Medicare in West Virginia
- Want to find out if you're eligible for Medicare in West Virginia? Start with this guide, which covers the plans you can choose from and when you can apply.
What West Virginia Medicare Plans Are Available?
As in most other states, West Virginia residents have the option for Original Medicare. Original Medicare is a program enacted in the 1960s and managed by the Social Security Administration (SSA) to provide certain types of medical coverage for eligible citizens.
Original Medicare, or, as it's more commonly called, Medicare Part A and B, offers coverage for inpatient and outpatient medical care respectively. These two parts make up the core components of what Medicare has to offer. However, these are not the only Medicare options available to residents. Other options available include Medicare Part C, known as Medicare Advantage, Medicare Part D, and Medicare supplement insurance, which is also called Medigap.
Medicare Part A and Part B are both provided through the federal government by way of the SSA. These plans are directly managed by the government agency. The remainder of the offerings are provided by third-party private entities.
Currently, the total number of West Virginia residents enrolled in Medicare is 441,852. That number is split between Original Medicare and Medicare Advantage plans, with 294,946 West Virginians taking advantage of Original Medicare and 146,906 enrolled in Medicare Advantage.
Medicare Part A
Medicare Part A is the foundational coverage for the system. This coverage focuses on paying for inpatient care. It covers things like:
- Inpatient hospital care
- Short-term nursing facility care
- Home health care
- Inpatient rehabilitation
- Inpatient psychiatric care
In addition to that, Medicare Part A also covers:
- Medicines as part of a hospital stay
- Meals during care
- Nursing care
- Shared and semi-private rooms
Medicare Part B
Medicare is not limited to inpatient care only though, and that’s where Part B comes in. Medicare Part B covers a variety of outpatient and preventative services and is aimed at covering services that are necessary but not part of emergency or sudden care. Things like:
- Medically necessary diagnostic testing
- Equipment related to those services
- Preventive checkups
- Routine office visits
- Intravenous antibiotics and other clinically administered drugs
- Short term mental health care such as residential drug and alcohol treatment
- Medical transportation
- Clinical research, including experimental drug trials for things like Alzheimer’s and dementia
Medicare Part C
Medicare Part C, also called Medicare Advantage, is slightly different than traditional Medicare plans. By law, these plans must cover the same things as part A and B, but they also offer additional benefits. One of the biggest differences between Part C and the original plans is that Part C plans are offered by private insurance companies who are then authorized to bill the SSA. These plans offer
- The same coverages as Part A and B
- Some prescription drug benefits
Because these plans are offered through private insurance carriers, the benefits and how they are offered can vary from state to state.
Medicare Part D
Part D is intended to provide coverage for prescription drugs. You have to opt into the plan and purchase it separately from your Part A and B Original Medicare plans. Some Medicare Part C plans have prescription drug benefits built in, but make sure you understand your benefits when choosing a plan so you know whether you need Part D coverage.
Medigap plans are supplemental insurance policies that pick up the costs of copays and deductible after Medicare processes a claim. These can help reduce your out-of-pocket costs, making them a generally good idea for those with chronic conditions or who expect to need a lot of medical care.
Who Is Eligible for Medicare in West Virginia?
As with other states, eligibility for Medicare in West Virginia varies based on certain circumstances. By and large, any resident of the state age 65 or older is likely to qualify. If you are receiving Social Security retirement benefits at least 4 months prior to your 65th birthday, you will be automatically enrolled in Original Medicare.
Your automatic enrollment and your ability to sign up for any additional Medicare plans will happen during what’s called the Initial Enrollment Period (IEP). This time period represents your initial eligibility for Medicare. It lasts until you are 3 months past the month of your 65th birthday.
Every year, there is a general enrollment period for you to sign up for Medicare Parts A and B. This period is from January 1st to March 31st . But keep in mind that if you are signing up after your IEP, you might incur a penalty for doing so that can increase the cost of your Medicare coverage.
Annual Enrollment Period
There is also a yearly Annual Enrollment Period (AEP) in the fall. This period runs from October 15th to December 7th. At this time, you can join or make changes to your specific Medicare plan as well as drop your plan if need be.
There are also special enrollment periods for those who are encountering changes in their life. If you find yourself in this position and you need to enroll in Medicare, you might qualify for a special enrollment period. Reasons for this include having been on an employer’s plan that changed or ended, moving out of the coverage area for your plan, or other major life changes.
How Do I Enroll in Medicare in West Virginia?
If you need to sign up for Original Medicare, you apply through the Social Security Administration if you were not automatically enrolled. There are multiple options available to you to achieve this:
- Online through the Social Security website
- Apply by going to your local Social Security office
- Or call the SSA at 1-800-772-1213
If you do choose the phone option, live representatives are only available between 7:00 a.m. and 7:00 p.m., Monday through Friday. However, you can receive recorded information all other hours of the day and on weekends.
Contact Information for West Virginia Medicare, Medicaid and Insurance Help
HelpAdvisor has plenty of information about Medicare and Medicaid in West Virginia if you need more assistance. Plus, you can also reach out to the West Virginia health insurance online information page.
In addition to those, you can also access the West Virginia Consumer Assistance Programs or the West Virginia Assistance Programs. Both of these pages have helpful information to clarify any other questions you might have.