Who qualifies for Medicare in West Virginia?
In general, Medicare in West Virginia is available through the federal government to eligible people age 65 or older and those who have disabilities. People who are 65 or older are eligible for Medicare in West Virginia as long as they meet the following criteria:
- U.S. citizen, or
- Lawful permanent resident who has resided in the U.S. for five or more years, and
- Already receiving Social Security or railroad retirement benefits, or
- Are eligible for Social Security or railroad retirement benefits but are not collecting them yet, or
- Government employees or retirees who paid Medicare payroll taxes through employment but did not pay into Social Security
People under age 65 might still be eligible for full Medicare coverage in West Virginia when they meet one of the following criteria:
- Have received or been eligible for Social Security disability or Railroad Retirement Board benefits for 24 or more months
- Are diagnosed with Lou Gehrig’s disease, which will immediately qualify an applicant for premium-free Medicare coverage
- Have received a kidney transplant, are on dialysis, have end-stage renal disease, and have paid into Social Security for a period that depends on age
People who do not otherwise qualify for the Medicare program but who are U.S. citizens or lawful permanent residents who have lived in the U.S. for five or more years can still get Medicare at age 65 by buying into Medicare Part A and Part B. They will have to pay premiums for Medicare Part A based on the work credits they have earned. Those who have earned between 30 and 39 credits will pay the lowest premiums, and if they continue working until they have earned 40 credits, they will no longer have to pay Medicare Part A premiums.
They will also have to pay monthly premiums for a Part B health plan that others enrolled in Part B pay. As of 2021, individuals who earn up to $88,000 and joint tax filers who earn up to $176,000 pay $148.50 per month.
People in West Virginia are allowed to enroll in Part B for outpatient services without purchasing Part A. However, those who purchase Part A are required to enroll in Part B. Medicare beneficiaries who are enrolled in Part A and Part B are eligible for coverage for prescription drugs through a Part D plan under the Medicare program.
Finally, people cannot enroll in Medicare Advantage plans or Medigap Supplements through private health insurance companies unless they are enrolled in Medicare Part A and Part B. These medical insurance plans provide additional coverage options.
Is Medicare in West Virginia free?
Under the Medicare program, people earn Medicare benefits through work credits. While they might have worked enough to qualify for premium-free Part A hospital benefits, Medicare Part B requires people to pay monthly premiums. The different Medicare parts and plans also have deductibles that people will still be responsible for paying before their benefits will kick in, and copays might also be required.
How Much is Medicare Part A?
As of 2021, people who have not earned 40 or more credits will have to pay a Part A premium. Those who have earned between 30 and 39 credits during the past 10 years will pay a premium of $259. People who have earned fewer than 30 credits will pay a premium of $471.
Part A also comes with deductibles for inpatient hospital stays of $1,484 for each benefits period. The coinsurance people will have to pay for inpatient hospital stays is $0 for the first 60 days during a benefits period. They will have to pay $371 in coinsurance for days 61 to 90. If people remain in the hospital for 91 or more days, they will be responsible for $741 per day up to 60 days as part of their lifetime reserve. If people have used all of their 60 lifetime reserve days, they will then be responsible for all costs for inpatient stays.
How Much is Medicare Part B?
As of 2021, the standard Medicare part B premium for individual tax filers earning up to $88,000 or joint filers earning up to $176,000 is $148.50 per month.
Most people only pay the standard Part B premium of $148.50 per month, however.
The Medicare Part B deductible is $203. Following that, people are responsible for 20% of the provided outpatient services.
How Much is a Medicare Part D prescription drug plan?
Part D plan prescription drug coverage premiums vary by plan with higher earners paying more. In 2021, the weighted average premium is $38 per month for prescription drugs through Medicare Part D plans. The standard deductible for Part D plans is $447. Most Medicare beneficiaries pay less than $10 in coinsurance for generic prescriptions up to a maximum coinsurance of 33% for brand-name drugs.
What if I choose a $0 Premium Medicare Advantage Plan?
Medicare Part C or Medicare Advantage plans are medical insurance with premiums that vary by plan. Some offer $0 premiums. While $0 premium Medicare Advantage plans do not have premiums, people who have them are still required to pay their Medicare Part B premiums before they will be eligible for Medicare Advantage plans. Medicare Part C plans frequently include additional perks, including vision, dental, hearing, wellness, and fitness, and many also have Part D prescription drug plans built-in. An insurance agent can help you to understand the different coverage options, including wellness benefits.
How Much is a Medicare Supplement plan?
The costs of Medicare Supplements, which are offered by private insurance companies, vary by gender, age, location, and the health insurance plan chosen out of the 10 available standardized plans. Regardless of the insurance plan that you might choose, you will have to pay this premium on top of the premium you pay for Part B. Frequently, Medicare Supplement plans do not include Part D plans. People tend to choose Medicare Supplement plans because they offer comprehensive coverage options and do not require people to participate in networks. This makes their associated medical costs more predictable.
What Medicare plans are available in West Virginia?
Best for Network Freedom: Medicare Supplement
Medicare Supplement or Medigap plans have a higher monthly premium ranging from $125 to $250. However, they are not limited to set service areas and instead provide nationwide coverage. Since there isn’t an assigned service area, you can receive specialty care out of state. You do not need referrals, and your plan will not undergo annual changes. The premiums can change, however.
Best for Lowest Premiums: Medicare Advantage
A Medicare Advantage PPO has a larger network and doesn’t require referrals. The premiums for Medicare Advantage PPO plans range from $0 up to $100 per month.
A Medicare Advantage HMO plan has a smaller network. Referrals for specialty care are required. In general, the premiums for Medicare Advantage HMO plans are $0 per month.
Best for Low-Income or Health Conditions: Medicare Advantage D-SNP
Medicare Dual Eligible Special Needs Plans (D-SNPs) are offered through the Centers for Medicare & Medicaid Services. They are best for low-income people and those who suffer from chronic health conditions such as end-stage renal disease or Lou Gehrig’s disease. These plans are available to people who are entitled to both Medicaid assistance and Medicare. You can be dually enrolled in Medicare and Medicaid to reduce your out of pocket costs on premiums and copayments.
West Virginia Medicare FAQ's
What is the income limit for Medicare in West Virginia?
There isn’t an income limit for Medicare eligibility in West Virginia. However, individuals earning more than $88,000 and joint filers earning more than $116,000 will pay higher Part B premiums based on their incomes.
For individuals earning from $88,001 up to $111,000 and joint filers earning from $116,001 up to $222,000, the monthly Part B premium is $207.90. Individuals who earn between $111,001 to $138,000 and joint filers who earn between $222,001 to $276,000 pay $297.50 per month.
Individuals earning from $138,001 to $165,000 and joint filers earning from $276,001 to $333,000 pay $386.10 per month. Individual tax filers earning from $165,001 to $499,999 and joint filers earning from $333,001 to $749,999 pay $475.20 per month. Finally, individuals earning $500,000 or more and joint filers earning $750,000 or more pay $504.90 per month in Part B premiums.
How do I apply for Medicare in West Virginia?
When you turn 65, you will likely become eligible for Medicare health coverage. Your enrollment steps for applying for Medicare Part A and B health care will depend on whether you are receiving Social Security or Railroad Retirement Board benefits at the time you enter the initial enrollment period.
People who are receiving retirement benefits through Social Security or the Railroad Retirement Board should automatically be enrolled in Medicare Part A and Part B. If you are not yet receiving retirement benefits when you reach age 65, you will have to apply to enroll in Medicare Part A and B for health care coverage. People who are automatically enrolled will receive packages in the mail three months before their health care coverage begins and their Medicare cards.
If you are not yet receiving Social Security or Railroad Retirement Board benefits, you will have to take steps to enroll in Original Medicare. You can sign up for Part A and/or Part B in one of the following ways:
- Applying in person at a Social Security office
- Calling the Social Security Administration at 1-800-772-1213
- Mailing a dated, signed letter to the Social Security Administration that includes the date you would like to be enrolled, your name, and your Social Security number
- Applying online at www.ssa.gov
If you are eligible to receive benefits from the Railroad Retirement Board, you can call them to sign up or contact the local Railroad Retirement Board office.
To prevent yourself from being charged a Part B premium penalty, make sure to keep proof of the date you try to enroll in Medicare in West Virginia.
When can I apply for Medicare in West Virginia?
The initial period for Medicare enrollment generally begins three months before you turn 65 and lasts until three months after the month of your 65th birthday for a total of seven months. If you miss this initial enrollment period, you might have to wait for Medicare enrollment and be forced to pay a late enrollment penalty for Part B coverage. If you do not have premium-free Part A, you might also be charged a Part A premium penalty.
Where do I apply for Medicare?
You can apply for Medicare benefits in West Virginia in one of the following ways:
- In person at your local Social Security Administration office or Railroad Retirement Board office
- Online at ssa.gov
- By phone at 1-800-772-1213 or 1-800-325-0778 if you are hard of hearing
You can also mail a letter to the Social Security Administration requesting an enrollment date with your name and Social Security number. However, since letters can be lost, it is better to apply in one of the other three ways.
What should I bring when applying for Medicare?
If you apply in person, you should bring the following documents in case they are needed to verify your eligibility:
- Birth certificate
- Proof of U.S. citizenship or lawful permanent residence in the U.S. for five or more years
- W-2s and tax returns from the last two years
- Current health coverage, if any
- Military service records
Is enrollment in Medicare mandatory at age 65?
Once people enroll in Social Security, they must sign up for Medicare part A since the two are linked. However, since the other Parts of Medicare, including B, C, and D are optional, you can delay enrolling in those parts as long as you have creditable health insurance coverage.
Medicare by State
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- In West Virginia, Medicare Advantage & Medicare Supplement plans are the most popular choices
- Your initial Medicare enrollment period begins three months before your 65th birthday and includes the entire month
- In West Virginia, apply for Medicare online, by phone or at a Social Security office in your service area.