Medicare Advantage Part C in West Virginia

Medicare Parts A & B (a.k.a. “Original Medicare”) aims to be comprehensive – but it unfortunately doesn’t cover 100% of your medical needs. There are little-known out-of-pocket expenses which can become expensive if you don’t have a good Medicare supplement insurance policy to protect you. One of the more popular supplements, Medicare Part C (or “Medicare Advantage), is the focus of this particular article.

Federal Regulations for Medicare Advantage

Medicare Advantage may also be referred to as a Medicare “Replacement” insurance policy. This is because signing up for Medicare Advantage involves replacing your federal Medicare benefits with a different insurance policy from a private company. However, there are laws in place to make sure that your Advantage plan is at least identical to – if not better than – Original Medicare. These laws are in place to protect you, the consumer.

Medicare Advantage Enrollment In West Virginia

A significant portion of all Medicare-qualified seniors in West Virginia – a number upwards of 25% – are signed up for a plan. And in the chart below, you can observe which Advantage plans are more popular than others:

Plan Type Enrollment Percentage
HMO Plans 59%
Local PPO Plans 13%
Special Needs Plans 11%
Regional PPO Plans 9%
Private Fee-For-Service Plans 5%
Other (Cost Plans, MSA’s, etc.) 3%

Plan Coverage & Cost

Many different factors, such as age and tobacco use, will influence your monthly premium. But there are ways to gather data and come up with a close estimate. Below, you can take a look at some of the estimated costs near you:

Most Popular Medicare Advantage Plans in West Virginia

Ranking different comparable products using a five-star ranking system is one of the easiest and most common ways to differentiate between goods and services. We’ve done the same thing with Medicare Advantage plans in your area to make your shopping experience easier and quicker. The more stars a Medicare Advantage plan earns, the more confident you can be that they excel at customer care, care management, processing claims, and maintaining financial stability – all for an affordable monthly premium.

Helpful Medicare Advantage Tips & Tricks

Doctor/Provider Network Restrictions

The provider network is the group of doctors and facilities from which your Advantage plan will allow you to receive medical care. If you want to see a doctor or use a facility which is outside of your provider network, your plan’s network restrictions may make that difficult or impossible without paying out-of-pocket. Make sure you check with your preferred doctor(s) and facilities before you decide on an Advantage plan.

  • HMO Plans – Most people on a tight budget with low to moderate medical needs do well with an HMO plan. Costs are kept low by restricting you to a Health Management Organization network of doctors and hospitals that have been pre-approved by your insurance company. You choose a primary care physician, and they choose who you get additional care from if they deem it necessary. You have less choice with an HMO because insurance companies tend to choose care providers that charge them the lowest rates. If you need emergency medical care, you shouldn’t have to pay out of pocket if your insurance company deems it a legitimate medical emergency.
  • PPO Plans – If you have a PPO plan, then you’ll get a greater variety of doctors, facilities, and hospitals to choose from – but you’ll have to pay a little bit of a higher price for it. Not only are the monthly premiums more expensive, but if you happen to choose an out-of-network care provider to get care from, your insurance company won’t reimburse you or won’t agree to pay as much of your medical costs as they will with an in-network “preferred” provider. But if this freedom of choice results in better health for you, and you have the money to spare, it may be a worthwhile trade-off.
  • PFFS Plans – You have the greatest amount of choice when it comes to a PFFS plan. As long as your chosen care provider and your insurance company are willing to agree to the same payment terms, you won’t be restricted to a specific medical network. However, they don’t always agree. When they don’t agree, you can either choose to pay out-of-pocket or choose to get care somewhere else. And this can change on an appointment by appointment basis; just because you see a doctor once and your insurance company decides to cover it doesn’t mean they will cover the same doctor for another appointment down the road.
  • Special Needs Plans – People who are eligible for a special needs plan are limited to those who demonstrate financial need due to a serious, chronic disease which requires a lot of medical care. SNP medical networks are limited to a small pool of low-cost providers to keep medical costs down. Your car must be managed through a primary doctor who refers you to other in-network doctors and facilities as needed. You can get some of your costs reimbursed if you have to get emergency care at an out-of-network facility. You might also be able to negotiate specific and specialized out-of-network care with your insurance provider – just understand that these exceptions are rare.

Doctor/Providers List

  • HMO Plans – If you take the affordability of an HMO plan, combine it with the health benefits of Medicare Parts A and B, and give seniors the option to purchase additional coverage, then you basically have a Medicare Advantage HMO plan. But you’ll still have to choose a primary care physician, and let them help you coordinate your care via referrals to other network-approved providers.
  • PPO Plans – PPO networks tend to cost more than HMO networks because you have a wider variety of doctors to choose from, and you’ll have more shared cost fees to deal with if you go out of the preferred provider network. But with a Medicare Advantage PPO, the government is helping you pay for those higher monthly premiums and shared costs. you’re also getting a wider selection of doctors and facilities because of how many of them willingly accept Medicare. For many seniors, PPO plans become realistically affordable when Medicare gets thrown in the mix.
  • PFFS Plans – If you’ve had trouble with private PFFS plants in the past, you might have an easier time with a Medicare Advantage one. Your Medicare Advantage provider will have an easier time negotiating payment terms and reaching an accord thanks to the universal acceptability of Medicare. You likely won’t have to worry as much about payment terms changing or doctors and facilities going back on their agreements.
  • Special Needs Plans – It doesn’t have to be expensive or difficult to have your health care needs managed if you purchase a Medicare Advantage SNP healthcare plan. These are more affordable than typical special needs plans because you have financial assistance coming from the Medicare program. You might also get lucky and have better doctors and facilities to choose from since having a Medicare plan will open more doors for you within your health provider network.

If you have a good doctor now, you shouldn’t have to lose them just a switch to a Medicare Advantage program. Look up your doctor’s name and address on the Medicare website Physician Search Tool page in order to find out which medical networks they are apart of. This should help make it easier for you to choose a Medicare Advantage plan and keep your doctor.

Drug, Vision and Dental Coverage

Your vision health is important as you age. Even if you have had 20/20 vision all your life, your eye health needs to be closely monitored and maintained as you get older. Medicare Advantage plans make it easier and more convenient to do that. They give you the option to add vision coverage to your policy for a small increase in your monthly premium. This gives you the added convenience of managing your vision needs on the same policy as you manage all your other medical needs. Original Medicare and Medicare supplements, unfortunately, don’t offer this.

Oral health is also important as you get older. Recent scientific studies have linked specific periodontal bacteria to age-related brain diseases – so you shouldn’t neglect your dental needs as you get older. Medicare Advantage gives you the same option to add dental insurance to your main policy the same way they do with vision insurance. But if they don’t have your preferred dentist in their dental network, then you may want to think about purchasing separate dental insurance on your own.

Enrollment Options & Best Time To Enroll

By far, the best time to enroll is during your 6 month IEP (see below) once you turn 65 and enroll in the federal Medicare program. Some companies may even approve you automatically without asking any questions about your health if you first qualify for federal Medicare benefits. If you wait, however, or if you are struggling with a serious health condition (such as End Stage Renal Disease), you may have to seek help from your local insurance agent or your state department of insurance. You can also take a look at our Medicare Advantage Enrollment Options page for more information.

  • Initial Enrollment Period: 6-month timeframe when you first enroll in Medicare to purchase a Medicare Advantage plan.
  • Annual Enrollment Period (AEP): This timeframe runs from October 15th through December 7th every year, and during this time you can change or cancel your Medicare Advantage and part D drug plan.
  • Special Enrollment Period (SEP): During special circumstances, you may be eligible to purchase/change a plan outside of the Annual Enrollment Period. Things such as moving out of the plans’ service area, losing group health or employer coverage, a company no longer offering plans in the area, etc. are all events that could trigger a SEP.

What Medicare Advantage Plan Is Best For Me?

What do you want most from your Medicare Advantage provider? A financially solid company? A medical network of doctors you trust? An easy-to-understand insurance policy that never leaves you guessing? If you’re searching on your own, it can be difficult to find all of that on your very first try with Medicare. But we want to help you out.

The sooner you enroll into a good Medicare supplement plan – whether you decide on Medicare Advantage, or whether you go a different route – the easier it’ll be to secure your benefits at an affordable price for the long-term. We have years of expertise on all things Medicare, and we want to make sure you get a plan that is stable, affordable, and comprehensive. And we can get you enrolled before the expiration on your enrollment period is up – so don’t hesitate to contact us!

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