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.

Medicare Plans in West Virginia

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.

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.

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.

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:

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.

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.