West Virginia is nicknamed as the “Mountain State”, and is located at an elevation of about 1,500 feet above sea level and is the highest of any U.S. state located east of the Mississippi River. The region of this state is economically and socially tied to the mountain spines that spreads across its length and breadth. It is a relatively small state that is also less populated. Despite having mountains and natural beauty, the state has a low health ranking, as the residents of this state come first in terms of accidents and 3rd for cancer. Thus, people living in the state need to work upon their health and should maintain a proper healthcare regimen in order to improve their health ranking. Residents of this state should be completely aware of the health insurance marketplace, so that they protect themselves and their families with the ideal health plan that perfectly cater to their healthcare requirements. There is a partnership exchange in the state that means residents enroll in health plans through HealthCare.gov, but the plans are managed by the state. west Virginia adheres to the federal Open Enrollment Period just like the majority of the states that starts from November 1 and ends on December 15 in every year.
Highlights & Updates of Health Insurance Marketplace in West Virginia
- Residents of West Virginia enroll in exchange health plans through HealthCare.gov but the plans are managed by the state because it has a partnership exchange.
- For 2020 health plan coverage in West Virginia, open enrollment has ended and now only residents with qualifying events can enroll.
- Open enrollment for the health plan effective in 2021 will begin from November 1, 2002.
- West Virginia defaults to new federal rules regarding short-term health plans, so the short-term plans are available in the state for initial terms of up to 364 days and renewals are permitted as long as the total duration of the coverage doesn’t exceed 36 months.
- Some of the insurers in West Virginia offer short term plan for a maximum duration of 184 days and don’t allow for any renewals.
- Two insurance carriers are offering coverage in 2020 through the West Virginia exchange.
- The average health premium increase for 2020 coverage in West Virginia is about 6.7%.
Individuals and Family Health Insurance Plans
Individuals and family health insurance plans become essential for people who do not receive coverage from their employers or young students who are no more covered under their parent’s plan. Residents of West Virginia can choose from health plans offered to individuals and families depending upon their healthcare needs. They can purchase individual and family plans either through healthcare exchange or through participating private insurers through HealthCare.gov. All qualifying individuals and family health insurance plans available in West Virginia offer ten standardized essential benefits along with some additional benefits to provide comprehensive health coverage to the residents of this state.
Health Maintenance Organizations (HMOs) – Health Maintenance organization has a network of healthcare providers, who agree to offer a wide range of healthcare services to the members associated with the HMO plan. The members are required to choose a primary care physician, who take care of their healthcare needs and also provide referral before seeing any specialist. HMO is a type of individual plan that offers coverage for a broader range of preventive healthcare services compared to other types of plan. Besides a wide range of preventive healthcare services, members also have lower out-of-pocket healthcare expenses. Members are not necessarily required to pay a deductible before start of the coverage and they also pay minimal co-payment. Members are not required to submit their claims to the insurance company, as the claims are submitted by the healthcare providers. Members enrolled in HMO plan should remember that they will not receive coverage for services rendered by out-of-network providers or for healthcare services received without a referral from the primary care provider.
Preferred Provider Organizations (PPOs) – Among all the individual and family plans available in the health insurance market, PPO is the most popular type of plan that allow members with complete freedom and flexibility. Right from visiting a physician of one’s choice to obtaining a referral from a primary care physician is concerned, members enjoy complete freedom and flexibility with PPO plans. Though, members are expected to use the insurance company’s network of preferred doctors but they do not require to choose a primary care physician. Members are free to choose the doctor of their choice but they should keep in mind the in-network healthcare services will be covered at higher benefit level compared to out-of-network services. Therefore to receive highest level of benefit coverage members of this plan should visit healthcare provider that accepts their health plan.
Exclusive Provider Organization (EPO) – It is a type of individual and family plan that allows members to receive health care services from doctors and hospitals who are within a certain network. If the members visit a doctor outside of that network, then they will lose their coverage with the only exception of emergency care. Members of this plan are also required to select a primary care physician, who will manage their healthcare but they will not require to obtain referral from their primary care physician to see a specialist physician. Since members of the EPO plan are required to visit healthcare provider from the network so they have to pay lower monthly premiums because in-network doctors have contracts with the insurance company. However, members are required to pay more out of pocket before insurance carrier starts covering for their medical expenses.
Point-of-service (POS) Plans – POS plan has qualities of both HMO and PPO plans and its benefits mainly depend whether members have received care in or out of the health insurance company’s network of providers. Members of this plan also need to designate a primary care physician, who will manage their healthcare and also provide referrals to network specialists when needed. Healthcare services rendered by the Primary Care Provider are usually not subject to a deductible and preventive care benefits are included in some of the POS plan. Members of the POS plan may receive care from non-network providers at greater out-of-pocket costs just like a PPO plan. Members of this plan may also be responsible for co-payments, coinsurance and an annual deductible.
Indemnity or fee-for-service plan – Indemnity or Fee-for-service plans allow members to have complete complete control on their health care and visit any doctor or hospital of their choice. Members are free to visit doctors or specialists of their choice without any need of requiring any referral. Although members may receive majority of their basic healthcare from a single doctor but it is not essential for them to choose a primary care physician. Members of this plan are required to pay up-front the cost of their healthcare services and then submit a claim for reimbursement from their insurance company. A certain portion of the total healthcare charges of the members are paid by the insurance company. Members are required to pay an annual deductible before start receiving coverage from the insurance company.
Short-term Plans in West Virginia
West Virginia defers to the federal rules for the maximum duration of short-term plans, as the state does not have regulations related to the maximum duration for short-term health plans. Short-term plans have initial terms of up to 364 days and total duration including renewals of up to 36 months. Renewals of short-term plans are permitted as long as the total duration of the coverage doesn’t exceed 36 months. However, renewability of the short-term plans vary from insurer to insurer and so some of the insurers in West Virginia have cap the plan terms at six-months and do not allow any renewals. Short term health insurance plans in West Virginia is not recommended for everyone and only individuals looking to save on health insurance costs and individuals who only need minimal coverage should opt for this plan. The benefits of short term plans are limited to just emergency care and these plans work well for individuals who don’t require regular medical care like frequent visits to the doctor or expensive prescriptions. These plans do not cover comprehensive benefits covered by major medical health insurance. However, these plans are affordable for many people.
Dental Insurance in West Virginia
Individual and family dental insurance plans available in West Virginia provide coverage for many dental care procedures such as regular checkups, teeth cleanings, root canals, x-rays and several other such services. West Virginia dental insurance plans are affordable plans offering coverage as per the specific needs of the individuals, as the state have cheap dental plan as well as preventive dental insurance plan. The dental plans available in the state differs in terms of the dentist network, dental care prices, monthly premium cost. Generally there are three types of dental insurance plans available in West Virginia such as:
Preferred Provider Organization Dental Plans – PPO dental plans are plans having a network of participating dentists to whom members can visit for their dental care. This plan is comparatively affordable compared to indemnity plan because all the participating dentist of the plan render dental care at agreed upon rates, which the insurance companies have negotiated to keep the dental care cost checked for the members of this plan. Though, members can go out-of-network in this dental plan but their out-of-pocket costs will steeply increased.
Indemnity Dental Plan – With indemnity dental plans members are allowed to visit dentist of their choice, as there are no dentist network maintained in this plan. Since, members are free to visit dentist of their choice, the dental insurance companies pay only usual, customary and reasonable amount. This further means that when members visit a dentist to receive dental care, the claim for the reimbursement is submitted by the dentist. The insurance company first check the dental care cost from their own network providers and reimburse only the amount which they would have charged if the same dental service would have been rendered be them. Policy members will be responsible for paying the remaining amount of the claim.
Dental Discount – These are not exactly dental insurance plans but are like buying a membership, in which members are given discounts on specific dental services, which they may need. However, members are required to visit the dental care provider within the network to receive the discounts. Members are not required to fill any insurance form and even billing is not required. Members just have to pay the specified amount mentioned on the card to the dentist after receiving the dental care.
Vision Insurance in West Virginia
Vision insurance plans in West Virginia is designed to provide coverage for several vision care expenses like routine eye exams, prescription glasses and contact lenses. Vision insurance plans available in the state provides both choice and flexibility along with no waiting periods. Besides, vision plans have a national network of providers offering vision care services as well as eye-wear, which members can use for the best coverage. Vision care plans also come with the freedom to use a non-network provider, though out-of-pocket costs may be higher. This gives members complete flexibility in selecting a eye-care provider that well caters to their eye-care and eye-wear needs.
Health Insurance Carrier in West Virginia
Currently there are two health insurance carriers associated with West Virginia’s health insurance exchange to offer health plans in 2020. The two health insurance carriers are:
Besides these two, Health Plan of West Virginia also offers ACA-compliant coverage in the state, though outside the exchange and their enrollment is quite low.