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West Virginia health insurance

Two carriers are offering 2020 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.

Open enrollment for 2020 coverage in West Virginia has ended. Open enrollment will begin again, for 2021 health plans, on November 1, 2020. For 2020 health coverage, enrollment is now available only for people with qualifying events.

(Native Americans can enroll year-round in the exchange, as can anyone eligible for Medicaid or CHIP.)

West Virginia’s exchange has two carriers – Highmark and CareSource – offering 2020 health plans through the exchange. 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 is 6.7 percent for 2020 — versus a national average of less than 0.2 percent.

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 total Medicaid/CHIP enrollment was 49 percent higher by September 2019 than it had been six years earlier, prior to the expansion of Medicaid.

As of mid-December 2019, there were 157,834 West Virginia residents enrolled in expanded Medicaid in the state (total Medicaid/CHIP enrollment, including people who were eligible under the pre-ACA rules, stood at 528,036 as of the fall of 2019.

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 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. 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

Senator 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.

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

There were 439,300 West Virginia residents enrolled in Medicare coverage as of October 2019. That’s 24.5 percent of the state’s total population. Nationwide, the average 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.

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 — there are pros and cons to either option. In 2018, 26 percent of all West Virginia Medicare recipients selected a Medicare Advantage plan – compared with 33 percent nationwide.

In late 2019, there were 188,749 West Virginia Medicare beneficiaries with stand-alone Part D coverage. An additional 121,899 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: