West Virginia Health Insurance Consumer Guide

Anyone who meets the following criteria can buy Marketplace health coverage in West Virginia:

• You live in West Virginia
• You’re a U.S. citizen, national, or lawfully present
• You’re not incarcerated
• You don’t already have Medicare

Your eligibility for financial assistance, like premium subsidies and cost-sharing reductions, depends on your income and how it compares to the cost of the second-lowest-cost Silver plan in your area. This cost varies based on your age and where you live. 

To qualify for financial help on the Marketplace, you must:

• Not have access to affordable health coverage through your employer. If you think your employer’s health coverage is too expensive, use our Employer Health Plan Affordability Calculator to see if Marketplace premium subsidies are available to you.

Not be eligible for West Virginia Medicaid or CHIP.

You can sign up for an ACA-compliant individual or family health insurance in West Virginia between November 1 and January 15 during open enrollment.³ 

Sign up by December 15 for your coverage to start on January 1. If you enroll between December 16 and January 15, your coverage will begin on February 1. 

If the open enrollment deadline has passed and you don’t meet the SEP requirements, you can still sign up for an ACA plan. However, specific conditions need to be met, such as:

• Your income falls below 150% of the poverty level, and you’re eligible for premium tax credits. In this scenario, you can enroll until at least 2025.
• Native Americans can enroll whenever necessary.

For people who lose Medicaid or CHIP coverage between March 31, 2023, and July 31, 2024, there’s an extended SEP available for enrollment.⁴

Use any of the following options to enroll in a Marketplace plan in West Virginia:

• Visit HealthCare.gov
• Call 1-800-318-2596 (TTY: 1-855-889-4325). The call center is available 24 hours a day, seven days a week, except for holidays.
  

You can also find local help from local insurance agents, brokers, or certified application counselors. They help you review plan options and choose a plan to fit your needs. Find help at localhelp.HealthCare.gov.⁵

You can find affordable health plans in West Virginia on the ACA Marketplace (HealthCare.gov).

For the 2023 open enrollment period on the exchange:

• 95% of eligible enrollees qualified for premium subsidies.⁶
• Subsidies (called Advance Premium Tax Credits or APTC) save West Virginians about $1,057 monthly in 2023. Those with subsidies pay an average premium of $128 per month.⁶

Apart from APTC, if your household income falls below 250% of the federal poverty level, you may also qualify for cost-sharing reductions (CSR).⁷ CSRs help reduce deductibles and out-of-pocket expenses. 

Medicaid is another affordable health insurance option if you’re eligible. 

Short-term plans are low-cost alternatives for people not eligible for Medicaid, Medicare, or subsidies. 

Source: CMS.gov⁸

Two companies provide 2023 individual and family plans through West Virginia’s exchange:⁹

• CareSource West Virginia Co. 
• Highmark Blue Cross Blue Shield West Virginia 

West Virginia’s individual market insurers have proposed the following average rate increases for 2024:¹⁰

Source: HealthCare.gov¹⁰

Rate changes apply to full-price premiums. Since about 96% of eligible people using the West Virginia exchange receive premium tax credits, they don’t pay the full premium amount.⁶

 If you qualify for subsidies, your actual rate change will depend on your plan and the subsidy amounts. Your age can affect your premium too. 

If the cost of your current plan increases, you can explore other health plans in the exchange that may be more affordable and offer similar benefits.

West Virginia’s 2023 open enrollment period marked the highest since 2017, with 28,325 individuals signing up for private plans.⁶

This rise in enrollment can be attributed to the American Rescue Plan (ARP). ARP has led to more substantial and widespread premium subsidies for ACA plans. The Inflation Reduction Act has extended the ARP has been through 2025. 

Source: 2014,¹¹ 2015,¹² 2016,¹³ 2017,¹⁴ 2018,¹⁵ 2019,¹⁶ 2020,¹⁷ 2021,¹⁸ 2022,¹⁹ 2023,⁶ 2024²⁰

HealthCare.gov
This is the ACA Marketplace, where you can enroll in a health insurance plan online. You may also get help by calling (800) 318-2596. 

West Virginia Offices of the Insurance Commissioner
Oversees and regulates insurance companies, brokers, and agents in the state while assisting consumers with insurance-related inquiries and concerns. 

West Virginia Navigator
A free, non-profit program accessible to all residents within the state, providing free enrollment assistance. 

West Virginia Senior Health Insurance Assistance Program (SHIP)
Helps answer questions and help Medicare beneficiaries.