Medicare in West Virginia: Key takeaways
- Last year, 433,494 West Virginia residents were enrolled in Medicare coverage.
- In West Virginia in 2017, 79 percent of Medicare beneficiaries were eligible due to their age.
- Original Medicare spending in West Virginia was a little lower than the national average, at $9,070 per beneficiary.
- In 2016, nearly 93,000 West Virginia Medicare beneficiaries had supplemental Medigap coverage.
- In West Virginia in 2017, 25 percent of Medicare beneficiaries were enrolled in private Medicare Advantage plans
- There are 27 stand-alone Part D plans available for purchase in West Virginia in 2019
Medicare enrollment in West Virginia
433,494 West Virginia residents had Medicare coverage as of November 2018. That’s 24 percent of the state’s population, whereas only a little more than 18 percent of the United States population is enrolled in Medicare. West Virginia has a larger than average share of disabled residents, and also a larger than average share of residents who are at least 65 years old. Medicare eligibility is based on age (65+) or disability, so it stands to reason that a larger than average share of West Virginia’s population is eligible for Medicare.
When we look at total enrollment numbers, Alaska is the only state with fewer than 100,000 Medicare beneficiaries (there are 97,195), while California, which has by far the largest population in the country, has more than 6.1 million Medicare beneficiaries (only about 15 percent of the state’s population).
Breakdown of the aged vs. disabled
In West Virginia in 2017, 79 percent of Medicare beneficiaries were eligible due to their age (at least 65), while the other 21 percent were eligible due to a disability. Nationwide, an average of 16 percent of Medicare beneficiaries were eligible due to a disability, and only four states had a higher percentage of disabled Medicare beneficiaries than West Virginia: Kentucky, Alabama, and Mississippi, at 23 percent, and Arkansas, at 22 percent.
On the other end of the spectrum, only 9 percent of Hawaii Medicare beneficiaries were eligible due to a disability (if we include the US territories, 31 percent of American Samoa Medicare beneficiaries were eligible due to a disability, while the Virgin Islands tied with Hawaii, at just 9 percent.
Medicare spending per recipient
In 2016, Original Medicare spent an average of $9,533 per beneficiary nationwide, based on data that eliminated regional differences in payment rates (and not counting spending for Medicare Advantage). Original Medicare spending in West Virginia was a little lower than the national average, at $9,070 per beneficiary.
Medigap in West Virginia
Medigap plans are used by many Original Medicare beneficiaries to supplement their coverage and pay out-of-pocket costs (for coinsurance and deductibles) that the enrollee would otherwise have to pay themselves.
According to data compiled by AHIP, 92,676 West Virginia Medicare beneficiaries had supplemental Medigap coverage in 2016.
The federal government imposes strict rules on Medigap plans, including standardized plans (denoted by the letters A through N and a six-month guaranteed-issue window for Medigap plans. When an enroll is at least 65 and enrolled in Part B, their six-month window begins, and Medigap insurers must allow them to enroll in any available Medigap plan, and premiums cannot be based on the person’s medical history.
But there is no ongoing annual enrollment period for Medigap (the way there is for Medicare Advantage and Part D coverage), and federal rules do not guarantee access to a Medigap plan if you’re under 65 and eligible for Medicare as a result of a disability. The majority of the states have implemented rules to ensure at least some access to Medigap plans for under-65 enrollees, but West Virginia has not.
The West Virginia Office of the Insurance Commissioner confirmed that there are no rules in West Virginia requiring Medigap insurers to offer coverage disabled Medicare beneficiaries under the age of 65, and most insurers choose not to offer such coverage. But the Office of the Insurance Commissioner clarified that there are two Medigap insurers in West Virginia that do allow Medicare beneficiaries under the age of 65 to enroll in their plans:
- United American offers Plan A to people under 65.
- Highmark Blue Cross Blue Shield offers all of their Medigap plans to enrollees under age 65, but only if the person had coverage under another Highmark plan (an employer-sponsored plan or individual market plan) prior to transitioning to Medicare.
On the available Medigap plans, premiums are higher for people under 65. But disabled enrollees gain access to the regular Medigap enrollment window when they turn 65, and can select from among all of the available plans, at standard pricing.
The lack of any state laws guaranteeing access to Medigap plans for people under 65 is significant, especially given that the state has the fifth-highest rate of disabled (under-65) beneficiaries in the country.
Medicare Advantage in West Virginia
Medicare Advantage offers an alternative way of obtaining Medicare benefits, via a private insurer instead of the federal government’s fee-for-service Original (Traditional) Medicare. Some Medicare Advantage plans are available with no premiums other than the premium for Medicare Part B (which has to be paid in conjunction with the Medicare Advantage plan’s premium).
There are pros and cons to both Medicare Advantage and Original Medicare with supplemental coverage. We’ve summarized up some of the ways the plans compare, but each beneficiary has to determine which option will best meet their needs, as there’s no one-size-fits-all solution.
As is the case nationwide, Medicare Advantage availabilty varies by county in West Virginia. There are 13 plans available in Hampshire County, 25 in Kanawha County, and the rest of the state has plan availability somewhere in the middle.
In West Virginia in 2017, 25 percent of Medicare beneficiaries were enrolled in private Medicare Advantage plans, while 75 percent had coverage under Original Medicare. Nationwide, an average of 33 percent of Medicare beneficiaries had Medicare Advantage plans in 2017.
In Minnesota, 56 percent of Medicare beneficiaries selected Medicare Advantage, while in Alaska, only 1 percent did so (and those enrollees had employer-sponsored Medicare Advantage plans, as there are no individual Medicare Advantage plans for sale in Alaska).
Stand-alone Medicare Prescription Drug plans
Medicare prescription drug coverage is called Medicare Part D. It was created by the Medicare Modernization Act of 2003, signed into law by President George W. Bush. Original Medicare does not cover prescription costs, so Medicare beneficiaries need supplemental coverage for medications. That can be obtained via an employer-sponsored plan or a stand-alone Part D plan, or beneficiaries can choose a Medicare Advantage plan that has integrated Part D coverage.
There are 27 stand-alone Part D plans available for purchase in West Virginia in 2019, with premiums ranging from $13 to $156 per month.
As of late 2018, there were 196,961 West Virginia Medicare beneficiaries with stand-alone Part D coverage. And additional 106,792 had Part D coverage as part of their Medicare Advantage plans.
West Virginia health insurance for people who aren’t eligible for Medicare
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.