Medicare Plan Options

Medicare coverage is available in several ways. If you are relatively healthy, Original Medicare is a good choice. If you have more complex health care needs, Medicare Advantage Plans may be the best option as they provide additional benefits like vision, hearing, dental, and often prescription drug coverage. Gaps in Original Medicare can be covered by a Medicare Supplemental Insurance Plan. You can get prescription drug coverage by purchasing a Medicare Part D plan or coverage in a Medicaid Advantage Plan. Medicare and Medicare Advantage do not cover long-term health care needs.

Original Medicare

Original Medicare is built on two components: Part A, which covers hospitalizations, hospice care, skilled nursing facilities, and home health care, and Part B, which covers doctor’s visits, durable medical equipment, preventative services, and mental health coverage. Under Original Medicare, after you meet your deductible, you’ll normally pay about 20% of the Medicaid-approved cost for most medical procedures. Original Medicare has no limits on out-of-pocket fees. If you want prescription drug coverage you’ll need to purchase a Medicare Part D plan.

Medicare Advantage Plans

Every Medicare Advantage Plan includes Original Medicare’s Parts A and B. The plans also cover hearing, vision, dental, some fitness programs, and many include prescription drug coverage. There are four different kinds of Medicare Advantage Plans: HMOs, PPOs, Private Fee-For-Service Plans (PFFS), and Special Needs Plans (SNP). While there are 33 plans available in West Virginia, you can only select a plan if it is available in the county where you live. If you move out of your county, you’ll need to enroll in a new plan if your previous plan is not available in your new location.

Medicare Prescription Drug Coverage Plans  

If you choose Original Medicare and you also want prescription drug coverage, you’ll need to purchase a Medicare Part D plan. The cost depends on several factors, including your pharmacy, the drug’s tier, and whether or not the company that makes the drug offers financial assistance.  Most Medicare Advantage Plans include prescription drug coverage, but not all do. If you decide you don’t want a Part D plan during your initial enrollment, and you don’t get coverage through a Medicare Advantage Plan, you can purchase a plan at a later date, but you may have to pay a penalty.

Medicare Supplement Insurance Plans

If your Original Medicare plan leaves gaps in your coverage that are costing you too much in excess fees, consider a Medicare Supplemental Insurance Plan. Also known as Medigap, it can cover copays, coinsurance, and deductibles as well as many excess Part B charges, depending on which plan you select. However, it will not cover the $148.50 Part B premium, dental, vision, hearing, or long-term care. Some Medicare Supplemental Insurance Plans will provide medical coverage if you travel outside the country. Medigap does not work with any Medicare Advantage Plan.

Medicare in West Virginia by the Numbers

People enrolled in Original Medicare  Average plan cost Annual state spending per beneficiary Spending per beneficiary compared to the national average
273,861 Plan A: $0 to $471 per month*
Plan B: $148.50 per month**
$9,852 -2.00%

*Most people pay no premium, but this can vary depending on how long they paid Medicare taxes.
**This is the average number, but it can vary based on income.

Medicare Resources in West Virginia

Choosing a Medicare plan can be daunting if you’re not sure of your options. Medicare Advantage Plans and Original Medicare will send you lots of information as you approach your initial enrollment window. Fortunately, you have access to several agencies in West Virginia that provide free, unbiased counseling to inform your Medicare choices.

Area Agencies on Aging (AAA) 

West Virginia’s four Area Agencies on Aging help develop comprehensive and coordinated plans to provide seniors across West Virginia with access to services and programs. The AAAs work with local senior centers to provide meals for in-need seniors, transportation to medical appointments, and health care counseling services that include Medicare, Medicaid, and other Medicare plans. They also advocate with lawmakers to provide needed services for seniors.

Contact Information: Website | 304-558-3317

West Virginia State Health Insurance Assistance Programs

West Virginia’s State Health Insurance Assistance Program (SHIP) provides free, unbiased, and confidential help to West Virginia Medicare beneficiaries, their families, or their caregivers who need information about Medicare benefits, long-term care insurance plans, or help with paying Medicare costs. No counselor will ever try to sell you a plan and they don’t work for any health insurance company. Trained SHIP counselors are available by phone, or you can arrange an in-person session.

Contact Information: Website | 877-987-4463

State Medicare Patrol (SMP)

The Senior Medicare Patrol provides information and education to seniors in West Virginia on detecting and reporting Medicare fraud. The SMP teaches seniors how to spot errors in Medicare billing and how to detect fraudulent manufacturers of goods who claim their goods are covered by Medicare. While the SMP holds community outreach programs, their trained volunteers are also available to work one-on-one with Medicare beneficiaries who may suspect fraudulent behavior.

Contact Information: Website | 855-254-1720

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