West Virginia health insurance Marketplace guide

Anyone who meets the following criteria can buy Marketplace health coverage in West Virginia:

• You live in West Virginia
• You’re a U.S. citizen, national, or lawfully present
• You’re not incarcerated
• You don’t already have Medicare

Your eligibility for financial assistance, like premium subsidies and cost-sharing reductions, depends on your income. In addition, to qualify for financial help on the Marketplace, you must:

• Not have access to affordable health coverage through your employer. If you think your employer’s health coverage is too expensive, use our Employer Health Plan Affordability Calculator to see if Marketplace premium subsidies are available to you.
• Not be eligible for West Virginia Medicaid or CHIP.
• Not be eligible for premium-free Medicare Part A.⁴
• If married, file a joint tax return.⁵
• Not be able to be claimed by someone else as a tax dependent.⁵

You can sign up for an ACA-compliant individual or family health insurance in West Virginia between November 1 and January 15 during open enrollment.⁶ 

Sign up by December 15 for your coverage to start on January 1. If you enroll between December 16 and January 15, your coverage will begin on February 1. 

Due to a federal rule change that was finalized in 2025, the open enrollment period will become shorter starting in the fall of 2026: The enrollment window will end on December 15, and all plans selected during open enrollment will take effect January 1.

Outside of open enrollment, you can only sign up for coverage or switch plans if you qualify for a special enrollment period (SEP). In most cases, SEPs are time-limited and triggered by a qualifying life event. But Native Americans can enroll anytime throughout the year.

Use one of the following options to enroll in a Marketplace plan in West Virginia:

• Visit HealthCare.gov
• Call 1-800-318-2596 (TTY: 1-855-889-4325). The call center is available 24 hours a day, seven days a week, except for holidays.
  

You can find local help from local insurance agents, brokers, or certified application counselors. They help you review Marketplace plan options and choose a plan to fit your needs. Find help at localhelp.HealthCare.gov.⁷

You can also enroll in a West Virginia Marketplace plan via an approved enhanced direct enrollment entity.⁸

You can find affordable health plans in West Virginia on the ACA Marketplace (HealthCare.gov).

Across people who enrolled in West Virginia Marketplace coverage during the open enrollment period for 2025 coverage:⁹

• 97% of enrollees were receiving advance premium tax credits (premium subsidies).
• The average premium subsidy amount was $1,102 per month (this is the largest average premium subsidy in the nation, because West Virginia has the nation’s highest full-price premiums). After the subsidies were applied, the average net premium for subsidy-eligible West Virginia Marketplace enrollees was about $74/month. Including the 3% of enrollees who paid full price, the average net premium was about $101/month.
• Thirty-nine percent of West Virginia Marketplace enrollees signed up for plans with built-in cost-sharing reductions (CSR), which are available on Silver-level plans if household income isn’t more than 250% of the federal poverty level.¹⁰ CSRs help reduce deductibles and other out-of-pocket expenses.

As noted above, West Virginia has the nation’s highest average Marketplace premiums,¹¹ which makes premium subsidies particularly important in terms of ensuring affordability. If Congress doesn’t extend the federal subsidies enhancements that are scheduled to expire at the end of 2025, after-subsidy premiums will increase sharply in 2026. And for West Virginia enrollees with household income above 400% of the federal poverty level, the return of the “subsidy cliff” (which will happen if the federal subsidy enhancements are allowed to expire) will be particularly challenging.

Source: CMS.gov⁹

Medicaid is another affordable health insurance option if you’re eligible. West Virginia expanded Medicaid under the ACA, so adults under age 65 are eligible for Medicaid with a household income up to 138% of the federal poverty level.

Two companies will offer 2026 individual and family plans through West Virginia’s exchange:²

• CareSource West Virginia Co.
• Highmark Blue Cross Blue Shield West Virginia

Both companies offered Marketplace coverage statewide in 2025.¹²

The following average premium changes have been proposed by West Virginia’s Marketplace insurers for 2026:²

Source: RateReview.HealthCare.gov²

The proposed rates apply to full-price premiums, before subsidies are applied. It’s important to understand, however, that if Congress doesn’t extend the federal subsidies enhancements that are scheduled to expire at the end of 2025, after-subsidy premiums will increase sharply in 2026, and some people will lose their subsidies altogether. This will be particularly challenging in a state like West Virginia, where full-price premiums are the highest in the country.¹¹

For perspective, here’s an overview of how average full-price (unsubsidized) premiums have changed in West Virginia’s individual market over time (note that in years where multiple carriers offer plans, the averages may be unweighted as enrollment numbers in West Virginia filings are often redacted):

• 2015: Average increase of 10%.¹³
• 2016: Average increase of 24%.¹⁴ (second carrier began participating)
• 2017: Average increase of 45%.¹⁵
• 2018: Average increase of 25%.¹⁶
• 2019: Average increase of 9%.¹⁷
• 2020: Average increase of 7%.¹⁸
• 2021: Average increase of 5%. ¹⁹
• 2022: Average increase of 13%.²⁰
• 2024: Average increase of 1.7%²¹
• 2025: Average increase of 7%²²

67,113 people enrolled in private plans through West Virginia’s Marketplace during the open enrollment period for 2025 coverage.²³ That was by far a record high.

As illustrated below, West Virginia’s Marketplace enrollment has been climbing since 2022, largely due to the American Rescue Plan’s enhancements of the ACA’s premium subsidy rules. The Inflation Reduction Act has extended the ARP’s subsidy enhancements through 2025. 

The enrollment growth in 2024 and 2025 was also driven by the “unwinding” of the pandemic-era Medicaid continuous coverage rule. CMS reported that nearly 29,000 people transitioned from Medicaid to a West Virginia Marketplace plan during the unwinding process.²⁴

Source: 2014,²⁵ 2015,²⁶ 2016,²⁷ 2017,²⁸ 2018,²⁹ 2019,³⁰ 2020,³¹ 2021,³² 2022,³³ 2023,³⁴ 2024,³⁵ 2025²³

HealthCare.gov
This is the ACA Marketplace, where you can enroll in a health insurance plan online. You may also get help by calling (800) 318-2596. 

West Virginia Offices of the Insurance Commissioner
Oversees and regulates insurance companies, brokers, and agents in the state while assisting consumers with insurance-related inquiries and concerns. 

West Virginia Navigator
A free, non-profit program accessible to all residents within the state, providing free enrollment assistance. 

West Virginia Senior Health Insurance Assistance Program (SHIP)
Helps answer questions and help Medicare beneficiaries.