Medicare Plans in West Virginia – Coverage and Benefits
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.
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)
||Medicare Part B (Medical Insurance)
|Medicare Part C (Medicare Advantage)
||Medicare Part D (Drug Coverage)
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||Medicare Part B Costs|
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.
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.
Top HMO Plans in the Area
|Cost||Plan Name||Coverage Type||Premium||Deductible||Rating|
|$192||SecureCare - Option I (HMO)||Health Only||$16.00||$0|
|$1333||SecureCare - Option II (HMO)||Health and Drug||$111.10||$0|
|$1764||SecureCare - Option III (HMO)||Health and Drug||$147.00||$0|
Top PPO Plans in the Area
|Cost||Plan Name||Coverage Type||Premium||Deductible||Rating|
|$708||Advantra Gold (PPO)||Health and Drug||$59.00||$0|
|$0||HumanaChoice R5826-062 (Regional PPO)||Health Only||$0.00||$0|
|$600||Freedom Blue PPO ValueRx (PPO)||Health and Drug||$50.00||$0|
More about Medigap Supplement vs. Medicare Advantage
We’ve set up the following table based on all of the differences and similarities of Medicare Advantage vs. Medicare Supplement insurance. Hopefully, it will help clear away some of the confusion:
|Questions||Medicare Advantage||Medicare Supplement|
|How are the plans funded?||Medicare will pay your insurance company a fixed amount based on average healthcare costs for your region. You may also be required to pay a premium based on your location and insurance company.||Your monthly premium takes care of the majority of your expenses.|
|Do I continue paying for Part B?||Yes||Yes|
|What does it cost me?||Some plans offer a zero-dollar premium (because the government subsidy covers the full cost). Other plans may cost up to 0-0 monthly.||While each plan does require a monthly premium, many of them are affordably priced.|
|What does the plan cover?||Depending on your plan, it will cover at least the same benefits offered by Medicare parts A & B. Possibly other benefits; but the more benefits you sign up for, the higher your out-of-pocket expenses may be.||All eligible expenses are split between Medicare, and your Medicare Supplement plan. If you have a comprehensive plan, such as Plan F, 100% of eligible expenses not covered by Medicare will be covered by your supplement insurance.|
|Can I budget my health care expenses?||It’s challenging; the more often you require medical care, the more often you may be required to pay out-of-pocket.||Budgeting is much easier with a Medicare supplement. You have fewer out-of-pocket expenses, and one simple monthly premium.|
|Can my plan be cancelled?||Yes. Unfortunately, your health insurance company has the legal right to review their Medicare Advantage services annually and decide whether or not they wish to continue providing coverage.||No – not unless you fail to pay your monthly premium, or your insurance company goes bankrupt. Only under such extenuating circumstances could your plan be cancelled.|
|Are pre-approvals or pre-certifications required?||Unfortunately, yes. These Plans usually require pre-certification or other qualification for some specific types of care.||No pre-approvals are required. If you qualify for Medicare, you will qualify for a Medicare supplement plan.|
|Can I use any doctor or hospital?||Usually, you choose from a network of pre-approved providers. These networks can fluctuate over time.||Yes. You are free to choose any doctor and/or hospital in the U.S. which accepts Medicare.|
|Can drug, vision, or dental coverage be included in the policy?||Yes.||No. These forms of coverage must be purchased separately.|
|Who is this plan type generally best suited for?||If you are relatively young, healthy, live in an urban area, and have a limited income, a Medicare Advantage plan could work for you.||If you live in a rural area without easy access to provider networks, if you like to budget your finances, or if you want comprehensive coverage, you might prefer a Medicare supplement plan.|
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.
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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.