West Virginia Health Insurance Consumer Guide

Anyone who meets the following criteria can buy Marketplace health coverage in West Virginia:

• You live in West Virginia
• You’re a U.S. citizen, national, or lawfully present
• You’re not incarcerated
• You don’t already have Medicare

Your eligibility for financial assistance, like premium subsidies and cost-sharing reductions, depends on your income. In addition, to qualify for financial help on the Marketplace, you must:

• Not have access to affordable health coverage through your employer. If you think your employer’s health coverage is too expensive, use our Employer Health Plan Affordability Calculator to see if Marketplace premium subsidies are available to you.
• Not be eligible for West Virginia Medicaid or CHIP.
• Not be eligible for premium-free Medicare Part A.²
• If married, file a joint tax return.³
• Not be able to be claimed by someone else as a tax dependent.³

You can sign up for an ACA-compliant individual or family health insurance in West Virginia between November 1 and January 15 during open enrollment.⁴ 

Sign up by December 15 for your coverage to start on January 1. If you enroll between December 16 and January 15, your coverage will begin on February 1. 

Outside of open enrollment, you can only sign up for coverage or switch plans if you qualify for a special enrollment period (SEP). In most cases, SEPs are time-limited and triggered by a qualifying life event. But there are some circumstances in which a SEP is available without a specific qualifying event. For example:

• Your income isn’t more than 150% of the poverty level, and you’re eligible for premium tax credits. In this scenario, you can enroll anytime.
• Native Americans can enroll whenever necessary.

For people who lose Medicaid or CHIP coverage between March 31, 2023, and November 30, 2024, there’s an extended SEP available for enrollment.⁵

Use one of the following options to enroll in a Marketplace plan in West Virginia:

• Visit HealthCare.gov
• Call 1-800-318-2596 (TTY: 1-855-889-4325). The call center is available 24 hours a day, seven days a week, except for holidays.
  

You can find local help from local insurance agents, brokers, or certified application counselors. They help you review Marketplace plan options and choose a plan to fit your needs. Find help at localhelp.HealthCare.gov.⁶

You can also enroll in a West Virginia Marketplace plan via an approved enhanced direct enrollment entity.⁷

You can find affordable health plans in West Virginia on the ACA Marketplace (HealthCare.gov).

Across people enrolled in West Virginia Marketplace coverage in early 2024:

• 97% of enrollees were receiving advance premium tax credits (premium subsidies).[efn_note]”Effectuated Enrollment: Early 2024 Snapshot and Full Year 2023 Average” CMS.gov, July 2, 2024[/efn_note]
• The average premium subsidy amount was $1,038 per month (this is the largest average premium subsidy in the nation, because West Virginia has the nation’s highest full-price premiums). After the subsidies were applied, the average net premium for West Virginia Marketplace enrollees was about $148/month.⁸
• One-third of West Virginia Marketplace enrollees were receiving cost-sharing reductions (CSR), which are available on Silver-level plans if household income isn’t more than 250% of the federal poverty level.⁹ CSRs help reduce deductibles and other out-of-pocket expenses.

(Note that the numbers above are based on effectuated enrollment as of early 2024, whereas the graphic below shows data from enrollments submitted during the open enrollment period that began in the fall of 2023, so the numbers differ and there are different metrics reported.)

Source: CMS.gov¹⁰

Medicaid is another affordable health insurance option if you’re eligible. West Virginia expanded Medicaid under the ACA, so adults under age 65 are eligible for Medicaid with a household income up to 138% of the federal poverty level.

Short-term plans are low-cost alternatives for people not eligible for Medicaid, Medicare, or subsidies. Note that for plans issued starting in September 2024, new federal rules will limit total duration, including renewals, to no more than four months.

Two companies provide 2025 individual and family plans through West Virginia’s exchange, and both offer coverage statewide.¹¹

The following average premium changes were approved for West Virginia’s Marketplace insurers for 2025:¹²

Source: RateReview.HealthCare.gov¹³

The rates were approved as-filed, and are applicable to full-price premiums, before subsidies are applied.

An additional carrier, The Health Plan of West Virginia, is increasing average premiums by 0.27% for 2025. But their policies are only available off-exchange in West Virginia,¹³ so subsidies cannot be used to purchase coverage from The Health Plan of West Virginia.

West Virginia’s average pre-subsidy premiums are the highest in the nation. But most enrollees (97% in 2024) get premium subsidies which are also the largest in the nation — more than $1,000 per month, on average, in 2024.¹⁴

If you qualify for subsidies, your actual rate change will depend on your plan and the subsidy amounts. Your age can affect your premium too. 

If the cost of your current plan increases, you can explore other health plans in the exchange that may be more affordable and offer similar benefits.

For perspective, here’s an overview of how average full-price (unsubsidized) premiums have changed in West Virginia’s individual market over time (note that in years where multiple carriers offer plans, the averages may be unweighted as enrollment numbers in West Virginia filings are often redacted):

• 2015: Average increase of 10%.¹⁵
• 2016: Average increase of 24%.¹⁶ (second carrier began participating)
• 2017: Average increase of 45%.¹⁷
• 2018: Average increase of 25%.¹⁸
• 2019: Average increase of 9%.¹⁹
• 2020: Average increase of 7%.²⁰
• 2021: Average increase of 5%. ²¹
• 2022: Average increase of 13%.²²
• 2024: Average increase of 1.7%²³

51,046 people enrolled in private plans through West Virginia’s Marketplace during the open enrollment period for 2024 coverage.²⁴ That was by far a record high.

As illustrated below, West Virginia’s Marketplace enrollment has been climbing since 2022, largely due to the American Rescue Plan’s enhancements of the ACA’s premium subsidy rules. The Inflation Reduction Act has extended the ARP’s subsidy enhancements through 2025. 

The 2024 enrollment growth was also driven by the “unwinding” of the pandemic-era Medicaid continuous coverage rule. CMS reported that by April 2024, nearly 29,000 people had transitioned from Medicaid to a West Virginia Marketplace plan during the unwinding process.²⁵

Source: 2014,²⁶ 2015,²⁷ 2016,²⁸ 2017,²⁹ 2018,³⁰ 2019,³¹ 2020,³² 2021,³³ 2022,³⁴ 2023,³⁵ 2024³⁶

HealthCare.gov
This is the ACA Marketplace, where you can enroll in a health insurance plan online. You may also get help by calling (800) 318-2596. 

West Virginia Offices of the Insurance Commissioner
Oversees and regulates insurance companies, brokers, and agents in the state while assisting consumers with insurance-related inquiries and concerns. 

West Virginia Navigator
A free, non-profit program accessible to all residents within the state, providing free enrollment assistance. 

West Virginia Senior Health Insurance Assistance Program (SHIP)
Helps answer questions and help Medicare beneficiaries.