Original Medicare can be a great source of foundational health insurance, but what if you could get more out of your Medicare plan? 

Medicare Advantage plans, while they can cost more than Original Medicare, offer a much more expansive range of benefits and coverage. Whether it’s dental, vision, hearing, or prescription drug coverage (among others), an MA plan could fill in many gaps inherent to Medicare Part A and Medicare Part B. If you’re looking to join the thousands of West Virginian Medicare beneficiaries, keep reading below!

Eager to get your search started right away? Check out Insurify’s plan-comparison tool! It’s free and easy to use and will give you everything you need to confidently find the right plan for you!

 

 

What Are the Best West Virginia Medicare Advantage Plans?

Though the following list includes some of the more highly rated insurance plans in West Virginia, it’s important to note that the star ratings may not indicate whether a plan works for your situation. Be sure to take stock of both your medical needs and your financial limitations before committing to a plan.

Also, as a disclaimer, this list is not intended as an endorsement of these plans or their providers. This is intended as a list of the top-rated MA plans in West Virginia.

#1 HumanaChoice H5216-021 (PPO)

    • Monthly Premium: $45
    • Prescription Drug Plan Deductible: $0
    • Out-of-Pocket Maximum: $6,700
    • Service Area Counties: Cabell, Braxton, Boone, Fayette, Clay, Mercer, Mason, Kanawha, Lincoln, Lewis, Putnam, Nicholas, Monroe, Roane, Webster, Wayne, Upshur

With a fairly moderate premium of $45 and a prescription drug deductible of $0, this plan appears to be fairly affordable up front. The prescription drug co-pays and coinsurance rates are moderate as well, along with low doctor visit co-pays. Although this plan has affordable preventive care coverage, coverage for benefits like hearing, vision, and dental can be a bit spotty, considering which services are actually covered. This plan earns four stars out of five.

#2 Humana Gold Plus H5619-113 (HMO)

    • Monthly Premium: $0
    • Prescription Drug Plan Deductible: $0
    • Out-of-Pocket Maximum: $6,700
    • Service Area Counties: Boone, Mason, Cabell, Logan, Kanawha, Lincoln, Wayne, Mingo, Putnam

Given its monthly premium and drug plan deductible of $0, this plan seems affordable, despite its moderate out-of-pocket maximum. This plan does have fairly competitive prescription drug co-pays and coinsurance rates but does not offer optional supplemental benefits. However, the doctor and specialist co-pays are fairly low, and the plan offers some hearing, dental, and vision coverage, among other benefits. With all of that considered, this plan earns four stars out of five.

#3 Humana Value Plus H5216-125 (PPO)

    • Monthly Premium: $22.10
    • Prescription Drug Plan Deductible: $445
    • Out-of-Pocket Maximum: $7,550
    • Service Area Counties: Wayne, Upshur, Tyler, Wetzel, Webster, Wirt, Wyoming, Wood, Tucker, Roane, Summers, McDowell, Calhoun, Barbour, Cabell, Brooke, Berkeley, Braxton, Boone, Doddridge, Hampshire, Clay, Greenbrier, Fayette, Grant, Gilmer, Harrison, Logan, Hardy, Hancock, Lincoln, Jackson, Kanawha, Lewis, Jefferson, Mingo, Marion, Marshall, Mineral, Mercer, Mason, Preston, Pocahontas, Monongalia, Morgan, Monroe, Nicholas, Pleasants, Pendleton, Ohio, Putnam, Randolph, Ritchie, Raleigh, Taylor

With a premium of $22.10, this plan will cost a minimum of $265.20 annually. Along with a relatively high prescription drug deductible and out-of-pocket maximum, this plan appears to be a bit steep at first. One major upside, however, is the extremely wide service area, which means that you’ll likely have access to this plan’s hearing, dental, vision, mental health, and other benefits regardless of where you live in West Virginia. On top of all that, you’ll get coverage for diabetes supplies, durable medical equipment, and prosthetics if you need them. Overall, this plan gets four stars out of five. 

#4 The Health Plan SecureCare Capitol Plan H3672-023 (HMO)

    • Monthly Premium: $65
    • Prescription Drug Plan Deductible: $100
    • Out-of-Pocket Maximum: $6,700
    • Service Area Counties: Boone, Putnam, Clay, Kanawha, Fayette, Jackson

This plan has a pretty narrow service area, as well as a monthly premium of $65 (costing $780 per year). Despite this, it has a low prescription plan deductible, as well as extremely competitive prescription drug co-pays and coinsurance rates. In fact, generic drugs have a co-pay of $3.70 or coinsurance of 5 percent, whichever costs more. If you require a steady supply of medication, this plan might be a good one for you. With a handful of other helpful benefits, this plan earns four stars out of five.

#5 The Health Plan SecureCare – Option II H3672-020 (HMO)

    • Monthly Premium: $65
    • Prescription Drug Plan Deductible: $100
    • Out-of-Pocket Maximum: $6,700
    • Service Area Counties: Mineral, Pocahontas, Barbour, Mercer, Mason, Grant, Monroe, Monongalia, Mingo, Morgan, Pleasants, Pendleton, Ohio, Nicholas, Raleigh, Preston, Wyoming, Taylor, Summers, Randolph, Roane, Ritchie, Upshur, Tyler, Tucker, Wayne, Wood, Webster, Wirt, Wetzel, Gilmer, Greenbrier, Berkeley, Marion, Hardy, Lewis, Lincoln, Hancock, Hampshire, Jefferson, Harrison, Logan, Marshall, McDowell, Calhoun, Doddridge, Cabell, Brooke, Braxton

Though this plan appears extremely similar to the previous one, it has a much more expansive service area. In addition, this plan offers an optional supplemental dental benefit, as well as extremely low co-pays for diabetes supplies. Like the previous plan, this one gets four stars out of five.

#6 WVU Medicine – The Health Plan SecureCare H3672-025 (HMO)

    • Monthly Premium: $23
    • Prescription Drug Plan Deductible: $100
    • Out-of-Pocket Maximum: $6,700
    • Service Area Counties: Upshur, Monongalia, Berkeley, Marion, Harrison, Mineral, Marshall, Wetzel, Wood

This plan has prescription drug coverage comparable to the previous two plans, so if medication is a priority, this plan might work for you. On the downside, the service area is fairly limited. The monthly premium will create a baseline cost of $276 per year, which isn’t extravagant, but isn’t the cheapest you can find. Like the previous plan, you can add a comprehensive dental benefit for an extra $23.60 per month. 

#7 AARP Medicare Advantage Choice Plan 1 H8211-001 (PPO)

    • Monthly Premium: $34
    • Prescription Drug Plan Deductible: $200
    • Out-of-Pocket Maximum: $5,900
    • Service Area Counties: Doddridge, Grant, Greenbrier, Hampshire, Hancock, Hardy, Harrison, Jackson, Jefferson, Kanawha, Lewis, Lincoln, Logan, McDowell, Marion, Marshall, Mason, Mercer, Mineral, Mingo, Monongalia, Morgan, Nicholas, Ohio, Pendleton, Preston, Putnam, Randolph, Ritchie, Roane, Summers, Taylor, Tucker, Upshur, Wayne, Webster, Wetzel, Wirt, Wood, Wyoming, Gilmer, Brooke, Cabell, Braxton, Boone, Berkeley, Clay, Calhoun, Fayette, Barbour

With a fairly wide service area, this plan is accessible throughout a wide swath of West Virginia. The monthly premium creates a yearly cost of $408, along with a moderate prescription drug deductible. With the inclusion of some vision, dental, hearing, and mental health coverage, this plan earns 3.5 stars out of 5.

#8 AARP Medicare Advantage Choice Plan 2 H8211-002 (PPO)

    • Monthly Premium: $49
    • Prescription Drug Plan Deductible: $100
    • Out-of-Pocket Maximum: $5,400
    • Service Area Counties: Barbour, Berkeley, Boone, Braxton, Brooke, Cabell, Calhoun, Clay, Doddridge, Fayette, Gilmer, Grant, Greenbrier, Hampshire, Hancock, Hardy, Harrison, Jackson, Jefferson, Kanawha, Lewis, Lincoln, Logan, McDowell, Marion, Marshall, Mason, Mercer, Mineral, Mingo, Monongalia, Morgan, Nicholas, Ohio, Pendleton, Preston, Putnam, Randolph, Ritchie, Roane, Summers, Taylor, Tucker, Upshur, Wayne, Webster, Wetzel, Wirt, Wood, Wyoming

As with the previous plan, this one also has a very wide service area, along with a fairly moderate monthly premium, which costs a baseline of $588 per year. This plan also offers some vision, dental, mental health, hearing, and wellness benefits. With other plan aspects carrying hefty costs (such as those for ambulances services and out-of-network medical supplies), this plan earns 3.5 stars out of 5.

Ready to look at more plans like these? Make use of Insurify’s plan-comparison tool! With the ability to make side-by-side comparisons and access detailed plan information, you’ll find the right plan for you in no time. 

Compare Medicare Advantage Side-by-Side

Compare Now

How Much Does Medicare Advantage Cost in West Virginia?

For 2021, the average premium for Medicare Advantage plans in West Virginia sits at $32.30 a month. Annually, this would cost an average of $387.60. While this may seem low, it does not necessarily take into consideration a number of different factors, such as:

    • Co-pay and coinsurance rates, which can vary from plan to plan
    • Service area coverage, which could make various West Virginia residents ineligible for plans that provide needed coverage at affordable rates
    • Additional plan benefits and coverage options, which if selected, could directly increase the overall cost of the plan
    • A plan’s actual network of healthcare providers, which can vary in size and costs for medical services
    • Medicare Part B premiums, which you will still be required to pay in addition to regular MA plan costs

 

What Is Medicare Advantage?

Medicare Advantage, also known as Medicare Part C, is an alternative to Original Medicare. Offered by private insurance companies (approved by the Centers for Medicare & Medicaid Services), Medicare Advantage plans are bundled policies that include Original Medicare coverage

They can also include various additional benefits, like Medicare Part D prescription drug, vision, hearing, and dental coverage, among many others. Some health plans might also tailor their coverage to benefit individuals suffering from specific chronic illnesses, such as diabetes or end-stage renal disease (ESRD).

Given that these plan options come from private insurers, their overall cost, coverage, and service areas can vary. The baseline portions of Medicare Parts A and B will always be included in an MA plan, but everything beyond that is not standardized and will require closer research to ensure that a plan can work for you.

For more information on Medicare Advantage, please visit www.medicare.gov, or call 1 (800) 633-4227; TTY users can call 1 (877) 486-2048.

What Types of Medicare Advantage Plans Are Available in West Virginia?

Health Maintenance Organization (HMO): HMO plans provide coverage for doctors, hospitals, and other healthcare providers in your plan’s network. Any visits outside your provider network will generally not receive coverage (unless those visits are for emergency or urgent care). For specialist services, you will need a doctor’s referral.

Preferred Provider Organization (PPO): A PPO plan is more flexible than an HMO, allowing you to visit doctors or other healthcare providers out of your network (albeit at a higher cost). For in-network providers, you can expect to pay less in coinsurance and co-payments.

Private Fee-for-Service (PFFS): PFFS plans generally have few limits on which medical service providers you can visit. However, these plans also reserve the right to decide how much they will cover for doctor visits, hospital visits, and other medical services.

Special Needs Plan (SNP): SNP insurance policies restrict eligibility to individuals who live in an institution (such as a nursing home) or suffer from a chronic health condition (such as HIV/AIDS, end-stage renal disease, or diabetes). Dual special needs plans (D-SNPs) exist for individuals who qualify for both Medicare and Medicaid.

Medicare Advantage Prescription Drug Plan (MA-PD): MA-PD plans roll health and prescription drug coverage into one plan. This type of plan serves as an alternative to the Medicare Part D plans you would have to enroll in if you had Original Medicare and needed prescription drug coverage.

 

 

FAQ: West Virginia Medicare Advantage

How do I enroll in a Medicare Advantage plan?

The first way to enroll in Medicare Advantage is during your Initial Enrollment Period, which begins three months prior to your 65th birth month and ends three months after. During this time, you can enroll in a Medicare Advantage plan, though you will first have to enroll in Original Medicare to obtain your Medicare number. Another way to enroll in Medicare Advantage is during the Open Enrollment Period, which begins on October 15 and ends on December 7 of each year. During this time, you can switch from Original Medicare to Medicare Advantage, switch from MA back to Original Medicare, or switch between MA plans. Finally, if you experience a qualifying life event, you can enroll during a Special Enrollment Period. For more information on qualifying life events, visit www.medicare.gov.

Is it possible to enroll in both Medicare Advantage and Medicaid?

Provided that you are eligible for both, yes, you can enroll in both Medicare Advantage and Medicaid services. You cannot, however, be simultaneously enrolled in Medicare Advantage and Medicare Supplement Insurance (also known as Medigap plans or Medicare Supplement plans).

Are there any downsides to Medicare Advantage?

The short answer is, yes, there are some downsides to Medicare Advantage health insurance. MA plans tend to be more expensive than Original Medicare. Things like variable co-pays and coinsurance rates, optional benefits, and monthly premiums have a serious impact on how much you can expect to pay.  Also, unlike Original Medicare, MA plans have service areas that can severely limit the number of plans available to you. If you live outside of a plan’s service area, you simply cannot enroll in the plan. If you’re looking for a much more affordable and basic plan, the standardized nature of Original Medicare might seem more attractive to you.

Conclusion: Compare Plans to Find the Right One

Highly rated plans are, of course, highly attractive. However, it’s important to take your own situation into consideration. If money is tight, you may not be able to afford one of the more expensive plans. If prescription medication is a priority, you’ll want a plan that covers the medicine you require. Take stock of your own medical needs along with your financial limitations, and you’ll be sure to find the right plan for you.

Have a solid understanding of your medical and financial situation? Then, you’re ready to start your search with Insurify’s plan-comparison tool! It’s free and easy to use and will put you on the best Medicare health insurance path for you!

Save Money On Medicare Advantage Plans Today!

Shop Plans

Updated April 30, 2021

Originally from Los Angeles, California, Adrian Coto is a writer living in Brooklyn, New York. A graduate of the NYU Creative Writing MFA program, he's worked as a legal assistant, a law school administrator, and now as a copywriter and editor.