Assisted living facilities primarily help residents with non-medical needs. Although minor and infrequent medical services, such as first-aid for a wound, can sometimes be met on-site by nurses. These communities may sometimes also be called ALFs, residential care facilities, retirement homes, or long-term care facilities.
The financial options available to help pay for senior care is dependent on, among other things, the type of care that is required. If you are just beginning the research process on how to pay for long-term care, it is helpful to have an idea about the type of care you or your loved one currently requires, as well as to anticipate future needs. In addition, it is important to be familiar with the associated eldercare terminology.
Can using home care technology help your family save money caring for an aging loved one? The answer is most certainly “Yes”. Our goal is not to provide a comprehensive list, but rather to make sense of those that are available on the market today and can reduce the care hours required by elderly persons. As such, they can reduce a family’s out-of-pocket care costs or reduce the hours they spend providing care themselves.
Medicare Advantage (Part C), a privately offered alternative to Original Medicare (Parts A and B), has grown in popularity over the years. Despite the growing popularity of Medicare Advantage, some seniors face obstacles that prevent them from truly understanding how it works and who it benefits. Common mistakes about Medicare Advantage include misunderstanding its differences from Original Medicare, getting it confused with other forms of private Medicare insurance (like Medigap or Part D), or not understanding how to look up or evaluate plans.
Medicare Advantage provides the same coverage as Original Medicare but often with additional benefits and lower cost sharing. While the federal government administers Original Medicare Part A and Medicare B plans, private insurers sell and manage Medicare Advantage or Part C plans. Medicare Advantage goes beyond traditional Medicare in offering eye care, hearing and dental services and fitness programs, except for hospice care, which Medicare Part A covers. Some Medicare Part C plans cover transportation to medical appointments, over-the-counter drugs and health and wellness resources as well. Most Medicare Advantage plans also carry prescription drug benefits, eliminating the need for any supplemental prescription coverage.
All Medicare Advantage providers must comply with the guidelines established by the Centers for Medicare & Medicaid Services, but they can determine their own out-of-pocket costs and set stipulations regarding referrals and the use of in-network and out-of-network health care facilities. In 2021, 37.8% of the total number of Medicare users in West Virginia were enrolled in Medicare Advantage. This is lower than the national average of 42%. There are 443,210 West Virginians enrolled in Medicare as of 2022.
This guide discusses Medicare Advantage plans in West Virginia and reviews coverage details, eligibility requirements and how to find and sign up with a Medicare Advantage plan.
The Top 10 Medicare Advantage Plans in West Virginia
Several insurance companies offer Medicare Advantage or Medicare Part C plans in West Virginia, giving Medicare-eligible residents a variety of options. The following table lists the most popular Medicare Advantage providers according to enrollment data. Since most of them offer multiple Medical Advantage plans, we display cost information as a range instead of an average price. We also compiled the enrollment figures for each plan to arrive at each provider’s total enrollment within the state. This plan information is accurate as of April 2022, but you can check with Medicare.gov for more current information on available plans in your area.
HMO, PPO, PFFS
The Health Plan
Anthem Blue Cross and Blue Shield
How Medicare Advantage Plans Work in West Virginia
Before enrolling in a Medicare Advantage plan, it’s important to know how this program works in West Virginia. Insurers often have multiple plans, including health maintenance organizations (HMOs) and preferred provider organizations (PPOs). Each type has different requirements pertaining to in-network and out-of-network coverage, choosing a primary care provider, referrals and prescription drug coverage. Here’s a description of the four most popular plans:
What Medicare Advantage Plans Cover in West Virginia
Medicare Advantage plans must cover the same provisions that are available to Original Medicare beneficiaries, except for hospice care. These services include preventive screenings, X-rays, lab tests and care provided during a hospital stay. Medicare Advantage providers may also cover other benefits such as eye care, dental care and hearing aids.
Coverage Available With Medicare Parts A & B?
Coverage Available With Medicare Advantage?
Durable Medical Equipment
*Select plans offer this coverage
** Most plans offer this coverage
Eligibility for Medicare Advantage in West Virginia
To qualify for Medicare Advantage, applicants must already be enrolled in Medicare Part A and Medicare Part B. They must also meet all other Medicare eligibility requirements and reside in the plan’s service area. Enrollees must be at least 65 years of age or have a disability that qualifies them for Medicare at a younger age. They must be a U.S. citizen or legal immigrant. Medicare has limited enrollment periods as with other types of health insurance, so it’s essential to know when to apply for Medicare or change plans. Refer to the list below for more information on enrollment timing.
Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.
Initial Coverage Election Period
3 Months Before One’s 65th Birth Month
3 Months After One’s 65th Birth Month
Annual Election Period (AEP)
Medicare Advantage Open Enrollment Period
Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.
How to Find & Choose a Medicare Advantage Plan in West Virginia
Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.
First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.
West Virginia’s State Health Insurance Assistance Program, WV SHIP, is a free, federally regulated service that helps seniors navigate their Medicare options. A statewide network of trained volunteer SHIP counselors offer one-on-one counseling appointments with seniors, caregivers and family members who need unbiased information and guidance about Medicare Advantage plans. SHIP counselors can also help seniors understand the various Medicare Part D/prescription drug coverage options, and provide information on medication discount programs that Medicare members can use to reduce out-of-pocket costs. SHIP counselors are often based in local senior centers, and some services are delivered over the phone and through group information sessions.
West Virginia’s Senior Medicare Patrol is a volunteer-based, federally funded organization that works to raise awareness about Medicare fraud, misuse and billing errors. SMP volunteers work in conjunction with SHIP counselors to deliver information to seniors through one-on-one sessions, public events and community-based workshops. Medicare Advantage members who have concerns about their plan are encouraged to contact their insurance provider. If the concerns remain unresolved, SMP volunteers may be able to advocate on behalf of the Medicare beneficiary. Seniors who believe they have been affected by MA billing errors or misuse can contact their local SMP branch. Cases that are suspected to involve criminal activities such as fraud are referred to the appropriate local, state or federal agency.
West Virginia Legal Aid provides low-income and marginalized seniors aged 60 and older with access to free civil legal advice on issues including Medicare health care coverage. The statewide organization maintains a network of participating lawyers who can assist seniors, and also maintains a current library of plain-language resources that provide in-depth information on Medicare and other legal issues related to seniors.
To contact West Virginia Senior Legal Aid, call 1-800-229-5068.
Medicare Premium Assistance Programs
Seniors and qualified adults with disabilities who have difficulty paying their Medicare Part A and Part B premiums, co-pays and deductibles may qualify for financial assistance through one of two West Virginia Medicare Premium Assistance Programs. Open to applicants with incomes up to 120% of the federal poverty level who have few countable assets, these programs are administered by the Department of Health and Human Resources, Bureau for Children and Families. Applicants may qualify for either the Qualified Medicare Beneficiary (QMB), or the Specified Low-Income Medicare Beneficiary (SLIMB) program.
For more information about the QMB and SLIMB Medicare Premium Assistance Programs, contact the Bureau for Children and Families at 304-558-0628.
Local Medicare Advantage Resources
Barbour County Senior Center
Located in the City of Philippi, the Barbour County Senior Center offers a range of educational, support and advocacy services to older adults. Seniors can access State Health Insurance Assistance Program counselors at the center, speak with a social worker about local resources and get referrals to low-cost legal services that specialize in Medicare Advantage issues. The center also hosts information workshops that help seniors understand their rights and responsibilities related to Medicare and Medicare Advantage plans.
The Barbour County Senior Center is located at 47 Church Street in Philippi, West Virginia. Seniors can contact the center at 304-457-4545.
Kanawha Valley Senior Services
Seniors in Charleston and the surrounding areas can contact Kanawha Valley Senior Services for help with Medicare Advantage plan selection and obtaining prescription drug coverage. Five KVSS representatives are available to provide seniors with unbiased information about Medicare, Medicare Advantage and Medicare Part D prescription drug plans. KVSS Medicare counselors can also answer questions about plan selection, and provide information about financial aid programs for those who have difficulty covering their Medicare costs.