Medicare in West Virginia
Last Updated : 09/16/20185 min read
If you’re new to Medicare in West Virginia, you may be wondering how the health insurance program works. As a Medicare beneficiary, you may have many choices available to you, and it’s important to carefully compare and consider all options. Here’s an overview of how Medicare works, how to enroll, and the various ways you can get your coverage.
About Medicare in West Virginia
Beneficiaries in West Virginia have a choice between Original Medicare (Part A and Part B), which is administered by the federal government, and Medicare Advantage plans (Medicare Part C), which are another way to get your Medicare benefits through private insurance companies that are contracted with Medicare.
Medicare Advantage plans must include at least the same amount of coverage as Medicare Part A and Part B (excluding hospice care), but may have other benefits such as routine vision, dental, and prescription drug coverage. If you stay with Original Medicare, you can add stand-alone prescription drug coverage (Medicare Part D Prescription Drug Plans) and supplemental insurance (Medigap).
Types of Medicare coverage in West Virginia
Original Medicare is made up of two parts, Medicare Part A and Part B. You’re covered for inpatient hospital care under Medicare Part A, and doctor services, some durable medical equipment, and other items and services through Medicare Part B. Original Medicare doesn’t include prescription drug coverage.
Medicare Part D is optional prescription drug coverage. You can get this coverage in two ways: Medicare Part D Prescription Drug Plans provide stand-alone drug coverage for Original Medicare beneficiaries, while Medicare Advantage Prescription Drug plans provide both Medicare Part A, Part B, and Part D benefits. Not every Medicare Part D plan in Virginia may be available in each area.
Medicare Supplement insurance, also called Medigap, is a type of private insurance that may cover Medicare Part A and Part B out-of-pocket costs such as deductibles, copayments, and coinsurance. Most states (including West Virginia) offer up to 10 Medicare Supplement plans — each one marked by a letter. Plan details are standardized so that details are the same no matter where you buy the policy. For example, if you have a Medigap Plan N, coverage is the same as any other Medigap Plan N in the country, although prices may differ.
Medicare Advantage plans (Part C) provide at least the same level of coverage as Original Medicare. Under a Medicare Advantage plan, you get your Medicare Part A and Part B benefits through a private insurance company. In many cases the Medicare Advantage plan covers prescription drugs, so you can get all your Medicare benefits in a single plan. You still pay the Medicare Part B premium even if you join a Medicare Advantage plan.
Local resources for Medicare in West Virginia
Medicare Savings Programs in West Virginia: If you are a Medicare beneficiary in West Virginia and your income falls below a certain limit, then you may qualify for financial assistance from a Medicare Savings Program.
West Virginia State Health Insurance Counseling and Assistance Program (SHIP): SHIP is funded by the Centers for Medicare & Medicaid Services (CMS) to provide informational resources and counseling in each state.
How to apply for Medicare in West Virginia
Applying for Original Medicare in West Virginia works the same in every state. To qualify for Medicare, you must be either a United States citizen or a legal permanent resident of at least five continuous years. You can visit your local Social Security Administration (SSA) office, register online, or do so over the phone.
- Visit the Social Security website.
- Call Social Security at 1-800-772-1213 (TTY users should call 1-800-325-0778), Monday through Friday, 7AM to 7PM.
- Apply in person at a Social Security office. To look up the closest location to you, visit SSA.gov.
- If you worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772 (TTY users call 312-751-4701), Monday through Friday, 9AM to 3:30PM.
Some West Virginia residents can be enrolled automatically at age 65 provided they already receive retirement benefits through Social Security or the Railroad Retirement Board (RRB). Disabled residents can qualify for Medicare at any age if they receive Social Security disability benefits, or certain disability benefits from the Railroad Retirement Board, for 24 consecutive months. People who have amyotrophic lateral sclerosis (ALS) are automatically enrolled in the first month of disability benefits. Those who qualify for Medicare because of end-stage renal disease must apply manually.
If you aren’t receiving retirement yet when you turn 65, you’ll have to enroll manually in Medicare. You’re generally first eligible to enroll during your Initial Enrollment Period, the seven-month period that starts three months before your 65th birthday, includes the month you turn 65, and ends three months later.
If you receive Medicare benefits through Original Medicare, Part A and Part B, you may still wish to consider additional coverage. When looking to enroll in a Medigap, Medicare Advantage, or Medicare Part D plan, you may apply by contacting the plan directly, or by calling 1-800-MEDICARE (TTY users call 1-877-486-2048), 24 hours a day, seven days a week. You may also get help finding plan options through an insurance broker, such as eHealth.
As a West Virginia resident, it’s important to understand your Medicare options. I have a lot of experience explaining the various choices; I can discuss your particular situation with you and help you find suitable coverage options. To learn why I enjoy helping Medicare beneficiaries find plans, click on the “View profile” link under my picture. Would you like to schedule a phone call with me or request that I send you information? To do that, follow the links below. Anytime you like, you can click on the Compare Plans button on this page.