Residents of the Mountain State have plenty of health care options. According to some sources, they need it. A study by US News found that WV has the seventh worst health care in the country. The study looked at access, quality, and good public health.
Health insurance options in West Virginia
According to the WV Offices of the Insurance Commissioner, residents have plenty of health insurance options:
Employer-provided
- From your employer
- Through your spouse's employer
Individual or family plans
- Through HealthCare.gov
- Directly from a health insurance company
Government-assisted
- Medicare
- Medicaid
Where do most West Virginians get their health insurance coverage?
| Sources | Percent | ||
|---|---|---|---|
| Employer-Provided | 44% | ||
| Individual or family | 3% | ||
| Medicaid | 26% | ||
| Medicare | 19% | ||
| Military | 1% | ||
| Uninsured | 6% | ||
| Source: Kaiser Family Foundation, Health Insurance Coverage of the Total Population | |||
Six percent of WV residents are uninsured, less than the national average. That’s good news for policyholders, as the more uninsured people there are, the higher rates are for insured people.
West Virginia health insurance companies
WV residents have a few options for health insurance providers in their state. The following companies offer both individual and family plans in West Virginia:
- CareSource
- Highmark Blue Cross Blue Shield
West Virginia health insurance costs and rate factors
WV residents spend an average of $9,462 on health care per year, more than the national average. What influences your costs in WV? Prices vary person to person, but depend primarily on these factors:
Health insurance plan type
More coverage will cost you more in monthly premiums. Marketplace plans come in metal tiers: bronze, silver, and gold.
So, how much should you expect to pay for health insurance in the Mountain State? These are the average monthly premiums for a middle-aged WV resident in 2020:
| Bronze | Silver | Gold | |
|---|---|---|---|
| $552 | $619 | $804 | |
| Source: Kaiser Family Foundation, Change in Average Marketplace Premiums by Metal Tier | |||
Gold plans cost about 46 percent more than a bronze plan. That’s because gold plans cover 80 percent of medical costs, whereas bronze plans cover 60 percent of costs.
You may also qualify for a catastrophic plan, the lowest level of coverage available. Catastrophic plans have low monthly premiums but a yearly deductible of $8,150. They’re essentially designed to save policyholders from medical bankruptcy. Because of this, you may save money in the long run with a bronze or silver plan if you use your health insurance.
Body mass index
According to the CDC, a high body mass leads to several serious health conditions. That’s why health insurance companies will look at your BMI to determine your risk-level. A high BMI leads to high insurance premiums.
In 2019, WV had a 40 percent obesity rate, the second highest rate in the country. Out of the many state residents who used QuoteWizard to compare health insurance plans, 33 percent of shoppers have a BMI in the obese range.
Tobacco use
Due to the substantial risks from smoking, tobacco users spend more on health insurance. About 24.8 percent of WV residents are smokers, the highest rate in the country.
Age
According to HealthCare.gov, older people spend up to three times more for health care than younger people. WV residents who used QuoteWizard to shop for health insurance are, on average, 41 years old.
Location
Where you live plays a big role in how much you’ll be paying for health care. Every state has their own health care rules, regulations, and providers.
Also, health insurance companies use community-rating to determine your rates. That means costs are based in part on the combined claims that everyone files. So, if your community files an unusual rate of claims, your prices could skyrocket.
That’s why your state’s overall health can affect your rates. And according to America’s Health Rankings, WV is the fifth unhealthiest state in the country. This ranking is due in large part to high smoking and obesity rates.
West Virginia health insurance laws
The Affordable Care Act limits what factors insurance companies can consider while pricing your policy.
- Pre-existing conditions: The ACA limits insurance companies from using knowledge of pre-existing conditions to raise your health care premium People with pre-existing conditions used to face steep premiums- if they could get coverage to begin with.
- Gender: The ACA also mandates that insurance companies can’t charge women and men different prices for the same plan. That’s good news, especially because women historically pay more for health care than men.
- Insurance and medical history: Insurance companies also used to analyze your medical history and your past insurance coverage. Now, people with previous medical problems or lapses in insurance don’t pay more for health care.
There’s a limit to how much you’ll pay out-of-pocket for marketplace plans. In 2020, the out-of-pocket maximum is $8,150 for an individual plan and $16,300 for a family plan.
WV state law requires that health insurance companies offer at least some coverage for the following services:
- Emergency services
- Nursing services
- Child immunizations
- Clinical trials
- Dental anesthesia services
- Treatment of serious mental illness
- Newborn screenings
There are additional services that companies need to offer coverage for. Find the full list on cms.gov.
Medicare and Medicaid in West Virginia
Medicare and Medicaid are federal and state-funded health care programs. Medicare covers seniors, and Medicaid helps low-income families and children.
Medicare
Medicare helps WV residents 65 and older. There are several options within the program, including parts A, B, C, D, and supplemental coverage plans. Residents can qualify for one of these Medicare Savings Programs:
- Individual monthly income limit: $1,456
- Married couple monthly income limit: $1,960
Medicaid
Medicaid aids low-income families and children. These are the state’s Medicaid financial requirements:
| Household Size | Maximum Yearly Income |
|---|---|
| 1 | $16,971 |
| 2 | $22,930 |
| 3 | $28,888 |
| 4 | $34,846 |
| 5 | $40,805 |
| 6 | $46,763 |
| 7 | $52,722 |
| 8 | $58,680 |
West Virginia Offices of the Insurance Commissioner
- Website:
- Homepage
- Insurance Commissioner:
- Allan L. McVey
- Insurance Hotline:
- (888) 879 – 9842
- Office Hours:
- Monday - Friday
8:00 am to 5:00 pm
- File a Consumer Insurance Complaint
- Complaint Page
Sources:
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