Key Takeaways:
- Medicare offers various pathways to meet your healthcare needs in West Virginia. Understanding the different plan options, costs, and benefits is critical for making informed decisions.
- The best Medicare plan for you depends on your circumstances, including your health status, budget, preferred doctors and hospitals, and lifestyle.
- Researching Medicare plans and seeking guidance from trusted resources can help navigate costs, coverage options, and provider networks in West Virginia.
Medicare is a vital lifeline for many West Virginians, providing essential healthcare coverage for those 65 and older and younger individuals with disabilities. However, navigating the world of Medicare can feel like venturing into uncharted territory.
This guide is your compass for understanding Medicare plans in West Virginia. We’ll break down the different plan types, explore their costs and benefits, and empower you to make informed decisions about your healthcare coverage.
Types of Medicare Plans Available in West Virginia
Medicare plans in West Virginia offer various options to meet healthcare needs. Before making your choices, it’s good to understand the different plan types and coverage levels.
Original Medicare (Part A and Part B)
Original Medicare, managed by the federal government, is the cornerstone of Medicare coverage. It consists of two parts:
- Medicare Part A (Hospital Insurance): This covers inpatient hospital stays, skilled nursing facility care, some home health services, and hospice care. If you or your spouse paid Medicare taxes while working for at least 10 years, you likely qualify for premium-free Part A.
- Medicare Part B (Medical Insurance): This covers outpatient services, including doctor’s visits, preventive screenings, and medical equipment. Part B requires a monthly premium, which varies based on your income. The standard premium in 2025 is $185.
Original Medicare doesn’t cover all healthcare expenses. You’ll typically have cost-sharing responsibilities, such as deductibles, copayments, and coinsurance. For example, the Part B deductible is $257 (in 2025), and after the deductible, you will likely pay 20% of the cost for each Medicare-covered service or item.
Medicare Advantage (Part C)
Offered by private insurance companies approved by Medicare, Medicare Advantage plans provide all the benefits of Original Medicare (Part A and Part B) and valuable extras.
These extras include prescription drug coverage, dental, vision, and hearing benefits, fitness programs, and even transportation assistance. However, benefits depend on your specific plan.
It’s important to research Medicare Advantage plans carefully, as they vary significantly in terms of costs, coverage, and provider networks. Many West Virginia residents benefit from having their preferred comprehensive coverage plan.
For 2025, 58 Medicare Advantage plans are available in the state. All Medicare-enrolled residents are eligible for a Medicare Advantage plan, including at least one plan with a $0 monthly premium.
- The average monthly Medicare Advantage plan premium will reduce to $16.62 in 2025 from $20.63 in 2024.
- The lowest monthly premium for a Medicare Advantage plan is $0.
Top Medicare Advantage Plans in West Virginia:
| Carrier | Average CMS Star Rating (All Plans) | Availability | Monthly Premium | Annual Deductible | Maximum Out-of-Pocket |
| UnitedHealthcare(AARP Medicare Advantage Plan) | 3.82 ★ | 49 states and D.C. | $45 | $0 | $6,700 |
| Humana (HumanaChoice Plan) | 3.63 ★ | 48 states, D.C., PR | $25 | $0 | $7,550 |
| Aetna(Medicare Advantra Credit Value Plan) | 4.27 ★ | 44 states and D.C. | $0 | $0 | $7,500 |
| Highmark (Freedom Blue Distinct | 4.52 ★ | 4 states | $14 | $0 | $5,700 |
Data gathered via CMS.gov and direct provider plans. Comparison of plans from West Virginia Zip Code 26554. Star ratings and plan information reflect publicly available data as of 2025.
Private insurers offering Medicare Advantage plans in West Virginia include:
- Aetna
- Humana
- Highmark Blue Cross and Blue Shield
- The Health Plan
Confidently Navigate Medicare in West Virginia.
CoverRight is your trusted partner in making informed Medicare decisions. Our expert advisors will help you understand your options, compare costs, and find the plan that fits your health needs and budget. Get started today!
Medicare Prescription Drug Plans (Part D)
Medicare Part D is a crucial piece of the puzzle when managing your medications and healthcare costs in West Virginia. These plans help cover the costs of prescription drugs, ensuring you have access to the medications you need without facing overwhelming financial burdens.
If you have Original Medicare, you can enroll in a stand-alone Part D plan or choose a Medicare Advantage plan with Part D coverage. The latter might simplify your healthcare and offer cost savings.
Every Part D plan includes a formulary, which is a list of the drugs that are covered under the plan. Be careful to pick a plan that includes your specific medications in the plan’s formulary at an affordable cost. If you have limited income and resources, you may qualify for Extra Help, a program that helps pay for Part D costs.
In 2025, 16 stand-alone Medicare prescription drug plans are available. All individuals with Medicare have access to a Medicare prescription drug plan.
- In 2025, 73.61% of West Virginia residents with a Medicare prescription drug plan can switch to a plan with lower premiums than they paid in 2024.
- The lowest monthly premium for a stand-alone Medicare prescription drug plan is $0.
- 29.91% of residents with stand-alone Medicare prescription drug plans receive Extra Help.
| Plan Name | Premium | Deductible | CMS Star Rating |
| Blue Rx PDP Complete | $168.20 | $590 | 3.5 ★ |
| Humana Basic Rx Plus | $70.60 | $0 | 3.5 ★ |
| Wellcare Value Script | $0 | $590 | 3.5 ★ |
Note: Data from MedicareWire
Medigap (Medicare Supplement) Plans
Original Medicare provides a valuable safety net but doesn’t cover all your healthcare expenses. Private insurance companies offer Medigap plans, also known as Medicare Supplement Insurance, which pay some or all out-of-pocket costs that Original Medicare doesn’t cover.
This helps make your healthcare spending more predictable, granting you peace of mind and protection from unexpected and potentially high out-of-pocket expenses.
Ten standardized Medigap plans are available, labeled from A to N, each offering a different combination of benefits. Plan G and N are popular plans in West Virginia.
While Plan G is more comprehensive, Plan N is a great budget-friendly option. The difference between the two plans is that Plan G excludes the cost of Part B deductibles, while Plan N also excludes smaller copayments and Part B excess charges.
Costs vary depending on age, gender, location, and tobacco usage.
Top Medigap providers in West Virginia, for both Plan G and Plan N, include:
- Thrivent
- AARP
- Globe Life
- Transamerica
Learn more: How to Compare Medicare Supplement Plans
Average Costs of Medicare Plans in West Virginia
Let’s go over the costs associated with different Medicare plans in West Virginia, including premiums and deductibles for each type.
| Plan Type | Average Monthly Premium | Average Deductibles | What it Covers |
| Original Medicare Part A | $0(if you do not qualify: $285 or $518) | $1,676 | Inpatient care, such as hospital stays, skilled nursing facility care, and hospice care |
| Original Medicare Part B | $185 | $257 | Outpatient care, preventative services, and medical equipment |
| Medicare Advantage | $16.62 | Vary per plan($0 – $590) | All Original Medicare + extra benefits like vision, hearing, and dental care |
| Part D | $71.53 | $452 | Prescription drugs |
| Medigap Plan G and N | $120 – $200 | N/A | Fills gaps in Original Medicare out-of-pocket costs |
Note: All data reflect 2025 averages sourced from Medicare.gov, CMS.gov, and MedicareWire and may vary by provider.
Top Medicare Advantage and Medigap Providers in West Virginia
In West Virginia, you have a variety of Medicare providers to choose from. But how do you know which one is the right fit for you? This section will guide you through the region’s top Medicare Advantage or Medigap providers.
Best Medicare Advantage Providers
When choosing a Medicare Advantage provider, think of it as selecting a long-term partner for all your healthcare needs. Medicare Advantage plans go beyond Original Medicare, so look for the extra benefits most relevant to you.
For example, if you expect hearing issues to increase, look for plans with comprehensive coverage for such conditions. Providers with preventive care and wellness programs can help you be proactive about your health, avoiding costly problems later on.
Aetna Medicare Advantage plans, for example, are rated above the industry average but have ended their fitness reimbursement program. When deciding, carefully weigh these costs and benefits.
| Carrier | Highest Rating | Lowest Rating | Median Rating | Total Number of MA Contracts |
|---|---|---|---|---|
| Aetna | 4.5 | 2.5 | 4.0 | 45 |
| Centene | 4.0 | 2.0 | 3.0 | 106 |
| Cigna | 4.5 | 3.0 | 3.5 | 17 |
| Elevance (Anthem BCBS) | 5.0 | 2.5 | 3.5 | 46 |
| Humana | 5.0 | 3.0 | 4.0 | 48 |
| United Healthcare | 5.0 | 3.0 | 4.0 | 75 |
Best Medigap Providers
Each Medigap provider usually offers multiple plans with varying levels of coverage. While you may like one provider, its plans may not suit you — so choose accordingly.
The Centers for Medicare & Medicaid Services (CMS) award plans yearly star ratings. The best providers will also have high customer satisfaction scores. Ensure you check such measures along with evaluating affordability.
Here’s how the top providers for Plan G and Plan N coverage compare:
Plan G Providers
| Carrier | Average Monthly Premium | Fee | A.M. Best Rating |
| Thrivent | $95.64 | None | A++ |
| AARP | $109.36 | None | A |
| Globe Life | $118.00 | None | A+ |
| Transamerica | $128.14 | None | A+ |
| Highmark Blue Cross Blue Shield | $130.00 | None | A- |
| United American | $165.00 | None | A+ |
| Guarantee Trust Life | $94.98 | $25.00 | B++ |
| ManhattanLife | $95.25 | None | B+ |
Plan N Providers
| Carrier | Average Monthly Premium | Fee | A.M. Best Rating |
| Thrivent | $78.86 | None | A++ |
| AARP | $91.51 | None | A |
| Globe Life | $100.00 | None | A+ |
| Transamerica | $109.78 | None | A+ |
| United American | $137.00 | None | A+ |
| Highmark Blue Cross Blue Shield | $137.40 | None | A- |
| National Guardian Life | $83.87 | None | A- |
| Guarantee Trust Life | $78.03 | $25.00 | B++ |
Note: Plan G and Plan N data from MedicareWire
How to Choose the Right Medicare Plan in West Virginia
Choosing the right Medicare plan depends on your needs, lifestyle, and preferences. Before diving into Medicare plans, take some time to reflect on your healthcare needs and priorities.
Ask yourself the following questions:
- Are you generally healthy, or do you have any chronic conditions that require ongoing care?
- Do you anticipate needing specialized care or surgery in the near future?
- Are you active and independent, or do you require assistance with daily activities?
- Do you travel frequently or prefer to stay close to home?
- What are your financial resources and limitations?
- Do you have a regular income stream, and does it seem likely to change?
- Which doctors and hospitals are you most comfortable with?
- What extra benefits are you most likely to need?
Once you understand your needs and preferences, you can start exploring the different Medicare plans in West Virginia.
- Original Medicare: This traditional fee-for-service plan allows you to see any doctor or hospital that accepts Medicare. You can customize your coverage with a Medigap plan to help with out-of-pocket costs and a Part D plan for prescription drugs.
- Medicare Advantage: These plans offer comprehensive coverage, often including prescription drugs and extra benefits like dental, vision, and hearing. They typically have a network of providers and may offer lower out-of-pocket costs than Original Medicare.
Begin planning early and take the time to find your perfect match. The peace of mind that comes with knowing you have the right coverage for your healthcare journey is invaluable.
How to Enroll in a Medicare Plan in West Virginia
Your Initial Enrollment Period is a 7-month window that begins 3 months before your 65th birthday, includes your birth month, and ends 3 months after. This is your chance to enroll in Original Medicare, Medicare Advantage, and Medicare Part D.
Enrolling during this initial period is crucial because if you delay enrollment in Part B or Part D, you may face a late enrollment penalty.
The Medicare Open Enrollment period, which runs from October 15 to December 7 each year, is when you can review your healthcare needs for the upcoming year and decide if changing plans would benefit you. In West Virginia, for example, most beneficiaries can switch to a Medicare prescription drug plan with lower premiums.
Before enrolling, gather the required documents, such as personal IDs or your Medicare card (for those already enrolled). You can then enroll online at Medicare.gov, by phone at 1-800-MEDICARE, or with the help of a licensed insurance agent, such as CoverRight.
Medicare Resources for West Virginia Residents
Multiple local and national resources can help West Virginia residents navigate the world of Medicare. These include:
- West Virginia Department of Health and Human Resources (DHHR): The DHHR offers various programs and services to support West Virginia residents, including those related to Medicare, Medicaid, and public health.
- West Virginia State Health Insurance Assistance Program (SHIP): SHIP is a free, unbiased counseling service for Medicare beneficiaries and their families. SHIP counselors can help you understand your Medicare benefits, compare plans, enroll in coverage, and resolve problems with your Medicare claims or coverage.
Medicare Rights Center: This national nonprofit organization ensures access to affordable health care for older adults and people with disabilities. Their national helpline number is 800-333-4114, Monday through Friday.
Need help understanding Medicare coverage options?
CoverRight helps you navigate coverage gaps and options to find the right plan for your loved ones. Start today.
Sources
- Centers for Medicare & Medicaid Services (CMS)
- Medicare Open Enrollment Partner Resources. Published 2024. Available at: cms.gov. Last Accessed November 13, 2024
- Centers for Medicare & Medicaid Services (CMS)
- 2024 Medicare Advantage and Part D Ratings Fact Sheet. Published October 13, 2023. Available at: cms.gov. Last Accessed November 13, 2024
- Medicare.gov
- Medigap Coverage Information: When to Buy. Available at: medicare.gov. Last Accessed November 13, 2024
- Medicare.gov
- Medigap Overview. Available at: medicare.gov. Last Accessed November 25, 2024
- Medicare.gov
- What Does Medicare Cost? Available at: medicare.gov. Last Accessed November 26, 2024.
- Medicare.gov
- When Does Medicare Coverage Start? Available at: medicare.gov. Last Accessed November 26, 2024.
- Medicare.gov
- What Does Medicare Cost? Available at: medicare.gov. Last Accessed November 26, 2024.
- Kaiser Family Foundation (KFF)
- Key Facts About Medicare Part D Enrollment, Premiums, and Cost Sharing in 2024. Available at: kff.org. Last Accessed November 13, 2024.
