West Virginia Health Insurance Consumer Guide

West Virginia has a partnership exchange for its health insurance Marketplace. This means you enroll through HealthCare.gov, which is the Marketplace platform run by the federal government. However, West Virginia oversees the plan certification process for plans sold in the state.

You can use the West Virginia Health Insurance Marketplace to enroll in health coverage for yourself or your family; two private insurance companies offer Marketplace plans throughout West Virginia. 1 The Marketplace also allows you to see if you qualify for premium subsidies or cost-sharing reductions (CSR) to lower your premiums and out-of-pocket costs.

The Marketplace is a good option for:

• Self-employed individuals
• Early retirees not yet on Medicare
• People whose employers don’t provide health insurance coverage

This guide explains the West Virginia ACA Marketplace and helps you understand your options.

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West Virginia’s Medicaid program

Learn about West Virginia's Medicaid expansion, the state’s Medicaid enrollment and Medicaid eligibility.

Medicare coverage options and enrollment in West Virginia

Use our guide to learn about Medicare, Medicare Advantage, and Medigap coverage available in West Virginia as well as the state’s Medicare supplement (Medigap) regulations.

Short-term coverage in West Virginia

Short-term health plans provide temporary health insurance for consumers who may find themselves without comprehensive coverage. Learn more about short-term plan availability in West Virginia.

Frequently asked questions about health insurance in West Virginia

Who can buy Marketplace health insurance?

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, t o 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

When can I enroll in an ACA-compliant plan in West Virginia?

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

How do I enroll in a Marketplace plan in West Virginia?

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

How can I find affordable health insurance in West Virginia?

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.)

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.

How many insurers offer Marketplace coverage in West Virginia?

Two companies provide 2024 individual and family plans through West Virginia’s exchange, and both offer coverage statewide. 11

Both will continue to offer Marketplace coverage in West Virginia in 2025. 12

Are Marketplace health insurance premiums increasing in West Virginia?

West Virginia’s individual market insurers have proposed the following average rate increases for 2025: 13

West Virginia’s ACA Marketplace Plan 2025 PROPOSED Rate Increases by Insurance Company

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

How many people are insured through West Virginia’s Marketplace?

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 2024 36

What health insurance resources are available to West Virginia residents?

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.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org.

1. Plan Year 2024 Qualified Health Plan Choice and Premiums in HealthCare.gov Marketplaces. Centers for Medicare and Medicaid Services. October 25, 2023. ⤶
2. Medicare and the Marketplace, Master FAQ . Centers for Medicare and Medicaid Services. Accessed November 2023. ⤶
3. Premium Tax Credit — The Basics . Internal Revenue Service. Accessed May 10, 2024 ⤶⤶
4. “ When can you get health insurance? ” HealthCare.gov. Accessed Aug 5, 2024 ⤶
5. ”HHS Takes Additional Actions to Help People Stay Covered During Medicaid and CHIP Renewals” CMS Newsroom. Mar. 28, 2024 ⤶
6. “ Find Local Help ” localhelp.HealthCare.gov, Accessed September 2023 ⤶
7. Entities Approved to Use Enhanced Direct Enrollment. CMS.gov, Accessed November 2023 ⤶
8. ”Effectuated Enrollment: Early 2024 Snapshot and Full Year 2023 Average” CMS.gov, July 2, 2024 ⤶
9. “Federal Poverty Level (FPL)” HealthCare.gov, 2023 ⤶
10. “2024 Marketplace Open Enrollment Period Public Use Files” CMS.gov, March 2024 ⤶
11. ” Plan Year 2024 Qualified Health Plan Choice and Premiums in HealthCare.gov Marketplaces ” Centers for Medicare & Medicaid Services. October 25, 2023. ⤶
12. ”West Virginia Rate Review Submissions” RateReview.HealthCare.gov. Accessed Aug. 5, 2024 ⤶⤶
13. ”West Virginia Rate Review Submissions” HealthCare.gov, 2023 ⤶
14. ” Effectuated Enrollment: Early 2024 Snapshot and Full Year 2023 Average ” CMS.gov, July 2, 2024 ⤶
15. Analysis Finds No Nationwide Increase in Health Insurance Marketplace Premiums . The Commonwealth Fund. December 2014. ⤶
16. Highmark Blue Cross Blue Shield considered pulling out of Obamacare exchange. Metro News. November 2015. ⤶
17. Avg. UNSUBSIDIZED Indy Mkt Rate Hikes: 25% (49 States + DC) . ACA Signups. October 2016. ⤶
18. West Virginia: 24.8% Rate Hikes; 10.9 Points Due To CSR Sabotage. ACA Signups. October 2017. ⤶
19. 2019 Rate Hike Project Wrap-Up: FINAL/APPROVED Rate Changes For West Virginia. ACA Signups. November 2018. ⤶
20. 2020 Rate Changes . ACA Signups. October 2019. ⤶
21. 2021 Rate Changes . ACA Signups. October 2020. ⤶
22. 2022 Rate Changes . ACA Signups. October 2021.[/efn-note]
23. 2023: Average increase of 5%.[efn_note]West Virginia: Final Avg. 2023 #ACA Rate Changes: +5.0%. ACA Signups. October 2022. ⤶
24. ”West Virginia: *Final* Avg. Unsubsidized 2024 #ACA Rate Changes: +1.7% (Unweighted)” ACA Signups. Nov. 8, 2024 ⤶
25. ” Health Insurance Marketplaces 2024 Open Enrollment Period Report ” CMS.gov. March 22, 2024 ⤶
26. ” HealthCare.gov Marketplace Medicaid Unwinding Report ” Centers for Medicare & Medicaid Services. Data through April 2024; Accessed Aug. 5, 2024 ⤶
27. “ASPE Issue Brief (2014) ” ASPE, 2015 ⤶
28. “ Health Insurance Marketplaces 2015 Open Enrollment Period: March Enrollment Report ”, HHS.gov, 2015 ⤶
29. “ HEALTH INSURANCE MARKETPLACES 2016 OPEN ENROLLMENT PERIOD: FINAL ENROLLMENT REPORT ” HHS.gov, 2016 ⤶
30. “ 2017 Marketplace Open Enrollment Period Public Use Files ” CMS.gov, 2017 ⤶
31. “ 2018 Marketplace Open Enrollment Period Public Use Files ” CMS.gov, 2018 ⤶
32. “ 2019 Marketplace Open Enrollment Period Public Use Files ” CMS.gov, 2019 ⤶
33. “ 2020 Marketplace Open Enrollment Period Public Use Files ” CMS.gov, 2020 ⤶
34. “ 2021 Marketplace Open Enrollment Period Public Use Files ” CMS.gov, 2021 ⤶
35. “ 2022 Marketplace Open Enrollment Period Public Use Files ” CMS.gov, 2022 ⤶
36. “2023 Marketplace Open Enrollment Period Public Use Files” CMS.gov, March 2023 ⤶
37. ”HEALTH INSURANCE MARKETPLACES 2024 OPEN ENROLLMENT REPORT” CMS.gov, 2024 ⤶