Frequently asked questions about health insurance
coverage options in West Virginia
The West Virginia health insurance marketplace is a partnership exchange, which means residents (individuals or families) enroll in plans through HealthCare.gov. The HealthCare.gov site is run by the federal government, with the state overseeing the qualified health plan certification process for the plans that are offered in West Virginia. The marketplace, which is also called the health insurance exchange, was established by the Affordable Care Act.
You can use the marketplace to enroll in healthcare for yourself or your family and to see if you qualify for premium subsidies or cost-sharing reductions (CSR) to help you pay for monthly premiums and other costly out-of-pocket expenses (like a deductible or copay). The health insurance marketplace is a good option for people who are self-employed or employed by a business or other organization that doesn’t provide health insurance coverage.
Read our overview of the West Virginia health insurance marketplace.
The open enrollment period for 2022 coverage ran from November 1, 2021 to January 15, 2022.
Outside of the annual open enrollment window, you’ll need a special enrollment period to enroll or make a change to your coverage. Most special enrollment periods are linked to qualifying life events, but there are some special enrollment periods (such as the enrollment opportunity for Native Americans, or for people earning under 150% of the poverty level) that don’t depend on experiencing a specific life event.
Health Plan of West Virginia (Optum) also offers ACA-compliant coverage in the state, but only outside the exchange (and their enrollment is very low).
Overall average rates increased by almost 13% in West Virginia for 2022. The following average rate changes have been approved for West Virginia’s marketplace insurers:
- CareSource: 14.9% average increase
- Highmark: 11.6% average increase
These are quite a bit higher than the average rate increases we saw across most states for 2022. Nationwide, average premiums increased by about 3.5%. But many residents may find that their coverage is more affordable in 2022 than it was in previous years.
West Virginia regulators instructed insurers to start adding the cost of cost-sharing reductions (CSR) to silver plan rates for 2022, instead of spreading the cost across rates for all plans (West Virginia had been one of just three states taking that approach through 2021). The result is that silver plan rates are disproportionately larger for 2022, which result in larger premium subsidies as well (subsidies are based on the price of the second-lowest-cost silver plan).
The combination of enhanced premium subsidies under the American Rescue Plan (in place through the end of 2022) and the silver-loading approach to CSR result in larger subsidies and more affordable coverage for enrollees who receive subsidies.
There are very few West Virginia enrollees who don’t qualify for subsidies in 2022. The American Rescue Plan eliminated the income cap for subsidy eligibility through the end of 2022. And the state’s highest-in-the-nation full-price premiums (an average of $1,038 per month in 2021) mean that nearly all enrollees qualify for subsidies.
As a result of the Affordable Care Act, the uninsured rate in West Virginia declined from 14% in 2013 to just 5.3% in 2016, according to U.S. Census data. But it had increased to 6.7% by 2019, in line with a nationwide trend of increasing uninsured rates under the Trump administration. (For perspective, the national average uninsured rate in 2019 was 9.2%).
A large part of the reason for West Virginia’s lower-than-average uninsured rate is the state’s decision to accept federal funding for Medicaid expansion under the ACA. Nearly 190,000 people were enrolled as of mid-2021 under the expanded eligibility guidelines in West Virginia.
Sen. Joe Manchin is the only Democratic member of West Virginia’s Congressional delegation, and the only one who supports the ACA.
Although Senator Shelly Capito has taken a more moderate stance than many of her fellow Republican Senators, she ultimately voted in favor of all of the Better Care Reconciliation Act and “skinny repeal” in July 2017, although she voted against the Obamacare Repeal Reconciliation Act. Capito voted in favor of the tax reform bill that passed the Senate in early December 2017, which includes some of the provisions of the “skinny repeal” bill, including repeal of the ACA’s individual mandate.
In the House of Representatives, all three of West Virginia’s representatives are Republicans, and all are opposed to the ACA.
Gov. Jim Justice won the 2016 gubernatorial election in West Virginia. Justice ran as a Democrat (albeit a conservative one, intent on reviving the coal mining industry in West Virginia), and won despite the fact that the state overwhelmingly voted for Donald Trump for president. In August 2017, however, Justice announced that he was switching to the Republican party. While he was a Democrat, Justice had voiced his opposition to the US House legislation that would have repealed the ACA.
The previous governor, Democrat Earl Ray Tomblin took office in 2010 (replacing Manchin, who left the Governor’s office for the Senate), and was generally supportive of the ACA. He opted to expand Medicaid, which has had a huge impact on the uninsured rate in West Virginia in 2014. But Tomblin was term-limited, and could not run again in 2016.
West Virginia operates a partnership exchange with the federal government, using Healthcare.gov as their portal for residents to select plans. They opted for this route instead of running their own exchange, because they felt that they would get more bang for their buck by expanding Medicaid and letting HHS handle the operational aspect of the exchange. The state has frequently been held up as an example of how successful Medicaid expansion can be when implemented well.
West Virginia opted to expand Medicaid eligibility under the Affordable Care Act in 2014. Under the new eligibility guidelines, West Virginia’s total Medicaid/CHIP enrollment was 66% higher by July 2021 than it had been in 2013, prior to the expansion of Medicaid.
As of mid-2021, there were 189,640 residents enrolled in Medicaid plans through the West Virginia Medicaid expansion. Total Medicaid/CHIP enrollment, including people who were eligible under the pre-ACA rules, stood at 588,279 by July 2021; it had been at around 510,000 in the spring of 2020. Medicaid expansion enrollment has likely grown to nearly 200,000 people, due in part to the COVID pandemic.
West Virginia expanded CHIP in 2019 to include coverage for pregnant women.
Read more about West Virginia’s Medicaid expansion.
Starting in October 2018, new federal rules regarding short-term insurance allow plans to have initial durations of up to 364 days, and renewals are permitted as long as the total duration of the coverage doesn’t exceed 36 months. Since West Virginia does not have regulations pertaining to the maximum duration for short-term health plans, the state defaults to the federal rules.
Read more about short-term health insurance in West Virginia.
There were 443,555 West Virginia residents enrolled in Medicare plans as of late 2021. That’s 25% of the state’s total population; nationwide, about 19% of Americans are covered by Medicare.
The state has a relatively high percentage of individuals who qualify for Medicare due to disability, at 19% (the other 81% are eligible due to being at least 65 years old). Only four states have a higher percentage of beneficiaries eligible due to disability, and the national average is 14%.
Read more about Medicare in West Virginia, including the state’s rules for Medigap plans.
From 2005 until 2014, West Virginia did have a high-risk pool. Prior to Obamacare, in nearly every state, applicants’ medical history could prevent them from obtaining coverage in the private individual insurance market, or could result in significantly higher premiums or pre-existing condition exclusions. Thirty-five states – including West Virginia – took it upon themselves to create their own high-risk pools (not to be confused with the PICP risk pools created by the ACA in 2010).
AccessWV was created in 2005 to give people an alternative coverage option if they could not get individual health insurance because of their medical history. Now that all health insurance plans are guaranteed issue – thanks to the ACA – high-risk pools are largely obsolete. AccessWV stopped accepting new members in November 2013, but continued to cover existing members until March 31, 2014. At that point, the program ceased operation.