Assisted living facilities primarily help residents with non-medical needs. Although minor and infrequent medical services, such as first-aid for a wound, can sometimes be met on-site by nurses. These communities may sometimes also be called ALFs, residential care facilities, retirement homes, or long-term care facilities.
The financial options available to help pay for senior care is dependent on, among other things, the type of care that is required. If you are just beginning the research process on how to pay for long-term care, it is helpful to have an idea about the type of care you or your loved one currently requires, as well as to anticipate future needs. In addition, it is important to be familiar with the associated eldercare terminology.
Can using home care technology help your family save money caring for an aging loved one? The answer is most certainly “Yes”. Our goal is not to provide a comprehensive list, but rather to make sense of those that are available on the market today and can reduce the care hours required by elderly persons. As such, they can reduce a family’s out-of-pocket care costs or reduce the hours they spend providing care themselves.
Medicare Advantage (Part C), a privately offered alternative to Original Medicare (Parts A and B), has grown in popularity over the years. Despite the growing popularity of Medicare Advantage, some seniors face obstacles that prevent them from truly understanding how it works and who it benefits. Common mistakes about Medicare Advantage include misunderstanding its differences from Original Medicare, getting it confused with other forms of private Medicare insurance (like Medigap or Part D), or not understanding how to look up or evaluate plans.
Eligible Medicare beneficiaries in West Virginia can choose between enrolling in Original Medicare or Medicare Advantage Plans. Original Medicare is overseen and administered by the federal government in Medicare Part A and Medicare Part B plans. Part A covers hospitalization services and access to skilled nursing along with some home health care, while Part B covers medically necessary outpatient care, preventative care, home health care and some durable medical equipment. Medicare Advantage (often called Medicare Part C) plans are administered by private insurance providers. These providers must be approved by the Centers for Medicare and Medicaid Services and must follow all regulations provided.
Medicare Advantage Plans cover the same services as Part A and Part B Medicare, while often including additional features, such as adding a prescription drug benefit that isn’t offered by Original Medicare without an extra plan. Medicare Advantage Plans also often cover dental and vision care and may provide wellness programs or emergency medical transportation. However, beneficiaries of Medicare Advantage Plans should note that most plans require them to visit in-network providers for coverage and sometimes reside within the region they represent. If beneficiaries change their residence, they often have to change their MA Plan enrollment as well.
In West Virginia in 2023, approximately 446,562 individuals were eligible for Medicare Advantage enrollment, with 212,190 of them enrolled in Medicare Advantage Plans, constituting around 48% of the eligible population. This percentage reflects the nationwide trend of eligible enrollees opting for these plans in 2023. While the state experienced a modest 0.86% increase in eligible enrollees compared to 2022, the national figure stood at 2.66%. Nonetheless, there was a substantial 11.69% surge in Medicare Advantage enrollment in West Virginia in 2023 compared to the previous year, contributing to a noteworthy 10.74% growth in the enrollment of eligible beneficiaries. This underscores a growing awareness and interest in Medicare Advantage Plans within West Virginia.
This guide delves into Medicare Advantage Plans in West Virginia, covering key aspects such as coverage details, eligibility criteria and the process of locating and enrolling in a plan.
The Top 10 Medicare Advantage Plans in West Virginia
Across West Virginia, there are several insurance providers which offer Medicare Advantage Plans for Medicare-eligible residents. The table below lists the eight most popular Medicare Advantage providers based on enrollment data, as well as the Medicare star rating and a range of estimated cost data. Because many providers offer numerous plans across the state, enrollment data for individual plans under a provider have been combined. Likewise, the minimum and maximum cost ranges are based on several plans offered by each provider. This information is up to date as of July 2023, but the most recent information can be reviewed on Medicare.gov.
Name
Enrollment
Medicare Star Rating
Monthly Cost Range
Plan Types
Humana
109233
4
$0 – $136
PPO, HMO
Aetna Medicare
34235
3.5
$0 – $55
PPO, HMO
UnitedHealthcare
13249
4
$0 – $32
PPO
Highmark Inc.
12030
5
$0 – $163
PPO
The Health Plan
4933
4.5
$0 – $33
HMO
Blue Cross and Blue Shield of IL, NM
1391
4
$0 – $71
PPO
Anthem Blue Cross and Blue Shield
1136
N/A
$0 – $0
PFFS
Blue Cross Blue Shield of Michigan
283
N/A
$0 – $113
PPO
How Medicare Advantage Plans Work in West Virginia
Before enrolling in a Medicare Advantage plan, it’s important to know how this program works in West Virginia. Insurers often have multiple plans, including health maintenance organizations (HMOs) and preferred provider organizations (PPOs). Each type has different requirements pertaining to in-network and out-of-network coverage, choosing a primary care provider, referrals and prescription drug coverage. Here’s a description of the four most popular plans:
What Medicare Advantage Plans Cover in West Virginia
Medicare Advantage plans must cover the same provisions that are available to Original Medicare beneficiaries, except for hospice care. These services include preventive screenings, X-rays, lab tests and care provided during a hospital stay. Medicare Advantage providers may also cover other benefits such as eye care, dental care and hearing aids.
Coverage Available With Medicare Parts A & B?
Coverage Available With Medicare Advantage?
Preventive Screenings
Yes
Yes
Hospital Care
Yes
Yes
Durable Medical Equipment
Yes
Yes
Prescription Drugs
No
Yes**
Vision Care
No
Yes*
Dental Care
No
Yes*
Hearing Aids
No
Yes*
*Select plans offer this coverage
** Most plans offer this coverage
Eligibility for Medicare Advantage in West Virginia
To qualify for Medicare Advantage, applicants must already be enrolled in Medicare Part A and Medicare Part B. They must also meet all other Medicare eligibility requirements and reside in the plan’s service area. Enrollees must be at least 65 years of age or have a disability that qualifies them for Medicare at a younger age. They must be a U.S. citizen or legal immigrant. Medicare has limited enrollment periods as with other types of health insurance, so it’s essential to know when to apply for Medicare or change plans. Refer to the list below for more information on enrollment timing.
Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.
Start Date
End Date
Initial Coverage Election Period
3 Months Before One’s 65th Birth Month
3 Months After One’s 65th Birth Month
Annual Election Period (AEP)
October 15th
December 7th
Medicare Advantage Open Enrollment Period
January 1st
March 31st
Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.
How to Find & Choose a Medicare Advantage Plan in West Virginia
Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.
First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.
West Virginia’s State Health Insurance Assistance Program, WV SHIP, is a free, federally regulated service that helps seniors navigate their Medicare options. A statewide network of trained volunteer SHIP counselors offer one-on-one counseling appointments with seniors, caregivers and family members who need unbiased information and guidance about Medicare Advantage plans. SHIP counselors can also help seniors understand the various Medicare Part D/prescription drug coverage options, and provide information on medication discount programs that Medicare members can use to reduce out-of-pocket costs. SHIP counselors are often based in local senior centers, and some services are delivered over the phone and through group information sessions.
To find a nearby SHIP provider, seniors and their families can use the search tool on West Virginia’s SHIP website. SHIP can also be contacted by phone at 877-987-4463 or 304-558-3317.
West Virginia’s Senior Medicare Patrol is a volunteer-based, federally funded organization that works to raise awareness about Medicare fraud, misuse and billing errors. SMP volunteers work in conjunction with SHIP counselors to deliver information to seniors through one-on-one sessions, public events and community-based workshops. Medicare Advantage members who have concerns about their plan are encouraged to contact their insurance provider. If the concerns remain unresolved, SMP volunteers may be able to advocate on behalf of the Medicare beneficiary. Seniors who believe they have been affected by MA billing errors or misuse can contact their local SMP branch. Cases that are suspected to involve criminal activities such as fraud are referred to the appropriate local, state or federal agency.
West Virginia Legal Aid provides low-income and marginalized seniors aged 60 and older with access to free civil legal advice on issues including Medicare health care coverage. The statewide organization maintains a network of participating lawyers who can assist seniors, and also maintains a current library of plain-language resources that provide in-depth information on Medicare and other legal issues related to seniors.
To contact West Virginia Senior Legal Aid, call 1-800-229-5068.
Medicare Premium Assistance Programs
Seniors and qualified adults with disabilities who have difficulty paying their Medicare Part A and Part B premiums, co-pays and deductibles may qualify for financial assistance through one of two West Virginia Medicare Premium Assistance Programs. Open to applicants with incomes up to 120% of the federal poverty level who have few countable assets, these programs are administered by the Department of Health and Human Resources, Bureau for Children and Families. Applicants may qualify for either the Qualified Medicare Beneficiary (QMB), or the Specified Low-Income Medicare Beneficiary (SLIMB) program.
For more information about the QMB and SLIMB Medicare Premium Assistance Programs, contact the Bureau for Children and Families at 304-558-0628.
Local Medicare Advantage Resources
Barbour County Senior Center
Located in the City of Philippi, the Barbour County Senior Center offers a range of educational, support and advocacy services to older adults. Seniors can access State Health Insurance Assistance Program counselors at the center, speak with a social worker about local resources and get referrals to low-cost legal services that specialize in Medicare Advantage issues. The center also hosts information workshops that help seniors understand their rights and responsibilities related to Medicare and Medicare Advantage plans.
The Barbour County Senior Center is located at 47 Church Street in Philippi, West Virginia. Seniors can contact the center at 304-457-4545.
Kanawha Valley Senior Services
Seniors in Charleston and the surrounding areas can contact Kanawha Valley Senior Services for help with Medicare Advantage plan selection and obtaining prescription drug coverage. Five KVSS representatives are available to provide seniors with unbiased information about Medicare, Medicare Advantage and Medicare Part D prescription drug plans. KVSS Medicare counselors can also answer questions about plan selection, and provide information about financial aid programs for those who have difficulty covering their Medicare costs.
