Medicare Part C (more commonly known as Medicare Advantage) was designed to give West Virginia seniors more choices when it came to their healthcare. This page explains Medicare Advantage plans in West Virginia and how to compare your options.
What is Medicare Advantage?
Medicare Advantage plans must provide the same benefits that you get with Original Medicare, which includes Part A, hospital insurance, and Part B, medical insurance. Original Medicare does not include prescription drug coverage, though. For that, you need Medicare Part D.
Although the law only requires them to offer the same coverage as Original Medicare, most MA plans provide additional benefits.
Prescription drug coverage is a common add-on that is available in around 90 percent of Medicare Advantage plans. Known as Medicare Advantage Prescription Drug plans (MA-PD), these all-in-one policies combine your Parts A, B, and D benefits into a single plan.
Other common Advantage plan benefits include:
- Fitness programs
- Hearing aids
- Routine dental care
- Routine vision care
Please note that not all MA plans offer the same types of benefits.
Types of Medicare Advantages plans in West Virginia
There are four main types of Medicare Advantage plans in West Virginia. They include:
- Health maintenance organizations: HMO plans have a provider network of doctors, labs, hospitals, clinics, and more. They require plan members to choose a primary care physician who provides specialist referrals and coordinates patient care. Most HMO plans won't cover services from an out-of-network provider unless it's a medical emergency.
- Preferred provider organizations: PPO plans also have a provider network. If you're willing to pay a higher out-of-pocket cost, though, these plans cover care received from out-of-network providers.
- Private Fee-for-Service: PFFS plans set a price point for all services. Most PFFS plans also have a network, but like a PPO, they allow you to see an out-of-network provider if you're willing to pay more for the service.
- Special needs plans: SNPs are limited to beneficiaries who meet certain criteria, such as having a chronic condition, qualifying for both Medicare and Medicaid (i.e. dual eligibility), or living in an institution such as a nursing home.
How to compare Medicare Advantage plans in West Virginia
You should look at three metrics when comparing Medicare Advantage plans in West Virginia: Costs, coverage, and provider network.
How much does the plan cost?
Out-of-pocket costs with a Medicare Advantage plan may include:
- Yearly deductible
- Monthly premium
- Copayments or coinsurance
The average monthly premium for Medicare Advantage plans in 2024 is $19 ($45 when you don't include $0 premium plans). Please note that you are still responsible for the Medicare Part B premium – even if your MA plan has a premium.
What does the plan cover?
Knowing what the plan covers helps put its costs in perspective.
Medicare Advantage plan benefits vary widely. After prescription drug coverage, the most common additional benefit is coverage for eye exams and/or prescription lenses. Next are fitness benefits and routine dental care.
Don't forget to review the drug formulary of a Medicare Advantage Prescription Drug plan. If it doesn't include one or more of your medications, you should keep looking for a plan that does.
Does the network include your providers?
Provider networks may include any entity you'd rely on for healthcare, not just doctors and nurse practitioners. A provider network may include:
- Clinics and urgent care centers
- Durable medical equipment providers
- Hospitals
- Labs
- Nursing homes
- Pharmacies
How to choose a Medicare plan in West Virginia
Our Find a Plan tool makes it easy to compare Medicare Advantage plans in West Virginia. Enter your location information to review the Medicare plan options in your area.