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Are you considering enrolling in a Medicare Advantage plan in West Virginia? You're in good company. In 2023, more than 31 million people are expected to get a private Medicare health plan. Some want lower costs. Some are looking for more benefits. Others need access to more healthcare providers and doctors.
2024 Medicare Advantage Plans for West Virginia Beneficiaries
Be the first to know. Sign-up for 2024 Medicare Advantage plan notification HERE. The 2024 Medicare Part C information will be available in early October.
What are the Best Medicare Advantage Plans in West Virginia?
If you’re looking for the best Medicare Advantage plans available in your West Virginia community, that suit your individual needs, MedicareWire is here to assist. Using the overview of the West Virginia market below, and our other online tools, you will get a clear understanding of your top plan options, who the top-rated plan providers are, and how much you should expect to pay each month for a plan.
Table of Contents
- Medicare Advantage Plans are available to U.S. citizens and legal U.S. residents living in West Virginia who are enrolled in Original Medicare.
- Insurance plans are offered by private health insurance companies and provide an alternative way to receive Medicare benefits in your West Virginia County.
- Medicare Advantage Plans in West Virginia are required to provide at least the same benefits as Original Medicare, but they may also provide additional benefits such as vision, dental, and hearing coverage.
- Plans may also offer prescription drug coverage, which is not available with Original Medicare. A stand-alone Medicare Part D plans available in West Virginia can be added if the health plan does not include Part D.
- Medicare Advantage Plans in West Virginia may have different cost-sharing requirements than Original Medicare, such as copayments, coinsurance, and deductibles. Be sure to compare plans, including prices, quality and affordable out-of-pocket costs, to determine the best Medicare insurance for your situation.
- Medicare Advantage Plans in West Virginia may also have different provider networks than Original Medicare, so it is important to make sure that your preferred doctors and hospitals are in-network.
- Medicare Advantage insurance has specific open enrollment periods. Unlike Medicare Supplement plans, you cannot join, switch, or drop a plan outside of an enrollment period.
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Who Has The Best Plans in West Virginia?
Each year, the Centers for Medicare & Medicaid Services (CMS), reviews and rates West Virginia's Medicare Advantage plans based on a 5-star scale. The information used to create a plan's star rating comes from member input and data reported by the plan.
West Virginia has 5-star Medicare Advantage plans available in 2023. Not all states and locations do. This year, the highest rated Medicare plans available in West Virginia come from:
MedicareWire recommends evaluating plans from these West Virginia health insurance companies first. Why? Because more stars mean a better plan. For instance, members may get better care, customer service, and phone support from a 5-star plan than from a 4-star one.
IMPORTANT: Depending on where you live in West Virginia, Medicare Advantage plans may have many valuable benefits (as compared to Original Medicare). But, before you choose, it's crucial that you understand the potential disadvantage of Medicare Advantage plans, as well as Medigap vs Advantage plans. Compare coverage and costs with care to find the plan best suited to your health and financial needs.
Complete List of West Virginia's 2023 Providers
West Virginia has 6 providers that offer Medicare Advantage plans. They include:
- Aetna Medicare
- Lasso Healthcare
- The Health Plan
West Virginia's Top-Rated Plans in 2023
Here are the top-ranked 2023 Medicare Advantage plans in West Virginia, according to the Centers for Medicare & Medicaid Services:
Top Medicare Advantage Plans in West Virginia
|Provider||Plan ID||Plan Name||Premium||Limit||Stars|
|Highmark||H5106-029||Freedom Blue PPO Distinct (PPO)||$33.00||$6,500||5.0|
|Highmark||H5106-031||Freedom Blue PPO Merit (PPO)||$0.00||$8,300||5.0|
|Highmark||H5106-032||Freedom Blue PPO Prestige (PPO)||$48.00||$6,000||5.0|
|Highmark||H5106-030||Freedom Blue PPO Signature (PPO)||$0.00||$7,550||5.0|
|Highmark||H5106-013||Freedom Blue PPO Standard (PPO)||$163.00||$6,500||5.0|
|Humana||H5216-124||HumanaChoice H5216-124 (PPO)||$136.00||$6,700||4.5|
|Humana||H5216-182||HumanaChoice H5216-182 (PPO)||$18.00||$6,700||4.5|
|Humana||H5216-327||HumanaChoice H5216-327 (PPO)||$0.00||$7,200||4.5|
|Humana||H5216-328||HumanaChoice H5216-328 (PPO)||$0.00||$7,550||4.5|
|Humana||H5216-021||HumanaChoice H5216-021 (PPO)||$44.00||$5,500||4.5|
|Humana||H5216-052||HumanaChoice H5216-052 (PPO)||$47.00||$6,700||4.5|
|The Health Plan||H3672-020||The Health Plan SecureCare - Option II (HMO)||$33.00||$6,700||4.5|
|The Health Plan||H8604-011||The Health Plan SecureChoice - Option II (PPO)||$113.00||$6,700||4.5|
|The Health Plan||H3672-023||The Health Plan SecureCare Capitol Plan (HMO)||$0.00||$6,700||4.5|
|The Health Plan||H8604-013||The Health Plan SecureChoice Capitol Plan (PPO)||$78.00||$6,700||4.5|
Interested in joining a plan from one of the top-rated providers? That has a lot to do with your West Virginia County. Medicare Advantage plans are regional, and you can't join a plan that isn't in your area.
Best Plans in West Virginia by County
Choose your West Virginia County below to see the best (and the worst) 2023 plans.
For fast, friendly assistance call 1-855-728-0510 (TTY 711) .
How to Choose the Best Plan in West Virginia
If you’re approaching the age of 65, navigating a special enrollment event, or looking to review your plan options ahead of the Annual Enrollment Period, there are a number of details you need to consider when comparing your options.
1. Consider Your Expected Utilization
Do you believe that you will get the most out of your plan's benefits, including hospital inpatient care? If you do, evaluate plans with higher monthly premiums, low copayments, and low maximum out-of-pocket limits. Conversely, if your health is good and you rarely use services, look for plans with low premiums or a zero-dollar premium. These plans may have high out-of-pocket maximums and high deductibles, so weigh your risk carefully.
2. Evaluate Your Prescription Costs
For many seniors, prescription drugs are what drive up their healthcare costs the most. And, because most Medicare Advantage plans include Part D benefits for your regular prescriptions, you need to make sure the plan you choose covers your drugs at a price you can afford.
3. Understand Your Additional Coverage Needs
Original Medicare does not all health care costs. It covers your major medical and some preventive care services, but it does not cover dental, vision, hearing, or prescriptions. A growing number of Medicare Advantage plans cover many of the essential services that your Part A and Part B benefits do not.
4. Consider Your Healthcare Providers
Most Medicare Advantage plans available in West Virginia use local healthcare provider networks to deliver care. But not all specialists and primary care doctors accept all plans. It can be exhausting trying to find a plan you want that your doctors will accept. We can help!
Should I Choose an HMO or PPO plan?
There are many plan options available when shopping for Medicare Advantage plans in West Virginia, including HMO and PPO options. These are some of the differences you should consider before making a plan selection.
- With an HMO you may pay less out-of-pocket, but you will need to choose a primary physician to coordinate your care. Referrals for specialists are often required. Except in an emergency, you must remain within the provider network.
- With a PPO you are not required to get referrals for specialty care. You have the option to get health care outside of the plan's provider network. However, typically you will pay more and the out-of-pocket maximum for out-of-network care will be higher.
Need help choosing? Call 1-855-728-0510 (TTY 711) for plan assistance. There's no obligation.
Find Plans in your area with your ZIP Code
Medicare Advantage plans are available to people ages 65 and older. They are also available to individuals with certain disabilities. When eligible, you can generally join one of these Medicare Advantage Plans:
- Health Maintenance Organization (HMO)
- Preferred Provider Organization (PPO)
- Private Fee-for-Service (PFFS)
- Medical Savings Account (MSA) Plan
You must live in the service area (i.e., County) of the plan you want to join. If you reside outside the plan's service area for part of the year, ask if the plan will cover you there. You must also have both Medicare Part A and Part B and be a U.S. citizen or a legal resident.
Medicare Advantage Plans are an alternative to Original Medicare coverage. However, there is another option. You can keep your Original Medicare benefits and add one of the best Medicare Supplement plans in West Virginia for additional coverage. And, there are West Virginia Medicare Part D plans for coverage of prescription drugs.
Many experts feel Medicare Supplement insurance plans offer superior financial coverage and the most flexibility. Plus, benefits rarely change and you can get a policy outside of a Medicare enrollment period. However, plans may not be affordable for all West Virginia seniors.
Due to the fact that Medicare Supplement plans cover more costs than Medicare Advantage Plans, their monthly premiums are generally higher. If you cannot afford Medicare's out-of-pocket costs, another alternative is a dual-eligible Medicare Special Needs Plan in West Virginia. D-SNP plans help West Virginia seniors who qualify for both Medicare and Medicaid. D-SNP plans offer quality care at very affordable prices.
Call 1-855-728-0510 (TTY 711) for assistance. There's no obligation.
Frequently Asked Questions
Still have questions? These common questions and answers might help.
What is the biggest disadvantage of Medicare Advantage?
Medicare Advantage plans can have some potential drawbacks. Many plans require members to use their provider network. Costs are also heavily influenced by how you use healthcare services. This makes it difficult to budget for healthcare expenses. Most plans require members to get referrals for specialists or authorization before they can receive healthcare services. Learn more about the pros and cons of Medicare Advantage plans.
How much does Medicare Advantage cost in West Virginia?
On average, the cost of a Medicare Advantage plan in West Virginia is $33.86 (based on 2023 rates). That's just the cost of the monthly premium to be in the plan. If you have chronic health conditions, the plan's out-of-pocket costs, including copays and deductibles, should also be considered. Additionally, Medicare Advantage plans often include Part D prescription drug benefits that have out-of-pocket costs at the pharmacy.
What do Medicare Advantage plans include?
All Medicare Advantage plans offered in West Virginia must cover all of the Original Medicare benefits. But, private Medicare plans are not required to provide healthcare services similarly. For instance, Medicare Part A covers 80% of hospital stays, skilled nursing, home care, hospice care, and home health care. And Part B covers 80% of doctor visits, lab tests, and other outpatient services. However, Medicare Advantage plans are allowed to set their own copays and routinely charge more than 20%. That said, they do have an annual limit, whereas Original Medicare doesn't.
Methodology and Sources
Our analysis of the top-rated Medicare Advantage plans in West Virginia excludes employer group plans, Medicare-Medicaid Plans (MMPs), Medicare Savings Account Plans (MSAs), Special Needs Plans (SNPs), and plans that do not include Part D benefits.
CMS rates and reviews health plans in several categories, including delivery of health care, member experience and customer service. When comparing plan ratings, we use state-specific data, not CMS' nationwide figures.
Medicare Advantage plan data is sourced from CMS public use files (see: Citations & References). When needed, we combined affiliated companies to calculate insurer averages.
Our research does not include West Virginia's Medicare Advantage SNP Plans. We evaluate these plans separately. We also did not include plans without Part D benefits for prescription drugs, employer plans, or Medicare-Medicaid Plans (MMPs). If you're not looking for a Medicare Advantage plan but want to cover out-of-pocket costs that Original Medicare plan doesn't cover, MedicareWire also ranked the best Medigap Plans in West Virginia.
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Centene Corporation, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna-HealthSpring, Humana, Molina Healthcare, Mutual of Omaha, Oscar Health Insurance, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, and UnitedHealthcare.
Citations & References
- CMS.gov, 2023 Medicare Part C Landscape Source Files, Last Accessed January 13, 2023
- CMS.gov, "5-STAR PLAN RATINGS", Last Accessed October 22, 2022
- Medicare.gov, "Understanding Medicare Advantage Plans", Last Accessed October 16, 2022
- KFF.org, "Medicare Advantage 2022 Spotlight: First Look", Last Accessed November 2, 2022
- Medicare.gov, "How do Medicare Advantage Plans work?", Last Accessed October 13, 2022
- CMS.gov, Part C and D Performance Data, Last Accessed January 13, 2023
- CMS.gov, Monthly MA Enrollment by State/County/Contract, Last Accessed January 13, 2023
- CMS.gov, Biden-Harris Administration Announces Lower Premiums for Medicare Advantage and Prescription Drug Plans in 2023, Last Accessed September 29, 2022
- CMS.gov, Medicare Marketing Guidelines, Last Accessed February 2, 2023
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Our content follows the guidance provided by the Medicare Marketing Guidelines on CMS.gov. If you believe the information on this page is inaccurate, please contact us.