Get Affordable Health Insurance In West Virginia – Free Quotes

By: Astoria
Updated: September 27, 2022
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Get the health insurance quotes for free and take out the best health insurance coverage in West Virginia.

You should consider a lot of factors if you want to get the best health insurance in West Virginia for yourself. Things you’d best consider include the level of income you earn, your average expected medical costs, and even the county you live in.

For individuals seeking coverage on health and medical expenses in West Virginia, the state decided, under the Affordable Care Act (ACA), to expand its Medicaid plan to accommodate residents in the state that have less than 138% gross household income to still qualify for the health insurance coverage.

Now, for those not included in the above description, you should be able to purchase a health insurance plan. The health insurance plans you can get from the West Virginia exchange might differ but you can still choose any of the plans from the metal tier categories if you qualify. These metal tiers differ in the cost of deductibles, the amount of premium you pay, and other out-of-pocket expenses.

Affordable Health Insurance in West Virginia

Most people may be familiar with the group coverage health insurance plan one can get from employment. How this group health insurance works is that the employee company pays a partial amount of the insurance costs for the employees. Typically, the company pays a larger portion of the insurance premium amount while the employee makes up for the rest of the costs.

Group health insurance plans however will only allow you to have certain benefits, which are determined by negotiations with the insurance provider, from the insurance plan.


Things to know about affordable health insurance in West Virginia

affordable health insurance in wv

Marketplace Plans

You can acquire two health insurance plans available in West Virginia’s Health Insurance Marketplace. Though you can still buy other health care plans, the plan would likely not assure you of the coverage rights under the Affordable Care Act compliant policies.

Open Enrollment for Insurance Plans

The enrollment for health care insurance plans in the West Virginia marketplace usually is from November 1 to January 15.

Special Enrollment

Apart from the open enrollment period, there is a special enrollment period with which you can sign up for a health insurance plan if you underwent or are in a life situation that qualifies you for special enrollment.

An example of such an event like losing a job that previously covers your health expenses and grants insurance, relocating to a new region and a different zip code, having a child or getting married.

Health Insurance Marketplace

The health insurance marketplace in West Virginia is a partnership exchange platform where you register to be enrolled with in the state’s health care coverage.

Premium tax credit

Using the West Virginia Health Insurance Marketplace qualifies you for a premium tax credit. And if you’re not eligible for an Advanced Premium Tax Credit or decide not to take advantage of the credit, you can buy health coverage from the health insurance companies in West Virginia.

Coverage types

The uninsured percentage of the population of the state of West Virginia is low – about 6.6%. Many West Virginia residents get their health insurance coverage plans from their jobs – about 44% of the population.

Next to this population sector are those that get their coverage types from Medicaid which is about 26.6% and then, the population that uses Medicare, about 19%. Non-group insurance policyholders and the military health insurance coverage types are only about 2.5% and 1.3% of the population respectively.


Sign Up for Affordable Health Insurance in the West Virginia Marketplace

For the many West Virginia residents that have in mind to enroll on the list of health insurance coverage beneficiaries in the health marketplace of the state, the platform has been made available by the state’s government.

You’re required to create a personal account and then, once you’re an account holder, you have access to the platform to review, compare and contrast the different available health insurance plans and decide which is the best choice for you. In making this choice on which has the best offers, you’re to compare the costs of the deductibles, copays, and coinsurance to help you reduce what you have to pay for the premium and other out-of-pocket costs.

In creating the account, you’ll be asked to input some of your pers like the total or gross income of your household per month or per year, and your Social Security number.

You can then check to see the offers and insurance plans you like and which ones you are eligible to apply for after you have successfully created the account with

There is another feature on the program called the Small Business Health Options Programs (SHOP). As the name suggests, this feature is for small businesses in the state. With the SHOP feature, you see the lowest insurance rates for your small business that are up for grabs.

Small businesses can be termed as those that have an employment width of just between one to fifty employees. These can use SHOP to buy health care insurance plans for their employees that are compliant with the Affordable Care Act.

There are two plans at the moment that are available for individual affordable health insurance in West Virginia and both of the plans are available throughout the state. They are;

  • CareSource West Virginia
  • Highmark West Virginia


Types Of Health Coverage in West Virginia

There are just two types of companies that are health insurance providers. These are the;

  • private insurance providers, and
  • government subsidized providers

As for the types of health insurance plans that are available, you can select what’s best for you from many different types. Let’s look at these different plans, so you can better understand the system of health coverage you can get from the best health insurance provider companies in the state.


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Health Maintenance Organizations (HMOs)

With Health Maintenance Organizations, you have the choice to decide which primary care physician (PCP) you’d get healthcare from. The Health Maintenance Organization plans typically bear the cost of treatment and other health services that are referred by the primary care physician when you need special health care. Also, to make sure the costs are still affordable, you can negotiate the fees upfront.

Preferred Provider Organizations (PPOs)

The Preferred Provider Organizations work with the approved providers to reduce the costs of the health insurance plans through negotiations. The Preferred Provider Organizations are more flexible plans when compared to the Health Maintenance Organizations. And though you can choose an insurance provider that operates outside the network, you will be charged less for the health care services if you opt for an in-network health insurance provider. Also, you won’t need your primary care physician’s referral before you can have access to see a specialist.

Exclusive Provider Organization (EPO)

Unlike the Preferred Provider Organizations coverage type, the Exclusive Provider Organizations (EPO health insurance) coverage plan is more rigid and has more restrictions compared to the Health Maintenance Organizations and the Preferred Provider Organizations plans.

It’s so because the EPO limits you to using only one network. Out-network healthcare services would disqualify you from using the benefits you should get from the Exclusive Provider Organizations plan. You would have to receive treatment and health care help only from the health and medical professionals in the network.

Point-of-Service (POS) Plans

This type of coverage plan is a blend of both the Health Maintenance Organization and Preferred Provider Organization plans. You are free to go outside of the network to choose a primary care physician, at higher costs though. If not, you can select any of the in-network physicians to be your primary care physicians. And you won’t be obliged to pay more costs for a referral by the primary.

Also, you won’t pay extra if your PCP refers you to a provider that’s outside the network.


Health Insurance in West Virginia And Their Costs

In West Virginia, the health insurance plans are grouped into four based on their costs and prices. The four groups are named metal tiers. The value of the metal that is the name of a health insurance plan tier level reflects the cost of the plan. The four metal tier plans currently in the state are; the Catastrophic metal tier, the Expanded Bronze metal tier, the Silver metal and the Gold metal tier.

As you’d expect, the insurance plans with the higher value metals cost more premium monthly.  But they would also cost fewer deductibles and out-of-pocket costs.

The monthly averages in West Virginia, for each of the metal tiers in West Virginia, are:

  • Catastrophic: $482 per month
  • Expanded Bronze: $641 per month
  • Silver: $695 per month
  • Gold: $874 per month

Bronze plans have the least expensive monthly premiums. On the other hand, though, the deductibles will be significantly higher. You will also have to pay a 40% coinsurance fee when you need treatment.

A bronze plan would be best for you if your health care needs presently are very low and seldom. The cheapest Bronze plan in West Virginia, now, has a monthly premium of $621.

The silver plans have much higher premiums, but you’ll only pay the deductible, which is much lower when you require health services. The coinsurance fee is about 30% for the silver health insurance plan.

If you meet the requirements for cost-sharing reductions (CSRs), you could even pay less for a Silver plan than a Bronze plan. The most affordable Silver plan, at the moment, in West Virginia is only about $752 a month.

The Gold plans, as well as the Platinum plans in other states, are the ideal plan for West Virginia residents with health care needs that extend for a long period. Because of the frequency, these individuals would need a health insurance plan that offers low costs of deductibles. Costs of coinsurance are also less with only about 20% for Gold insurance plans and 10% for the Platinum plans. The only demerit of these health insurance plans is that they have more expensive premium amounts per month. The cheapest Gold health insurance plans in West Virginia have an average of  $839 a month as their monthly premium.




Medicare is the West Virginia federal health insurance program that comprises the younger residents that may be disabled in one form or the other. Only residents that are U.S. citizens for a minimum of five years now can be qualified for the Medicare program.

The open enrollment period runs from October 15 – December.


Being the health insurance program offered by the state of West Virginia, Medicaid is a nationwide health insurance program that includes residents that have only very low household income. The beneficiaries of this program also must be citizens of the United States or legal residents for a minimum of five years. West Virginia has expanded the Medicaid coverage to host even more individuals.

Ryan White and the AIDS Drug Assistance Program

For those with HIV, a federal program called the Ryan White HIV/AIDS Program helps with the coverage gaps for people with insurance. It covers outpatient HIV care and treatment for those without insurance. The program might also be able to assist with expenses like insurance premiums, cost-sharing, and prescription drug costs.

Ryan White includes the AIDS Drug Assistance Program (ADAP). For those with poor to moderate incomes and little to no prescription drug coverage, it helps cover the cost of HIV-related prescription drugs. A lot of states also use ADAP to help their citizens in paying for their health insurance. There are a lot of differences, now though, across the country as a result of the fact that each state runs its own ADAP, including deciding the eligibility requirements and other components.

With the Affordable Care Act (ACA) now passed into law and taking effect, there are now more options for people with HIV and other pre-existing conditions from which they can get cheap health insurance WV. The options now also include purchasing health insurance coverage from the insurance marketplace through the various expanded Medicaid programs. Some services that were previously covered by the Ryan White and ADAP may be replaced by other insurance policies and that would also provide a wider range of health care.

Small Group Plans

For the self-employed, you can be eligible to get a health insurance plan within a small group in West Virginia. For this, there should be at least two qualified employees who work full hours. Depending on the carrier with which you apply, the number of employees will vary.

Also, no set time’s needed before you apply for health insurance coverage. West Virginia’s small group plans underwrite for the health carriers. So, everyone in the group must be entitled to health insurance coverage and the insurance carrier can inflate the health insurance rates based on the health records of the employees being registered for the health insurance plan.


Health Insurance in West Virginia FAQs

Is Pre-K required in West Virginia?

Yes. West Virginia law was passed sometime in the year 2002 by the legislative arm of government in West Virginia that demanded that every county in the region – fifty-five of them, should offer a Universal Pre-K space to every child of age 4 years and even some children of age 3 years if they had special needs to be met.

What is the West Virginia premium plan?

The West Virginia Health Insurance Premium Payment (HIPP) program reimburses residents that use Medicaid to bear the costs of health insurance. The program is self-funded, and provided by a job, or through COBRA, without cost.

This West Virginia Health Insurance Program is run by the West Virginia Bureau for Medical Service.

Can you get cheap health insurance WV plans in West Virginia?

Yes, you can. West Virginia offers two different insurance programs for affordable health insurance WV coverage that target the residents that are low-income earners. These health insurance programs are CHIP and Medicaid.

CHIP provides health insurance coverage for children in households where the household income is low. The insurance cover is determined by the age of the child or children and the household income.

The Medicaid program is essentially a combined effort of the federal government and the West Virginia state.

What does West Virginia CHIP cover?

The West Virginia CHIP program covers children from low-income households in the range of age zero to nineteen years of age.

The West Virginia CHIP is comprehensive and free and comprises children’s visits, prescriptions, visits to the doctor’s, and immunizations.

Do I need long-term disability coverage in West Virginia if I have health insurance?

Yes… maybe. Whether short-term or long-term, disability coverage plans help with medical expenses for people with a disability. Regular health insurance plans coverage does not offer this kind of cover.

Especially if the type of job you have is a risky one, and accidents could easily occur to anyone, it’d be wise to get disability health insurance coverage.

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