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West Virginia health insurance

Two carriers are offering 2019 plans through the state's exchange; short-term plans are limited to durations of 185 days.

Health insurance in West Virginia

West Virginia’s health marketplace

State legislative efforts to preserve or strengthen provisions of the Affordable Care Act

West Virginia is one of the states that has done the least to preserve the Affordable Care Act’s provisions.

West Virginia has a partnership exchange, which means residents enroll in exchange plans through, but the state oversees the plans that are sold through the exchange.

West Virginia residents had until December 15, 2018 to enroll in a plan for 2019 — on or off-exchange. After that, individual market coverage for 2018 will only be available to people who experience a qualifying event during the year. (Native Americans can enroll year-round in the exchange, as can anyone eligible for Medicaid or CHIP.)

In 2017, 27,409 people enrolled in plans through West Virginia’s exchange – a 19 percent drop from the 2017 enrollment total. Only Louisiana had a larger percentage drop in enrollment from 2017 to 2018. And from 2016 to 2018, enrollment in West Virginia’s exchange was down more than 26 percent — a drop of nearly 10,000 people.

West Virginia’s exchange has two carriers – Highmark and CareSource – offering 2019 health plans through the exchange. Charles Gaba, at, estimates that the average rate increase for individual health plans in the state will be about 9.28 percent higher for 2019.

Medicaid expansion in West Virginia

West Virginia opted to expand Medicaid under the Affordable Care Act in 2014.  Under the new eligibility guidelines, West Virginia’s Medicaid enrollment grew by almost 62 percent from mid-2013 and October 2016. By March 2018, nearly 166,000 West Virginians had enrolled in Medicaid thanks to the ACA’s expansion.

As of late 2017, West Virginia’s Department of Health and Human Resources was considering the possibility of seeking a waiver from the federal government in order to implement a work requirement for the state’s Medicaid expansion population. (However, as of March 2018, West Virginia did not have any pending 1115 waivers with CMS, so nothing had been submitted at that point.)

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 helped 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. (For perspective, the national average uninsured rate in 2016 was 8.6 percent). A large part of this is due to the ACA’s expansion of Medicaid; more than 200,000 people gained coverage under Medicaid and CHIP in West Virginia between late 2013 and September 2017.

Primarily because of Medicaid expansion, West Virginia was one of the states predicted to see the largest drop in its uninsured rate following implementation of the Affordable Care Act (aka, Obamacare). According to U.S. Census data, the state’s uninsured rate was fairly comparable to the U.S. average in 2013, but was well below the national average by 2016.

West Virginia’s uninsured population at about 14 percent in 2013 (compared with 14.5 percent nationwide), and that number fell to 5.3 percent by 2016.

The ACA is given most of the credit for the state’s success in reducing its uninsured population, as much of it comes from the expansion of Medicaid, which is a provision in the ACA.

West Virginia and the Affordable Care Act

In 2010, both of West Virginia’s U.S. Senators – Robert Byrd and John Rockefeller – voted yes on the health reform law. In the House, the two Democratic Representatives voted yes: Alan Mollohan and Nick Rahall. Republican Representative Shelley Capito voted against the ACA.

The makeup of West Virginia’s congressional delegation has changed considerably since 2010. Capito is now a Senator, along with Joe Manchin, a moderate Democrat. Mollohan and Rahall have since been replaced with Republicans in the House. So all of West Virginia’s Representatives are Republicans, and all are opposed to the ACA.

Senator Manchin is the only current member of West Virginia’s Congressional delegation who supports the ACA. Although 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.

Governor 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?

Prior to Obamacare, in nearly every state, applicants’ medical history could prevent them from obtaining coverage in the private 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 in the state of West Virginia

In 2017, 433,494 West Virginia residents were enrolled in Medicare coverage. That’s 24 percent of the state’s total population. Nationwide, the average was about 18 percent.

The state has a relatively high percentage of individuals who qualify for Medicare due to disability – 21 percent. Only four states have a higher percentage of beneficiaries eligible due to disability. The remainder of West Virginia Medicare enrollees are eligible due to age.

Annual per-enrollee Medicare spending in West Virginia was $9,070 in 2016. That was slightly below national spending ($9,533).

West Virginians can enroll in Medicare Advantage plans instead of Original Medicare. These private plans offer additional benefits. In 2017, 25 percent of all West Virginia Medicare recipients selected a Medicare Advantage plan – compared with 33 percent nationwide.

In late 2018, there were 196,961 West Virginia Medicare beneficiaries with stand-alone Part D coverage. An additional 106,792 had Part D coverage as part of their Medicare Advantage plans.

State-based health reform legislation

Recent bills in the West Virginia legislature related to health reform include: