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West Virginia Health Insurance

Choosing the right health insurance plan can be very difficult. If you are looking for a health insurance plan in West Virginia, you are in the right place. Get up-to-date West Virginia health insurance quotes by entering your zip code and compare quality plans from trusted health insurance providers. Learn more about West Virginia health insurance plans and find out how you can save on your health coverage.

Facts and Figures

  • Place in State
    Health Report Card
  • Insured 1,528,300
  • Uninsured 261,800
  • Insurance
  • Number of
    Primary Care Physicians
  • Number of
  • Average Cost of
    Health Insurance*

Breakdown of Insureds

  • Employer-sponsored health insurance 56%
  • Private plans 2%
  • Medicaid 19%
  • Medicare 23%

Insurance Carriers

State Health Report Card

Diabetes went up from 7.6 percent to 11.7 percent of the adult population in the past ten years. There are now 171,000 adults with diabetes in the state. Obesity went up 23.2 percent to 32.9 percent among adults in the past ten years. There are now 482,000 obese adults living in the state. Smoking in West Virginia has not decreased in the last ten years. There are 393,000 adult smokers in the state. The rate of preventable hospitalizations is down from 105.4 to 100.7 discharges per 1,000 Medicare employees in the last year.

West Virginia Health Insurance Laws and Regulations

West Virginia health insurance plans must be sold with a guaranteed renewability clause. This will enable policyholders to renew their coverage every time they see it necessary. Furthermore, health insurance companies are not allowed to terminate a coverage on the grounds of sickness or injury on the part of the insured. Newborns and newly adopted children in the state are automatically covered under a parent’s health policy, as long as the policy in question covers dependents. This can last up to 31 days, giving parents enough time to look for a more long-tem solution. When writing new West Virginia health insurance plans, insurers can exclude coverage for a pre-existing condition. This exclusion period can last for months, years, or even permanent. However, when you want to switch plans, the exclusion period you’ve already spent on one plan shall be credited to your next plan. Health insurance is not strictly regulated by the state government, this allows insurers to deny applications for a new plan based on age, family history, health, and other risk factors. Such factors can also be used to determine the cost of your coverage. West Virginia holds an annual open-enrollment period. During this time, certain HMOs must accept all applications regardless of health status. Small businesses with two to fifty employees can purchase group health plans comparable to what is available to small businesses in other parts of the state. West Virginia health insurance quotes for group coverage can vary according to the risk factors of its members. To avoid cancellation of group health plans, small businesses may have to meet certain requirements like a minimum percentage of employee participation or an employer contribution to the members’ premiums. Self-employed residents in West Virginia can purchase group health plans, even without any other employees. In addition, they can also choose an individual health insurance and such plans give them the advantage of being able to deduct a large portion of the premiums from their taxes. 

Heath Care Reform

With the new health care law, children under the age of 26 can choose to stay under their parent’s West Virginia health insurance as long as they are not offered an employer-based health insurance. This provision enabled 2.5 million young adults to have insurance nationwide. In West Virginia, 16,232 young adults have insurance coverage through this provision as of June 2011.

The new health care law allowed 39,164 Medicare policyholders in West Virginia to receive a $250 rebate check to help with prescription drug costs when they fell into the Medicare gap in 2010. In 2011, 36,036 Medicare plan holders were given a 50% discount on brand-name prescription drugs covered by their plans when they hit the donut hole. An average of $653 per person or a total of $23,543,921 was saved in West Virginia.

Previously uninsured individuals without health coverage because of a pre-existing condition can now apply for a Pre-Existing Condition Insurance Plan. This plan is available to U.S. citizens or legal residents with a pre-existing condition and have been uninsured for at least 6 months. In 2011, 76 individuals in West Virginia have benefited from this new law.

When looking at West Virginia health insurance quotes, applicants are assured that at least 80 percent of the price will go directly to health care services and other related improvements. A rebate or premium discount shall be provided if the minimum is not met. With this, 352,000 private policyholders in West Virginia will get greater value for their premium payments because of this 80/20 rule.

Preventive care services like immunizations, colonoscopies, mammograms, or annual wellness doctor visits must be included in all West Virginia health insurance with no deductibles or co-pays. In 2011, 236,654 Medicare subscribers and 300,000 individuals with private policies received such services in West Virginia.

Under the new law, insurance companies are no longer allowed to impose an annual dollar limit – a cap on the yearly spending for your benefits, or a lifetime dollar limit – a lifetime cap for spending for your covered benefits. This law frees chronically ill individuals like cancer patients from worrying about getting further treatment because of such limitations. In 2011, 581,000 West Virginia residents have benefited from this law.

If insurance companies want to raise their premium rates by ten percent or more, they are required by federal law to publicly announce and justify their actions. To guard against such unreasonable increases, the state of West Virginia received a total of $4 million.

All fifty states receive increases in funding for community health centers under the Affordable Care Act. This will help construct new health centers, provide medical services to more patients, improve preventive and primary health care services, and fund infrastructure projects. In West Virginia, 206 community health centers received a total of $69.9 million to fund these improvements.

In 2010, the Affordable Care Act created the Prevention and Public Health Fund. This new fund was created for wellness promotion, disease prevention, and protection against public health emergencies. West Virginia has already received a total of $9.9 million to support its policies, programs, and communities to help its residents lead healthier lives.

State Government Insurance Programs Offered


304-348-3365 888-483-0797

Medicaid provides comprehensive coverage to qualified low-income families who need assistance to pay for their medical care. Services covered include physician services, lab and x-rays, inpatient and outpatient hospital care, nursing home care, health centers and rural health clinics, family planning, immunizations and other early and periodic screening, diagnostic, and treatment (EPSDT) services for children, and many more. To qualify for Medicaid in West Virginia, applicants must: 1. Be U.S. citizens or qualified residents living in West Virginia. 2. Not exceed income limits: Pregnant women and children aged 0-1: 150% of the federal poverty level (FPL). Children aged 1-5 years: 133% of the FPL. Children aged 6-18 years: 100% of the FPL Parents or Caretakers living with children aged 0-18 years: 33% of the FPL. Aged, blind, and disabled: 75% of the FPL with assets not exceeding $2,000 for singles; 83% of the FPL with assets not exceeding $3,000 for couples. Medically-needy: $200/month income with assets not exceeding $2,000 for singles; $275/month income with assets not exceeding $3,000 for couples.

West Virginia Children’s Health Insurance Program (WVCHIP)

877-982-2447 304-558-2732

West Virginia Children’s Health Insurance Program (WVCHIP) was created to provide health coverage uninsured children and teenagers of working families. Covered services include doctor visits, hospital visits, tests and x-rays, prescriptions, immunizations, vision care, dental care, emergency care, urgent care or after hour clinic visits, mental health, diabetic supplies, case management for special needs, and many more. To qualify for WVCHIP, children must be U.S. citizens or qualified residents living in West Virginia and under 19 years old. Must not be eligible for West Virginia Medicaid or West Virginia State Employee Health Insurance. Must have lost family coverage in the last three months and family income must not exceed 300% of the federal poverty level (FPL).

West Virginia Breast and Cervical Cancer Screening Program

800-642-8522 304-558-5388

The West Virginia Breast and Cervical Cancer Screening Program (WVBCCSP) was created to provide uninsured and underinsured women access to breast and cervical cancer screening services. The program covers screening and diagnostic services including clinical breast exams, mammograms, breast biopsies, Pap tests, and pelvic exams. Eligibility: 1. Must be between 25 and 64 years old. 2. Income must not exceed 200% of the federal poverty level (FPL). 3. Must be uninsured or current insurance does not cover the services offered by WVBCCSP or has an unmet deductible or a required co-payment that may cause difficulties in acquiring the same services from current health insurance.   

West Virginia Medicare

800-MEDICARE 800-633-4227

Medicare is administered by the federal government and provides health insurance coverage for Americans aged 65 and above or those younger than 65 but have a disability or end-stage renal disease. Coverage has four parts: Part A: provides inpatient care in hospitals and rehabilitative centers. Part B: provides doctor and some preventive services and outpatient care. Part C: provides Medicare benefits through Medicare Advantage. Part D: provides prescription drug coverage. Eligibility: 1. Must be a U.S. citizen or permanent U.S. resident. 2. Must be 65 years or older, with you or your spouse having worked in a Medicare-covered employment for at least ten years; or have a qualified disability or end-stage renal disease, regardless of age.  


866-445-8491 304-558-8264

AccessWV is West Virginia’s High Risk Pool and offers health insurance to residents who may have been denied coverage due to a serious medical condition. AccessWV offers four comprehensive plans that cover physician visits, inpatient and outpatient hospital care, emergency services, prescription drug, preventive care, home health and hospice, nursing, durable medical equipment and supplies, mental health and chemical dependency services, and prenatal and maternity care. Eligibility: 1. Must be a West Virginia resident for at least thirty days. 2. Must have been denied health coverage in the last 6 months; or only able to access coverage with limited benefits or rates higher than the plans by AccessWV; or be uninsurable because of a serious medical condition. 3. Residents who are eligible for HIPAA or HCTC coverage are also qualified for the program. 4. Must not be eligible for group or public health insurance. 5. Must not be in a public institution. 

"Vista Health Solutions" Tel (888)215-4045 Email [email protected]