West Virginia Health Insurance Exchange Guide for Residents

If you're a West Virginia resident looking for affordable health insurance, the state's Health Insurance Exchange is a great place to start. The exchange offers a range of plans from private insurance companies, which can be purchased directly online or through a licensed agent.

The open enrollment period for the exchange typically runs from November to December, but you may also be eligible for special enrollment periods due to certain life events, such as losing job-based coverage or getting married. These periods can vary, so it's essential to check the exchange's website for the most up-to-date information.

The exchange offers financial assistance in the form of tax credits to help make premiums more affordable. In fact, nearly 75% of exchange enrollees receive some level of financial assistance, which can significantly reduce their monthly premium payments.

The West Virginia Health Insurance Exchange is a new marketplace that will help residents navigate their health insurance options. It's a partnership between West Virginia and the federal government.

In 2014, this exchange will inform consumers about their eligibility for premium tax credits and subsidies when purchasing health insurance.

A significant number of West Virginians will be impacted by this exchange - 285,930 non-elderly residents are currently uninsured, which is 18% of the state's non-elderly population.

The West Virginia Health Policy Unit is responsible for planning, implementing, and overseeing the exchange's functions.

You can enroll in a West Virginia Marketplace plan by visiting HealthCare.gov, calling 1-800-318-2596 (TTY: 1-855-889-4325), or finding local help from insurance agents, brokers, or certified application counselors at localhelp.HealthCare.gov.

You can also enroll through an approved enhanced direct enrollment entity.

If you're eligible, you can expect to qualify for federal tax subsidies to help reduce your monthly premium, possibly covering co-pays and deductibles as well.

Enrolling in a Marketplace Plan is a straightforward process in West Virginia. You can start by visiting HealthCare.gov, the official website for the Marketplace.

To get help with enrolling, you can call 1-800-318-2596 (TTY: 1-855-889-4325) 24 hours a day, 7 days a week, except for holidays. Local help is also available from insurance agents, brokers, or certified application counselors. You can find local help at localhelp.HealthCare.gov.

You can also consider enrolling through an approved enhanced direct enrollment entity.

Now that you've learned about the different types of plans available in the Exchange, it's time to take action. Enrolling in the Exchange is a straightforward process that can be completed online, by phone, or in person.

To get started, you'll need to create an account on the Exchange website. This will give you access to a secure online portal where you can review and compare plans, as well as enroll in the one that's right for you.

Make sure to carefully review the plan details, including the premium costs, deductibles, and out-of-pocket maximums. This will help you make an informed decision that meets your healthcare needs and budget.

Don't forget to also review the plan's network and provider information, including the list of participating doctors and hospitals. This will ensure that you have access to the care you need when you need it.

By following these steps, you'll be able to enroll in the Exchange and start taking advantage of the benefits it has to offer.

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

The average net premium for West Virginia Marketplace enrollees was about $148/month after premium subsidies were applied.

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.

To enroll in a Marketplace plan, visit HealthCare.gov or 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 also find local help from local insurance agents, brokers, or certified application counselors to review Marketplace plan options and choose a plan that fits your needs. Find help at localhelp.HealthCare.gov.

Here are some affordable health insurance options in West Virginia:

87% of people buying health insurance coverage in the Marketplace may qualify for a premium tax credit that lowers what they pay in monthly premiums.

The tax credit will depend on your household size and income.

Federal subsidies will be available for those who don't qualify for Medicaid yet earn less than 400 percent of the FPL, about $45,960 for an individual or $94,200 for a family of four.

In West Virginia, around 34 percent of uninsured blacks and 40 percent of uninsured Hispanics fall into this range and would possibly qualify for some level of tax subsidy in the Marketplace.

Around 95 percent of uninsured African Americans and Hispanics may qualify for assistance in accessing health coverage in West Virginia as a result of the ACA.

Here's a breakdown of the average premium changes for West Virginia's Marketplace insurers for 2025:

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.

51,046 people enrolled in private plans through West Virginia's Marketplace during the open enrollment period for 2024 coverage, a record high.

The 2024 enrollment growth was also driven by the "unwinding" of the pandemic-era Medicaid continuous coverage rule, with nearly 29,000 people transitioning from Medicaid to a West Virginia Marketplace plan by April 2024.

The American Rescue Plan's enhancements of the ACA's premium subsidy rules, extended through 2025 by the Inflation Reduction Act, have contributed to the steady climb in West Virginia's Marketplace enrollment since 2022.

51,046 people enrolled in private plans through West Virginia's Marketplace during the open enrollment period for 2024 coverage, a record high.

The number of people insured through West Virginia's Marketplace has been steadily increasing since 2022, largely due to the American Rescue Plan's enhancements of the ACA's premium subsidy rules.

The Inflation Reduction Act extended these subsidy enhancements through 2025, contributing to the growth.

Nearly 29,000 people had transitioned from Medicaid to a West Virginia Marketplace plan by April 2024, as the pandemic-era Medicaid continuous coverage rule unwound.

This unwinding process is driving enrollment growth in addition to the subsidy enhancements.

Marketplace health insurance premiums are indeed increasing in West Virginia, with some carriers seeing significant jumps. CareSource West Virginia Co. is raising its premiums by 12.38% for 2025.

The rates were approved as-filed, and are applicable to full-price premiums, before subsidies are applied. This means that if you don't qualify for subsidies, you'll be paying the full premium amount.

The Health Plan of West Virginia is increasing its average premiums by a much smaller 0.27% for 2025, but its policies are only available off-exchange, so subsidies can't be used to purchase coverage from this carrier.

West Virginia's average pre-subsidy premiums are the highest in the nation, which is a concern for many residents. However, most enrollees (97% in 2024) get premium subsidies, which are also the largest in the nation, averaging over $1,000 per month in 2024.

Here's a look at how average full-price premiums have changed in West Virginia's individual market over time:

If you're concerned about rising premiums, it's worth exploring other health plans in the exchange that may be more affordable and offer similar benefits.