Health insurance is a necessity — especially in West Virginia, where medical costs and premiums can be high and choices can be complex. Whether you’re exploring public coverage (Medicaid, Medicare) or private plans (Marketplace, employer‑sponsored, short‑term), this guide breaks down the options, real world costs, provider differences, and practical tips to help you choose the plan that fits your needs and budget.
West Virginia consistently has high health insurance premiums compared to other states — with average benchmark premiums higher than the U.S. average, and many residents relying on premium subsidies to afford coverage.
Access to affordable coverage can be life‑changing, protecting you from catastrophic medical expenses while ensuring access to preventive care and ongoing treatment for chronic conditions like diabetes, heart disease, and COPD, all of which are prevalent in the state.
Health coverage generally falls into two major categories:
| Feature | Public Insurance | Private Insurance |
|---|---|---|
| Who runs it | Government (Federal & State) | Private/Commercial companies |
| Eligibility | Based on age, income, disability | Open to anyone who pays premiums |
| Cost | Often low or no premium | Premiums vary widely |
| Options | Medicaid, Medicare, CHIP | Marketplace/ACA plans, employer plans, short‑term |
| Subsidies | Mandatory in some cases | Tax credits available via Marketplace |
| Network Flexibility | Can be limited | Depends on plan (PPO, HMO, EPO) |
Medicaid provides health coverage to low‑income adults, children, pregnant women, elderly adults, and people with disabilities. West Virginia expanded Medicaid under the Affordable Care Act, allowing adults with incomes up to 138% of the federal poverty level to qualify. (CGAA)
Children’s Health Insurance Program (CHIP) offers free or low‑cost coverage for kids whose families earn too much for Medicaid but cannot afford private insurance.
Managed care organizations in WV include:
Enrollment is through the West Virginia Department of Health and Human Resources (DHHR) or HealthCare.gov for Medicaid eligible adults.
Medicare is federal health coverage for:
Medicare has different parts:
| Part | What it Covers |
|---|---|
| Part A | Hospital stays |
| Part B | Doctor visits, outpatient care |
| Part D | Prescription drugs |
| Medicare Advantage (Part C) | Private alternative combining A & B (often includes D) |
| Medigap | Supplemental coverage to help pay out‑of‑pocket costs |
Costs in West Virginia:
Medicare Supplement (Medigap) plans vary widely, e.g., Plan F ranges from ~$115 to ~$1,744/month depending on age and insurer.
Every year during open enrollment (usually Nov 1 - Jan 15), West Virginians can buy individual and family health plans through the ACA Marketplace.
For 2026, two main insurers are offering Marketplace plans in West Virginia
Plans are grouped into metal tiers:
| Tier | What It Means |
|---|---|
| Bronze | Lower premiums, higher out‑of‑pocket costs |
| Silver | Balanced premiums & cost‑sharing; eligible for extra discounts |
| Gold | Higher premiums, lower out‑of‑pocket |
| Platinum | Highest premiums, lowest cost‑sharing |
West Virginia has some of the highest full‑price premiums in the nation. (healthinsurance.org)
| Coverage Type | Average Monthly Cost (Before Subsidy) |
|---|---|
| ACA Benchmark Premium | ~$1,073/month |
| Average net Marketplace premium | ~$101/month |
| Subsidized average | ~$74/month |
Most Marketplace enrollees, over 95%, qualify for federal subsidies that dramatically lower out‑of‑pocket premiums. (CGAA)
Both insurers raised premiums for 2026:
This underscores the importance of comparing plans each year before enrollment.
Many West Virginians get coverage through their jobs. Employers typically share costs with employees, often resulting in lower premiums than individual plans.
Costs vary widely based on:
On average nationally (and similarly in WV), employer plans are significantly cheaper than individual Marketplace plans due to shared cost obligations.
If you’re between jobs or not eligible for Marketplace coverage, short‑term plans are an option. These can have very low premiums but typically:
These plans are best as a temporary stopgap, not a long‑term health insurance solution.
Based on market presence, plan types, and cost averages, these are major players:
Although only two insurers sell on the ACA Marketplace in WV, other private insurers offer short‑term, supplemental, or group plans — including UnitedHealthcare, AgileHealthInsurance, and National General — especially outside the ACA Marketplace.
| Plan Type | Network Flexibility | Referral Needed | Best For |
|---|---|---|---|
| HMO | Only in‑network | Yes | Lower cost, basic care |
| PPO | In & out‑of‑network | No | Flexible provider choice |
| EPO | In‑network only | No | Lower premium with some flexibility |
CareSource typically offers HMOs while Highmark BCBS offers PPOs/EPOs, giving you options based on how you like to access care.
Here’s a snapshot of typical premiums and costs:
| Plan Tier | Avg. Monthly Premium |
|---|---|
| Catastrophic | ~$599 |
| Bronze | ~$772 |
| Silver | ~$1,087–$1,097 |
| Gold | ~$976–$1,015 |
| Platinum | ~$1,809 (HMO) |
| Company Size | Individual | Family of 4 |
|---|---|---|
| 1 Employee | ~$450‑$750/month | ~$1,350‑$2,250/month |
| Plan Type | Typical Cost |
|---|---|
| Part B | ~$164.90/month |
| Medicare Advantage | ~$21/month |
| Part D | ~$5.20/month+ |
| Medigap Plans | ~$115‑$1,744/month |
If you buy a plan on the ACA Marketplace and your income falls between 100% and 400% of the Federal Poverty Level (or higher when extended subsidies apply), you may qualify for tax credits that lower monthly premiums. (CGAA)
Available if your income is under 250% of the poverty level and you choose a Silver plan, reducing deductibles and copays. (healthinsurance.org. Average)
Without these subsidies, many plans would be unaffordable. Average benchmark premiums in WV are among the nation’s highest.
Health insurance in West Virginia can be complex, but understanding your options, especially the differences between public and private coverage, typical costs, and how to compare plan types, puts you in control of your healthcare decisions.
With careful comparison and use of subsidies, many West Virginians find affordable coverage, even in a state with high baseline costs. Taking time during open enrollment to evaluate plans each year can make a big difference in both your health and your finances.
