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Learn about short-term health insurance in West Virginia.
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Availability of short-term health insurance in West Virginia
In West Virginia, federal regulations limit initial durations of temporary health insurance plans to 364 days; this will drop to three months starting in September 2024
In West Virginia, federal regulations regarding short-term health insurance apply. Since 2018, this has allowed short-term policies to be sold with initial terms up to 364 days with the option to renew for a total duration up to 36 months.
However, those federal limits are changing in 2024 under new federal rules for short-term health plans. Short-term plans issued or sold on or after September 1, 2024 will be limited to total durations of no more than four months, including renewals. Initial terms will be capped at no more than three months.
As of 2024, there were at least five insurers selling short-term health insurance plans in West Virginia. Some of them have shorter term and policy duration limits than the maximums allowed under the state’s rules.
Frequently asked questions about short-term health insurance in West Virginia
Is short-term health insurance available for purchase in West Virginia?
Yes. As of 2024, there were at least five insurers offering short-term health insurance in West Virginia.
How much does short-term health insurance cost in West Virginia?
The average monthly premium for a short-term health insurance plan sold in West Virginia was $207.95 in 2023, according to data from IHC Specialty Benefits.
Which short-term plan durations are permitted under West Virginia rules?
West Virginia does not have regulations pertaining to the maximum duration for short-term health insurance plans, so the state defaults to the federal rules for short-term plan duration.
For plans sold or issued starting in September 2024, that means initial terms cannot exceed three months, and total duration, including renewals, cannot exceed four months.
The Trump Administration implemented short-term insurance rules in 2018, allowing the plans to have initial durations of up to 364 days. Renewals are permitted as long as the total duration of the coverage doesn’t exceed 36 months. Those rules are in place for plans sold or issued through August 2024.
Renewability is optional for insurers, and insurers can choose to offer plans with shorter terms. Some of the insurers that offer short-term health insurance in West Virginia cap their terms at six months and don’t allow for any renewals.
Who can buy short-term health insurance in West Virginia?
Short-term health insurance plans in West Virginia can be purchased by those who can meet the underwriting guidelines used by insurers.
In most cases, insurers will issue short-term health insurance to people under 65 years old and who don’t have any of the medical conditions that would result in a declined application.1 But the specific requirements vary from one insurance company to another.
Most short-term health insurance plans do not cover pre-existing conditions. And it’s common for them to use post-claims underwriting (meaning that they will go back through a person’s medical records after a claim is filed, to make sure it isn’t related to a pre-existing medical condition).2
Short-term health plans do not have to cover the ACA’s essential health benefits. The most often excluded are maternity care, prescription drugs, and mental health care.1 And the plans generally impose dollar limits on the coverage they do provide. It’s important to double-check all of the plan information before purchasing a short-term policy, to make sure that you understand the limitations of the plan.
If you need health insurance coverage in West Virginia, you’ll want to first determine whether you can enroll in an ACA-compliant major medical plan (ie, an Obamacare plan), either through the health insurance exchange (marketplace) in West Virginia or directly from an insurance company.
(Note that while the plans will be fully compliant with the ACA either way, premium subsidies and cost-sharing reductions are only available if you enroll through the exchange. Premium subsidy eligibility has been expanded under the American Rescue Plan and Inflation Reduction Act, but you have to enroll through the exchange to receive those benefits.)
In West Virginia, open enrollment for self-purchased ACA-compliant plans runs from November 1 – January 15 each year. Outside that window, you may still be able to enroll if you experience a qualifying life event that triggers a special enrollment period.
ACA plans are purchased on a month-to-month basis, so you can enroll in one even if you only keep it for a few months before another policy takes effect. So if you’ll soon be covered under Medicare, for example, or a new employer’s plan, you can still enroll in an ACA-compliant plan if you’re eligible to do so, and then cancel the coverage when the new plan takes effect.
And if you qualify for premium subsidies, the coverage may end up being much less costly than you had anticipated — perhaps even more affordable than a short-term health plan.
It’s also important to note that West Virginia has expanded Medicaid under the ACA. Adults under the age of 65 can enroll in Medicaid if their household income is up to 138% of the poverty level (f0r a single adult in 2024, that amounts to $20,782 in total annual income). And Medicaid eligibility can be based on monthly income, rather than yearly income. So if you’ve recently lost your job, for example, you may qualify for Medicaid to cover the gap until you’re employed again and receiving coverage under an employer’s healthcare plan.
But short-term plans can serve as a safety net if you’ve got no other alternatives.
When should I consider buying short-term health insurance in West Virginia?
An ACA-compliant health plan will provide better coverage than a short-term health plan. But depending on the circumstances, there may be scenarios in which a short-term health insurance policy is the only — or only realistic — alternative. For example:
- You missed open enrollment for ACA-compliant individual market coverage and do not have a qualifying event that would trigger a special enrollment period. (In this case, it’s important to pay attention to enrollment dates and make sure you sign up for an ACA-compliant plan during the next open enrollment period or if and when you qualify for a special enrollment period.)
- You’ll soon be enrolled in Medicare and aren’t eligible for any other coverage in the meantime. Note that although you’ll receive your Medicare card about three months before you turn 65 (assuming you’re already receiving Social Security benefits), your Medicare benefits don’t start until the month you turn 65, so you do need other healthcare coverage up to that point.
- You’re newly employed and the business has a waiting period of up to three months before you can enroll in the group health plan.
- You’ve already enrolled in an ACA-compliant plan, but have to wait up to several weeks until your new plan takes effect. For example, if you enroll during open enrollment, your new plan won’t take effect until January 1 or February 1, depending on the date you enroll. And if you sign up during a special enrollment period, you’ll generally have to wait until at least the start of the following month before your new plan is effective.
- You’re not eligible for Medicaid or a premium subsidy in the exchange. Depending on your circumstances, the monthly premiums for ACA-compliant plans might be too costly. Although the American Rescue Plan and Inflation Reduction Act have made subsidies larger and more widely available through the end of 2025, subsidies are not available to people who cannot enroll in a plan through the exchange because they are not lawfully present in the U.S.
How does West Virginia regulate the sale of short-term health insurance?
Insurers that offer short-term health insurance in West Virginia are required to file rates and plans with the West Virginia Office of the Insurance Commissioner.
The insurance commissioner’s office has published a guide for consumers, illustrating how short-term health insurance plans compare to ACA-compliant coverage, highlighting the fact that short-term health plans are not required to cover essential health benefits. The state passed legislation (SB273) in 2018 designed to reduce opioid utilization, and the Office of the Insurance Commissioner confirmed that the insurance-related provisions of that bill do apply to short-term plans.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org.
Footnotes
- ”ACA Open Enrollment: For Consumers Considering Short-Term Policies” KFF.org. Oct. 25, 2019 ⤶ ⤶
- ”Short-Term, Limited-Duration Insurance and Independent, Noncoordinated Excepted Benefits Coverage” U.S. Department of Health and Human Services. April 3, 2024 ⤶