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Medicare in West Virginia

October 6, 2016

Medicare beneficiaries in West Virginia may have several Medicare coverage options. Find out about Original Medicare, Part A and Part B, and Medicare plan options available from insurance companies in West Virginia.

Original Medicare for West Virginia beneficiaries

Original Medicare refers to Medicare Part A (hospital insurance) and Part B (medical insurance). Medicare Part A includes inpatient services in hospitals and skilled nursing facilities, limited home health services in certain situations, and hospice care. Medicare Part B may cover services and items including doctor visits, diabetic supplies, flu shots and other preventive services, and other medically necessary services and items. Some limitations and restrictions apply; for example, your care typically must be delivered by a provider that accepts Medicare assignment.

In West Virginia, as in every state, Medicare has certain eligibility requirements. You must be at least 65 years old or have a qualifying disability, and you must be an American citizen or permanent legal resident of at least five years in a row. Many Americans are automatically enrolled in Medicare when they turn 65 or have been receiving disability benefits for at least two years in a row.

If you don’t qualify for automatic enrollment, you can sign up using the information below.

To avoid late-enrollment penalties, you generally need to sign up during your Initial Enrollment Period (for most people, a seven-month period starting three months before your 65th birthday month, including your birthday month, and ending three months after your birthday).

To apply for Medicare Part A and Part B, you can contact Social Security:

If you get Railroad Retirement Board (RRB) benefits, call the RRB to apply for Medicare. Dial 1-877-772-5772 (TTY users, call 1-312-751-4701) Monday through Friday, from 9AM to 3:30PM.

Original Medicare doesn’t include prescription drug coverage (except for certain medications administered when you’re a hospital inpatient or outpatient in an office setting). Original Medicare may come with certain costs, such as copayments, coinsurance, and deductibles, depending on the service or item you receive.

Medicare plan options in West Virginia

In West Virginia, just as in all states, you may have a choice of various Medicare insurance options beyond Original Medicare. Here’s a summary of the Medicare plan options; availability can vary depending where in West Virginia you live. All of these types of Medicare insurance are sold by private companies that contract with Medicare.

  • Medicare Advantage (Medicare Part C) offers a way to get your Medicare coverage through a private, Medicare-approved insurance company instead of directly through the federal government. Although Medicare Advantage plans provide the same Medicare Part A and Part B benefits you get through Original Medicare (except for hospice care, which Part A still covers), it’s the insurance company that administers the plan. Often, Medicare Advantage plans include additional benefits, such as prescription drug coverage. A Medicare Advantage Prescription Drug plan lets you get your Medicare health and drug benefits in a single policy. You still pay your Medicare Part B premium if you have a Medicare Advantage plan. Read more about Medicare Advantage plans in West Virginia.
  • If you decide to stay with Original Medicare, another option you may have is to sign up for a Medicare Supplement (Medigap) plan to help pay for Original Medicare’s out-of-pocket costs. Different Medigap plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles. For more information, see how Medigap works in West Virginia.
  • Medicare Part D is prescription drug coverage. You can get this benefit through a stand-alone Medicare Part D Prescription Drug Plan to work alongside your Original Medicare coverage. Alternatively, you can get this coverage through a Medicare Advantage Prescription Drug plan (described above). Prescription drug coverage is optional, but if you don’t sign up for Part D when you’re first eligible for Medicare, you might face a late enrollment penalty. Read more about Medicare Part D plans in West Virginia.

West Virginia resources for Medicare beneficiaries

As a West Virginia resident, you might find these additional resources helpful.

  • For free health insurance counseling, contact the West Virginia State Health Insurance Assistance Program (SHIP); visit the website or call 304-558-3317 or 877-987-4463 from 8AM to 5PM Monday through Friday.
  • For a wide variety of health-care information, such as questions to ask your doctor, contact the Agency for Healthcare Research and Quality (AHRQ); visit the website or call 800-358-9295 (TTY users call 888-586-6340) from 8:30AM-5:30 PM Monday through Friday.

The product and service descriptions, if any, provided on these PlanPrescriber Web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.