If you live in West Virginia and are age 65 or over, you are probably already enrolled in the federal Medicare program. This affordably-priced program is designed to help retired citizens living on a fixed income get the health care they need. The basic plan, which includes Medicare Part A and Medicare Part B, covers most of your health care needs, from hospital visits to basic doctor care.

Coverage and Benefits

Depending on your employment history, your Part A benefits may be free if you have been employed for at least 10 years (or 40 quarters) cumulatively in your lifetime. If not, then you will be required to pay a deductible. Part B also comes with a deductible, as well as monthly premiums, which can be calculated here.

Medicare Part A (Hospital Coverage)

  • Inpatient care in hospitals
  • Skilled nursing facility care
  • Hospice care
  • Home health care
Medicare Part B (Medical Insurance)

  • Services from doctors and health providers
  • Outpatient care
  • Home health care
  • Durable medical equipment
  • Some preventive services
Medicare Part C (Medicare Advantage)

  • Includes all benefits and services covered under Part A and Part B
  • Usually includes Medicare prescription drug coverage (Part D) as part of the plan
  • Offered by Medicare-approved private insurance companies
  • May include extra benefits and services for an extra cost
Medicare Part D (Drug Coverage)

  • Helps cover the cost of prescription drugs
  • Run by Medicare-approved private insurance companies
  • May help lower your prescription drug costs and help protect against higher costs in the future

Did you recently turn 65 years old and decide you want to enroll in Medicare? If so, you have more choices than you might have thought. In order to have access to Medicare benefits, you must purchase Medicare Part A. But did you know that in some cases Medicare Part B is optional? Many seniors may choose to opt out of Part B because it’s the more expensive of the two and because they may be able to get similar benefits for cheaper somewhere else. Part B benefits have to do with doctors and outpatient care, as well as medical supplies. Part A benefits protect you from expenses associated with hospital care and hospice.

The scenarios in which Medicare Part B is not optional are under a Medicare Advantage plan, or if you want prescription Part D drug coverage. Medicare Advantage plans by law must contain equal benefits to Parts A & B of Original Medicare. The law also stipulates that if you stay with Original Medicare and want prescription drug coverage, you must purchase and pay for Part D benefits.

Different Types of Medicare Plans in West Virginia

There are 392,021 Medicare recipients currently living within the state of West Virginia. Of those, 24% (94,085 people) have chosen instead to replace their Traditional Medicare benefits with a Medicare Part C private insurance policy. And additional 16% (or 64,200 beneficiaries) are currently supplementing their Medicare with a Medigap supplement policy. But the largest percentage of seniors – 60%, or 235,212 people – either have some sort of employer-sponsored supplemental coverage, or no protection against Medicare coverage gaps at all.

No matter what sort of supplement plan you want to get, you must first make sure you are enrolled in Medicare before you purchase one. The good news is that Medicare enrollment is fairly simple. Learn more by clicking the provided link.

Why do People Need Additional Coverage beyond Traditional Medicare?

To be clear, the additional coverage is not mandatory. It exists for your piece of mind, and to protect you financially from out-of-pocket expenses which often pop up from relying on Original Medicare alone to cover your health care needs. Below are some of the coverage gaps and their associated costs. If you aren’t careful, you could end up paying full price for:

Medicare Part A Costs in 2022 Medicare Part B Costs in 2022
  • Part A is premium-free for most
  • Part A deductible is $1,556 per benefit period
  • Inpatient hospital stay days 61-90 is $389
  • The standard Part B premium is $170.10
  • The annual deductible for Part B is $233
  • Medicare pays 80%, you pay 20% out-of-pocket

There are several different supplemental health plans out there that you can choose from. Below, we’re going to go into more detail about the most popular two: Medigap insurance, and Medicare Advantage. It’s up to you to compare the two and figure out which is better for your personal situation.

There are parts of West Virginia which aren’t exactly known for having low healthcare costs. Unfortunately, medical expenses aren’t going to go down anytime soon. This is especially important for seniors whose average medical bills can be substantially higher than the rest of the population. If you don’t know how to purchase the right coverage, this can send your out-of-pocket costs skyrocketing. But there are some easy, affordable steps you can take in order to prevent this.

Unfortunately, most senior citizens cannot rely on Medicare Parts A & B alone. There are certain gaps in these coverages – especially for extended hospital stays, multiple blood transfusions, and coinsurance costs – which can sneak up on you and become very expensive very quickly. In order to protect yourself from these expenses, you have to make sure you have the right insurance supplement plan.

You do have a few options. Some of these options are easier to manage and more affordable than others. The plan you go with will be largely determined by what your medical needs are. In order to figure this out, you need to sit down and ask yourself what medical care you think you need and how much it will cost you. Then you have to start looking into plans which provide coverage for these needs at a price you can afford.

These plans fall into one of two categories: Medicare Advantage and Medicare Supplement insurance (Medigap). Both are private plans offered by private companies. But there are several differences between the two. You need to get familiar with these differences and how they relate to your personal needs. Only then will you be able to choose the best and most affordable option. Both are private plans offered by private companies. But there are several differences between the two. You need to get familiar with these differences and how they relate to your personal needs. Only then will you be able to choose the best and most affordable option.

Coverage Option #1: Medicare Supplement Plans

Most Medicare supplement policies are labeled as “Medigap” policies. If you have a Medicare supplement policy, you can be shielded from unexpected medical expenses incurred from the gaps in Medicare. Right now, there are 10 federally endorsed supplement plans available to the public. Plans A-D, F, G, and K-N are still in effect, but plans E, H, I and J have been weeded out due to the Medicare Modernization Act of 2010. All 10 of the active plans provide for equal forms of coverage, regardless of your state or insurance company. Costs will vary, so make sure you shop around for the best deal.

Below is a detailed explanation of what each plan covers in detail:

Top Medicare Supplement Plans in the Area

Type Starting From Part A Deductible Part B Deductible Excess Nursing Travel
F $120 $0 $0 100% Covered 100% Covered 100% Covered Request Info
C $118 $0 $0 Not Covered 100% Covered 100% Covered Request Info
G $114 $0 $147 100% Covered 100% Covered 100% Covered Request Info
B $99 $0 $147 Not Covered Not Covered Not Covered Request Info
N $81 $0 $147 Not Covered 100% Covered 100% Covered Request Info
D $124 $0 $147 Not Covered 100% Covered 100% Covered Request Info
A $68 $1 $147 Not Covered Not Covered Not Covered Request Info
L $68 $304 $147 Not Covered 75% Covered Not Covered Request Info
K $45 $608 $147 Not Covered 50% Covered Not Covered Request Info
M $112 $608 $147 Not Covered 100% Covered 100% Covered Request Info

Medicare Part C: Medicare Advantage

Medicare Part C, also known as Medicare Advantage, is a private variation of Original Medicare. It offers the same exact benefits that Traditional Medicare does (as required by law), but through a private insurance company. Sometimes, there may be additional coverage options in addition to what Traditional Medicare provides. But if you opt into a Medicare Advantage plan, you’ll essentially be opting out of getting your Medicare needs met by the government.

There are benefits and drawbacks to enrolling in Medicare Advantage. On the one hand, it isn’t uncommon for these plans to also offer benefits such as dental or prescription drug coverage – these extra benefits help sell policies and make money for private insurance companies. However, one of the most common complaints associated with Medicare Advantage is the restrictive medical networks. Whether or not your Medicare Advantage policy will require you to change doctors involves a number of variables.

The medical networks Advantage plans use are either Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs). For more information on plans near you, see below.

More about Medigap Supplement vs. Medicare Advantage

Medicare Advantage and Medigap policies differ in size, scope, and cost, among other things. It’s fairly easy to distinguish between the two. But it can be a lot harder to figure out which one is best suited for you. The more information you can learn about these two types of coverage, the better of a decision you can make.

Let’s start with talking about Medicare Advantage (Medicare Part C). This is a very large and comprehensive insurance policy which completely replaces your Medicare benefits from the government. By law, these policies have to start out as being identical to Medicare Parts A & B. From there, you can purchase additional riders that will supplement the holes in your coverage. You can also add things like prescription drugs and dental, as well as vision. Just keep in mind that the more coverage you purchase, the more you will likely pay in monthly premiums.

Medigap policies, on the other hand, are much smaller and simpler than Medicare Advantage. These plans are specifically designed with surgical precision to neutralize the gaps in Original Medicare coverage. They can help make extended hospital stays more affordable, they can reduce your coinsurance costs, and they may even help make your Part B premiums more affordable. The more comprehensive plans will cover more but may come with a higher monthly premium. Unfortunately, they do not cover prescription drugs or other incidentals like vision and dental.

There’s a little bit more wiggle room when it comes to Medigap compared to Medicare Advantage. For example, you have a greater network of doctors and hospitals to choose from with a Medigap plan. There are also more guarantees when it comes to Medigap. At the end of the day, though, it will all come down to which policy meets your needs best at the most affordable price.

So far, we’ve really only skimmed the surface of these two insurance policies. It’s up to you to find out all the information you can in order to make a well-informed decision. We would be more than happy to help you with that. Just give us a call or send us an email so that we can provide you with the assistance you need. We can even help you find affordable plans in your area.

Questions Medicare Advantage Medicare Supplement
How are expenses covered under each plan? Your estimated healthcare costs are calculated by your insurance provider who sends a bill to the US government for your monthly premium. Whatever the government will not pay, you will have to make up the difference. You will be responsible for paying your monthly premium on time every month in order to maintain coverage.
Will I still have to pay for Part B? Yes Yes
What will it cost me? Your monthly premium, co-pays, coinsurance, deductible, and out-of-pocket costs will be determined by your insurance company and will be your responsibility. The more comprehensive your Medigap plan, the fewer out-of-pocket costs – such as coinsurance, co-pays, and the like – you will have to worry about.
What will the plan cover? You start out with coverage which is identical to Medicare Parts A & B. After that, it’s up to you to decide whether or not you want extra coverage for Medicare gaps, prescription drugs, and other incidentals. The smaller Medigap plans only concern themselves with Medicare Part A coverage gaps and gradually scale up to cover some or all of the gaps in Medicare Part B.
Is it easy to budget my healthcare expenses? It mostly depends on how healthy you are. The more you need medical care, the more out-of-pocket expenses you will incur. Whether you are of above or below average help for your age, purchasing a more comprehensive Medigap plan can help make your medical costs more predictable.
Is my plan guaranteed? Or can it be cancelled? Your plan can be cancelled anytime at the discretion of your insurance provider as long as they find a legal reason to do so. Your coverage is guaranteed for life unless the company goes bankrupt or you fail to pay your monthly premium on time.
Do I have to clear a pre-approval or pre-certification process? Your insurance provider does not have to provide you with coverage if you fail to pass a mandatory pre-approval process. Qualifying for Medicare automatically approves you for a Medigap policy.
Am I limited to specific doctors or hospitals? Yes, your medical network will be limited in order to keep costs down. Medigap insurance is accepted wherever Medicare is accepted, so you have a much larger network to choose from.
What type of plan is best for me? If you feel you need more coverage than the average senior, if you live somewhere with many doctor and hospital choices, or if you want the convenience of having your medical needs managed in one single plan, there are some benefits to Medicare Advantage. For older seniors, for seniors with greater healthcare needs, and for seniors who live in areas with fewer doctor and hospital choices, Medigap policies are better at saving them money.

Additional Medicare Resources

It’s likely that you still have some questions. Take a look at the number directory below. These contact numbers will put you in touch with local offices and Medicare insurance experts who can give you the information you need in order to make the best decisions regarding your healthcare.

Useful Contacts

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Help with my Medicare options & issues
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General health & health conditions
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Important Medicare Terms

  • HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.
  • PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.
  • Co-Pay: Amount of money charged per visit to doctor, specialist, etc.
  • Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.
  • Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.
by Lindsay Malzone, Lindsay Malzone is the Medicare expert for Medigap.com. She's been contributing to many well-known publications as an industry expert since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.