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 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 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.
Unlike most years, there’s a one-time enrollment window for individual/family health plans in West Virginia in 2021, which continues through August 15. Enrollment and plan changes are normally only available during the open enrollment period in the fall or when a person experiences a qualifying event, but the rules are different in 2021 as a result of the COVID pandemic and the additional premium subsidies available as a result of the American Rescue Plan.
West Virginia residents do not need a qualifying event in order to enroll or make a plan change during the extra enrollment window in 2021. People with off-exchange plans can use this window to switch to an on-exchange plan, which is important for people who are newly eligible for premium subsidies as a result of the American Rescue Plan’s elimination of the “subsidy cliff” (subsidies are only available on-exchange, which is why it’s important for people in this situation to switch to the exchange).
The subsidy cliff was a significant problem in West Virginia, given that average full-price premiums are the highest in the nation. Now that the American Rescue Plan has eliminated the subsidy cliff for 2021 and 2022, some West Virginia residents will find that they’re newly eligible for subsidies even with incomes well above 400% of the poverty level (the normal cut-off for subsidy eligibility).
Some people who already have a marketplace plan will find that a different plan will allow them the best opportunity to use the newly enhanced premium subsidies, and the COVID/American Rescue Plan enrollment window is an opportunity to make that change.
For 2021, West Virginia’s health insurance marketplace offers plans from two carriers – Highmark and CareSource. 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).
For 2021, CareSource increased average premiums by 8%, and Highmark increased average premiums by 4.34%. Nationwide, average premiums increased by a little over 1%.
West Virginia’s average premiums were already the highest in the nation in 2020, and that continues to be the case in 2021: The average full-price premium in 2021 is $1,038 per month. But very few enrollees pay full price; most receive premium subsidies, which cover an average of $835/month in West Virginia.
During the open enrollment period for 2021 coverage, 19,381 people enrolled in private plans through West Virginia’s exchange . This was a record low, lower than even 2014 enrollment, when the exchanges were brand new.
But nearly 2,000 additional people enrolled in private health plans through West Virginia’s exchange during the first 2.5 months of the COVID/American Rescue Plan enrollment period in 2021 (the window continues through August 15).
That was about double the normal enrollment pace during that time of year in West Virginia (in other years, a qualifying event would be necessary in order to enroll outside of the open enrollment window, but that’s not the case during the extra enrollment window in 2021).
Read more about West Virginia’s health insurance exchange.
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. More than 160,000 people enrolled 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 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 56% higher by late 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 554,374 by late 2020; it had been at around 510,000 in the spring of 2020. So Medicaid expansion enrollment had likely grown to nearly 200,000 people by late 2020.
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 442,062 West Virginia residents enrolled in Medicare plans as of early 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 21% (the other 79% 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%.
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.