a 25-year-old female start at $405 per month and top out at $745 per month. Highmark’s 2020 plans include $0 prescriptions for common medications, 2 free PCP visits and 2 free mental health and substance abuse visits. Many plans also include free online doctor visits via telemedicine, preventive screenings and wellness exams, free immunizations and vaccinations and free contraceptives.
2. CareSource Health Insurance
CareSource offers affordable health plans through the Health Insurance Marketplace. CareSource is the second-largest health insurance provider in WV and earns an A+ rating by the BBB.
CareSource offers its members “real, affordable health insurance that covers the health care you need, when you need it.” The company covers people with preexisting conditions. A 25-year-old female can find plans starting at $474 per month to about $712 per month. CareSource covers the essential health benefits with options for dental, vision and fitness plans.
3. Golden Rule Insurance Company
Golden Rule Insurance is part of UnitedHealthcare. The company offers short term health insurance (30 days to 3 months) and tri-term health insurance (up to 36 months over 3 terms). Short term insurance is a good option if you’re between jobs or waiting for a new employer’s insurance to kick in.
Tri-term is a good option if you need insurance for longer than 3 months, you’re self-employed and/or don’t receive benefits through your employer. Short term insurance starts at about $40 per month and runs up to about $280 per month for a 25-year-old female. Tri-term insurance begins around $110 per month and stretches to about $200 per month. The BBB gives Golden Rule an A+ grade.
AgileHealthInsurance offers a comprehensive and simple-to-use platform for comparing the private health plan options such as short term health insurance and indemnity insurance.
Plans are cheap, at $44 per month, for a 25-year-old female. The most expensive plan runs about $525 per month. Agile pulls plans from Aspen, Companion Life, Everest, Everest Prime, LifeShield, National General and Standard Life in West Virginia. Agile gets an A rating from the BBB and is a consumer-friendly option that offers learning resources so you can make an informed decision.
5. National General
Formerly GMAC Insurance, National General offers PPO health insurance plans to West Virginia residents. Plans run from approximately $42 per month to $236 per month.
A majority of the plans offered for a 25-year-old female did not include prescription drug coverage. Known for its flexibility, you can choose the plan that fits your budget and lifestyle. Plans with lower monthly premiums come with higher deductibles. The opposite is also true — plans with higher monthly premiums come with lower deductibles. The BBB gives National General an A+ rating. Customer reviews on the site give it 3.5 out of 4 stars.
Get the Best Health Insurance in WV
The only health insurance pick for you is the one that fits your needs and your budget. Research the different plans available in your area. How accessible are services? Are a high quantity of affiliated doctors located nearby? Consider what you want and need from your health insurance plan and find the best one for you.