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West Virginia health insurance

Two carriers are offering 2020 plans through the state's exchange

Health insurance in West Virginia

This page is dedicated to increasing healthcare accessibility by connecting the West Virginia consumer who needs health insurance coverage to helpful resources. Use this page to get answers to your questions about health insurance.

You’ll find information about the options for individual health insurance coverage and find links to help you get enrolled. You can find the basics of the West Virginia health insurance marketplace and upcoming open enrollment period; a brief overview of Medicaid expansion in West Virginia; a quick look at short-term health insurance availability in the state; statistics about state-specific Medicare rules; as well as a collection of health insurance resources for West Virginia residents.

The exchange, Medicare, and Medicaid all include coverage for medical and prescription drug expenses.

West Virginia’s health insurance marketplace

The West Virginia health insurance marketplace is a partnership exchange, which means residents (individuals or families) enroll in plans through The site is run by the federal government, with the state governing 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 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.

West Virginia open enrollment period and dates

The open enrollment period for 2021 coverage in West Virginia ran from November 1 through December 15, 2020. Outside of open enrollment, enrollment is available only for people with qualifying events. Native Americans can enroll year-round in the exchange, as can anyone eligible for Medicaid or CHIP.

It’s important for each consumer to visit the exchange each year. Enrollment does not carry over from one year to the next. The available health plan options offered on the marketplace vary from one year to the next, and an income change can affect your qualification for subsidies or cost-sharing reductions.

Health plan options on the West Virginia exchange

For 2020, West Virginia’s health insurance marketplace had two carriers – Highmark and CareSource – that provide access to health insurance plans. 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).

Across all three carriers, the average rate increase was 6.7 percent for 2020 — versus a national average of less than 0.2 percent. For 2021, CareSource has proposed an average rate increase of 6.26 percent, while Highmark has proposed an average rate increase of 4.34 percent.

Read more about West Virginia’s health insurance exchange.

Medicaid expansion in West Virginia

In general, Medicaid is a health insurance option for people with no or very low income or have a disability. Medicaid is run jointly by state and federal government; Medicaid is primarily funded by the federal government. Each state determines specific eligibility rules and operates the program within the overall guidance and requirements established by the federal government. Income limitations for eligibility vary by state and for adults, children, pregnant women, and people with disabilities. Some people qualify for both Medicaid and Medicare.

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 44 percent higher by April 2020 than it had been in 2013, prior to the expansion of Medicaid.

As of May 2020, there were 162,169 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 510,167).

West Virginia expanded CHIP in 2019 to include coverage for pregnant women.

Read more about West Virginia’s Medicaid expansion.

Short-term health insurance in West Virginia

Starting in October 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 maximum duration for short-term health plans, the state defaults to the federal rules.

Read more about short-term health insurance in West Virginia.

How has Obamacare benefited West Virginians?

As a result of the Affordable Care Act, the uninsured rate in West Virginia declined from 14 percent in 2013 to just 5.3 percent in 2016, according to U.S. Census data. But it had increased to 6.4 percent by 2018, in line with a nationwide trend of increasing uninsured rates under the Trump administration. (For perspective, the national average uninsured rate in 2018 was 8.9 percent). A large part of this is due to the ACA’s expansion of Medicaid, with nearly 160,000 people enrolled under the expanded guidelines in West Virginia.

West Virginia and the Affordable Care Act

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 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 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.

Does West Virginia have a high-risk pool?

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.

Medicare coverage and enrollment in West Virginia

Medicare covers people who are age 65 or older, certain people with disabilities, and people with end stage renal disease (ESRD).

  • Medicare terminology can be confusing. Here is a simplified explanation of the difference between common Medicare-related terms:
  • Medicare Part A covers inpatient hospital care.
  • Medicare Part B covers medical services.
  • Medicare Part D covers prescription drugs.
  • Original Medicare includes both Part A and Part B. Under original Medicare, the federal government pays directly for services you receive.
  • Medicare Part C, also called Medicare Advantage, covers parts A, B, and, D. Through Medicare Advantage, you can chose from one of several private health plans in your state, and the federal government pays the plan for the services you receive

There were 441,672 West Virginia residents enrolled in Medicare plans as of June 2020. That’s nearly 25 percent of the state’s total population. Nationwide, the average Medicare enrollment is less than 19 percent.

The state has a relatively high percentage of individuals who qualify for Medicare due to disability, at 21 percent (the other 79 percent 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 15 percent.

Read more about Medicare in West Virginia, including the state’s rules for Medigap plans.

State-based health reform legislation

Scroll to the bottom of this page for a summary of recent West Virginia legislation related to health care reform.

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 Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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