Are you having trouble choosing between your different options when it comes to health insurance in West Virginia? You’re not alone. Thousands upon thousands of West Virginia residents are trying to figure out which health insurance options are best for them and their family. If you’re having trouble deciding between major medical, short-term health insurance, a health share plan, and more, we’re here to help. Just keep reading to learn more about what your different options are, and how best to choose between them.
Major Medical Insurance in West Virginia
Technically, West Virginia has its own local, state health exchange. However, the state has been relying upon HealthCare.gov for citizens to sign up, file an application, and wait to hear back their results. HealthCare.gov is how you access the national Health Insurance Marketplace, Due to West Virginia’s state exchange, you will only see health insurance providers the state has authorized to sell major medical plans within West Virginia borders.
Open Enrollment via HealthCare.gov starts on November 1st of every year and usually goes until about mid-December, although the deadline tends to vary from year to year. There are also special enrollment periods if you suffer a job loss, welcome a new member of the family, or move far enough to change zip codes. If you are outside of the Open Enrollment period and you don’t qualify for a special enrollment period, you might want to consider short-term health insurance to hold you over until the next Open Enrollment.
There are several reasons why the Health Insurance Marketplace should be your first stop if you are shopping for medical coverage. For one, all of the Health Insurance Marketplace policies are guaranteed issue – which means you cannot be rejected for coverage, nor can you be charged more for pre-existing conditions. There are only four factors that an insurance company can use as a legal basis for charging you more for your monthly premiums. Those factors are:
- Your age
- Your location
- Your use of tobacco products
- Whether you are applying for an individual policy or a family policy
Then there are the benefits you get with ACA health insurance. There are 10 guaranteed Essential Health Benefits in total, and experts believe that consumers need access to all of these benefits for optimal health and wellness. Just to review, those benefits include:
- Ambulatory/outpatient services
- Emergency services
- maternity/newborn care
- Mental health and substance abuse
- Prescription drugs
- hab/rehab services and devices
- Lab tests
- Preventive and wellness services and chronic disease management
- Pediatrics (including oral and vision)
Lastly, there’s the affordability. These types of health insurance policies would generally be considered too expensive for the average American; however, many people making at least 138% of the federal poverty limit will qualify for a generous premium tax credit that makes them affordable. The tax credit gets paid right to the insurance company so you don’t have to hassle with any paperwork. you just pay your share of the monthly premium in order to stay in good standing with your insurance company. The chart below can help you figure out whether or not you might qualify for a subsidy:
|Household Size||Annual Income (138% of FPL)|
Back in 2014, changes to the ACA gave states the option to either accept or reject federal funds for Medicaid expansion. West Virginia was an early adopter of the Medicaid expansion program, meaning that people who fell in the income gap between 138% of the federal poverty limit and the original maximum poverty threshold for receiving Medicaid are now eligible for the Medicaid program in West Virginia. To check and see whether or not you qualify for Medicaid in West Virginia, you should visit the West Virginia Bureau for Medical Services website and fill out an application.
Short Term Health Insurance in West Virginia
West Virginia allows federal rules to regulate short-term health insurance plans, which means you can purchase plan for an initial starting duration of 364 days and renew for a maximum of 36 months. But when you do this, you will have to undergo medical underwriting. The underwriting process is the exact opposite of guaranteed issue. Your insurance company will evaluate you and your health and decide how much to charge you (or possibly to reject you for coverage) based on whether or not you have pre-existing conditions. From there, you may have to pay a substantially high deductible before your insurance coverage starts paying out your claims (but There are supplements like fixed indemnity plans that can help with that). With short-term health insurance, you also won’t have access to all of the guaranteed Essential Health Benefits that you would get through the ACA, but you might have the option to negotiate with your insurance provider to purchase the coverage you need even if they don’t usually offer it.
On top of that, you can expect a potential 33% reduction in the price of your monthly premium compared to the price of an unsubsidized ACA plan. This can be a big help if you don’t qualify for a subsidy, but still need to find affordable coverage. You also have the greatest amount of consumer protections under the law with short-term health insurance. Some of the other options we will talk about later don’t necessarily offer such benefits. But if you ever have a claim dispute with your provider, you will have the option to take them to court and get it settled that way if they refuse to settle with you personally.
Christian Health Plans/Health Share Plans in West Virginia
If you can’t get healthcare through the Health Insurance Marketplace and you aren’t sold on short-term health insurance yet, you might want to consider a Christian health plan. These plans were a lot more popular during the years that the individual mandate was still charging people a penalty on their taxes for not purchasing the right kind of health insurance. That mandate was gone as of 2019, which now puts these health share plans on an even playing field with short-term health insurance.
Let’s start by talking about all the ways in which Christian health plans are similar to short-term health insurance so that you understand why these forms of coverage are so competitive with one another:
- These plans are NOT guaranteed issue
- They will likely have unlimited out-of-pocket costs
- Almost all plans come with lifetime and annual benefit caps
- These plans do not include all of the guaranteed Essential Health Benefits
- Their monthly payments can be up to 33% less expensive than unsubsidized ACA health insurance premiums
At the same time, though, there’s some very important differences between these plans. The reason people used to receive an exemption to the individual mandate is because Christian health plans and health share plans are administered by non-profit religious organizations. For that same reason, these organizations are not regulated by the federal government and you won’t have any consumer protections against them if you feel they have unjustly denied you your claim. Their religious nature also allows them to impose participation guidelines if you want to remain in good standing in order to get your claims paid out. These guidelines might be as simple as declaring a specific religious faith and attending a specific church on a regular basis. You might also have to change lifestyle patterns, like your tobacco use, in order to be healthier and require less medical care. Lastly, although it seems minor, the language is a little different. Health share plans will charge you a monthly share amount instead of a monthly premium (even though this payment serves the same purpose). And instead of being charged a deductible, copay, or coinsurance, those costs are referred to as “personal responsibility amounts” or “unshared amounts”. Again, though, they still serve a very similar purpose despite the name change.
Fixed Indemnity Plans in West Virginia
Fixed indemnity plans work great as a supplement for things like major medical, short-term health insurance, or a health share plan – but they aren’t so good as their own form of insurance. Here are some of the benefits to a fixed indemnity plan: for one, you can go out of network and get care anywhere you want without worrying about paying full price out-of-pocket. Fixed indemnity plans are flexible and, depending on your provider, you could get a plan with doctor, hospital, or even dental benefits if you want. It’s a great way to help reduce your out-of-pocket costs, especially if your current insurance has a very high deductible that you have to meet before they will payout on any of your claims.
But here are the ways in which fixed indemnity plans don’t fare so well, especially when it comes to replacing something like major medical. Fixed indemnity plans payout a fixed amount of money per claim – usually on a daily, weekly, monthly, per incident, or per visit basis. Major medical, on the other hand, pays out a fixed percentage of your costs. It’s the difference between getting $60 of your $300 doctor bill or 60% of your $300 doctor bill paid for. And like many other options outside of the Health Insurance Marketplace, medical underwriting for a fixed indemnity plan could mean that you might get rejected for coverage, or you might get charged higher premiums. There’s also the lifetime and annual benefit caps to worry about, and the fact that you don’t have limits on your out-of-pocket costs.
Discount Cards in West Virginia
Medical discount cards can be a great way to supplement your out-of-pocket costs. But finding a good one is going to take a little work on your part. Medical discount cards aren’t regulated the way major medical insurance is, so some discount card companies will try to play fast and loose with the rules in order to get your money. The biggest sign that you might be falling for a scam is if the company advertises their medical discount card as a form of or a legitimate replacement for major medical insurance – because these cards are anything but. They don’t pay out claims that you file, or reimburse you for a fixed percentage of your medical expenses. All they do is offer you a moderate discount when you pay for goods and services at certain pharmacies and medical providers.
Medical discount cards are the least comprehensive of your options on this list, but they can still come in handy if you find the right one. Start by looking for free offers in your state. There are lots of different state-based prescription discount cards available free and online at no charge to you. Then there are the carts that you have to pay a membership fee for. But be careful with these. You want to find a card that can save you more money in discounts than it costs for the membership fee. If you can find one, it’ll be a great way to save a little money on your medical expenses. But all too often, certain medical discount card companies advertise greater discounts than they actually offer or more providers than they actually work with, and trick people into paying a substantial membership fee while giving them very little in return.