Availability of short-term health insurance in West Virginia

Yes. As of 2024, there were at least five insurers offering short-term health insurance in West Virginia.

West Virginia does not have its own regulations pertaining to the maximum duration for short-term health insurance plans, so the state defaults to the federal rules for short-term plan duration.

Federal rules in place since 2018 limit the initial duration of short-term health plans sold in any state to 364 days, unless a state has stricter rules in place. Renewals are permitted as long as the total duration of the coverage doesn’t exceed 36 months.

However, new federal rules take effect for plans issued or sold starting on or after September 1, 2024, limiting initial terms to no more than three months and capping total duration, including renewals, at no more than four months.

But renewability is optional for insurers, and insurers can choose to offer plans with shorter terms.

Short-term health insurance plans in West Virginia can be purchased by those who can meet the underwriting guidelines used by insurers.

In general, people can qualify for short-term health plans if they’re under 65 years old and do not have a specific medical condition that will result in a declined application.¹ But the underwriting rules vary from one insurance company to another.

Since short-term health insurance plans typically include blanket exclusions for pre-existing conditions, they are not adequate for someone who is in need of medical care for an existing condition and seeking a policy that will cover the care required to treat that condition.

And short-term plans are not required to cover the Affordable Care Act’s (ACA) essential health benefits, and are not considered minimum essential coverage under the ACA. It’s common to see these plans exclude coverage for maternity care, prescription drugs, and mental health care, although the healthcare benefits and limitations will vary considerably from one policy to another.

If you’re in need of health insurance coverage in West Virginia, you’ll want to first determine whether you can enroll in an ACA-compliant major medical plan (ie, an Obamacare plan), either through the exchange (HealthCare.gov) or directly from an insurance company.

(Note that while the plans will be fully compliant with the ACA no matter how you enroll, premium subsidies are only available if you enroll through the exchange. Subsidy eligibility has been expanded under the American Rescue Plan and Inflation Reduction Act, but you have to enroll through the exchange to receive those benefits.)

In West Virginia, open enrollment for self-purchased ACA-compliant plans runs from Nov.  1 – Jan. 15 each year. Outside that window, you may still be able to enroll if you experience a qualifying life event that triggers a special enrollment period.

ACA plans are purchased on a month-to-month basis, so you can enroll in one even if you only keep it for a few months before another policy takes effect. So if you’ll soon be covered under Medicare, for example, or a new employer’s plan, you can still enroll in an ACA-compliant plan if you’re eligible to do so, and then cancel the coverage when the new plan takes effect.

And if you qualify for premium subsidies, the coverage may end up being much less costly than you had anticipated – perhaps even more affordable than a short-term health plan.

It’s also important to note that West Virginia has expanded Medicaid under the ACA. Adults under the age of 65 can enroll in Medicaid if their household income is up to 138% of the federal poverty level. (For a single adult in 2024, that amounts to $20,782 in total annual income.)² And Medicaid eligibility is based on monthly income, rather than yearly income. So if you’ve recently lost your job, for example, you may qualify for Medicaid to cover the gap until you’re employed again and receiving coverage under an employer’s healthcare plan.

An ACA-compliant health plan will provide better coverage than a short-term health plan. But depending on the circumstances, there may be scenarios in which a short-term health insurance policy is the only — or only realistic — alternative. For example:

• You missed open enrollment for ACA-compliant individual market coverageand do not have a qualifying life event that would trigger a special enrollment period.
• You’ll soon be enrolled in Medicare and aren’t eligible for any other coverage in the meantime.
• You’re newly employed and your employer has a waiting period before you can enroll in the group health plan. (Under the ACA, employers can impose waiting periods of up to 90 days before new employees can be eligible for coverage under the group health plan.)³
• You’ve already enrolled in an ACA-compliant plan, but have to wait up to several weeks until your new plan takes effect. For example, if you enroll during open enrollment. (Under the ACA, employers can impose waiting periods of up to 90 days before new employees can be eligible for coverage under the group health plan.)⁴
• You’ve already enrolled in an ACA-compliant plan but have to wait up to several weeks until your new plan takes effect. For example, if you enroll during open enrollment, your new plan won’t take effect until January 1. And if you sign up during a special enrollment period, you’ll generally have to wait until at least the start of the following month before your new plan is effective.
• You’re not eligible for Medicaid or a premium subsidy in the exchange, the monthly premiums for ACA-compliant plans might be too costly. Although the American Rescue Plan and Inflation Reduction Act have made subsidies larger and more widely available through the end of 2025.
• People who are not lawfully present in the U.S. and thus not eligible to enroll in a plan through the Marketplace, which also means premium subsidies are not available to them.

Insurers that offer short-term health insurance in West Virginia are required to file rates and plans with the West Virginia Office of the Insurance Commissioner.

The insurance commissioner’s office has published a guide for consumers, illustrating how short-term health insurance plans compare to ACA-compliant coverage, highlighting the fact that short-term health plans are not required to cover things like the ACA’s essential health benefits, pre-existing conditions, or preventative care.