Over 442,000 Medicare beneficiaries are living in West Virginia. So you’re probably wondering what you need to know if you’re living in West Virginia and getting ready to enroll. Or maybe you’ve recently enrolled but still have questions.

Below, we’re going to go over some of the basics so that you get a better understanding of your new health benefits.

West Virginia Medicare: Facts & Figures

  • There are nearly 290,000 retirees enrolled in Original Medicare
  • More than 289,000 of these enrollees have Medicare Part A
  • Over 260,000 have also enrolled in Medicare Part B and are not relying on qualifying coverage or any other alternative health plan
  • Nearly 223,000 beneficiaries aged into Medicare
  • An additional 57,000 qualified for Medicare based on medical disability
  • More than 167,000 Medicare recipients have chosen to purchase a Medicare Advantage plan
  • Just under 307,000 are getting help for their prescription costs through Medicare Part D

Medicare Costs in West Virginia for 2023

For bouts of short-term care, Medicare Part A is fairly inexpensive. But the longer your hospital stay, the more you will have to pay for coinsurance fees. Medicare Part B is inexpensive for relatively healthy people who require less care.

But each doctor visit you make, you need outpatient treatment, and every time you need medical equipment, it’ll cost you at least 20% of the total medical expense. Also, remember that with Original Medicare, these prices are standardized across all 50 states.

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

Original Medicare Coverage

Many beneficiaries don’t need to immediately enroll in Medicare Part B even if they have aged into retirement and are currently enrolled in Medicare Part A. Some health plans from private employers allow you to keep using those benefits whether you decide to keep working. This is called “qualifying coverage.”

If you decide to keep this coverage but need hospital care, Medicare Part A will pay your bills first, followed by any benefits your private plan offers. At least 29,000 Medicare recipients in West Virginia are not yet enrolled in Medicare Part B.

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

Supplemental Medicare Plans in West Virginia

The base of Medicare starts with your hospital benefits (Part A) and your medical benefits (Part B). but there are unfortunate gaps in coverage that you will need to purchase a supplement to avoid.

The price you pay for your supplement will vary based on the plans available in your area and the individual plan you select.

For the gaps in Original Medicare, you have one of two choices: Medicare Advantage or a Medigap insurance plan. Medicare Advantage contains all of the same health benefits as Medicare Parts A and B, but it also comes with options you can add (for a price) which protect you from coverage gaps.

Medigap plans are standardized plans which are specifically designed for Medicare coverage gaps. Both are sold and managed by private health insurance companies.

Nothing we’ve discussed so far — Original Medicare, Medicare Advantage, or Medicare supplements — covers prescription drugs by default. Most Medicare Advantage programs come with prescription drug coverage, but it’s not always guaranteed. Sticking with Original Medicare means you must sign up for Medicare Part D (which covers prescription drugs exclusively).

West Virginia Medicare Resources

Even with all the help available, finding the right plan can still be difficult. But we have the resources to help you shop for a great deal.

FAQs

What is the difference between a Medigap and a Medicare Advantage plan in West Virginia?

There are many important differences between Medigap and Medicare Advantage in West Virginia. But these differences are not unique from state to state.

Medigap policies cut out the gaps in Original Medicare like a scalpel. Medicare Advantage is more like a sledgehammer, completely wiping away your Medicare benefits and replacing them with something more comprehensive.

Can you have Medigap and Part D in West Virginia?

Yes, you can. In fact, for many seniors with a Medigap supplement, Medicare Part D is necessary to manage their expensive prescription drug costs.

Can you have a Medicare Advantage and a Medicare Supplement simultaneously in West Virginia?

No, you cannot. This would be redundant since both health plans are designed to protect you from the same types of out-of-pocket expenses.

Be wary, though, because some scammers try to sell duplicate coverage like this to Medicare recipients illegally. If someone tries to scam you, report them to your local insurance department immediately.

What is the biggest disadvantage of Medicare Advantage in West Virginia?

The biggest disadvantage of Medicare Advantage is the same in West Virginia as anywhere else: they work just like convoluted private health insurance plans. This is because they are private health insurance plans.

To make a profit, some companies make up confusing, complicated rules to nickel-and-dime customers into giving them more money while providing less coverage/benefits.

How to Sign Up for Supplemental Medicare in West Virginia

Most Medicare beneficiaries don’t know how easy it is to save money on healthcare. It only takes a few minutes of comparison shopping, and we can get you free rate quotes quickly and easily.

Our experts can start assisting you right away. Their willingness to help and their vast knowledge of Medicare are both resources for you to use.

So give us a call or complete our quick and easy online rate form to get the best West Virginia rates.

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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.