West Virginia Health Insurance

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West Virginia is home to acres and acres of beautiful, untouched wilderness. Unfortunately, the health of West Virginia residents has proven much more difficult to protect. A recent study published in Newsweek magazine ranked the state’s health care system as one of the worst in the nation, especially when it comes to “the ability to live long and healthy lives.”

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Thus, it is especially important to get the right health coverage so that in the event you or one of your family members falls ill, you will get the right care without sky-high costs. We’re here to help you start the process of finding the right policy and carrier in West Virginia. Read on to learn more about your health care options.

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Individual Medical Coverage Options in West Virginia

If you need health coverage for yourself, start by deciding if you want a group or individual policy. The first will be less expensive, but more restrictive (you can only visit doctors within the network), while individual plans cost more but are written especially for you. After you’ve done that, make sure you read your policy carefully, as there are many West Virginia state regulations governing the health insurance industry, such as the following:

  • In West Virginia, you can be turned down for medical coverage if you have health problems, unless you are HIPAA-eligible.
  • During open enrollment periods for HMOs, you cannot be turned down for coverage.
  • The past 2 years of your medical records can be reviewed by health carriers for preexisting conditions. Carriers can then attach elimination riders to your policy accordingly.
  • Health insurance companies are not limited on the rates they can charge you, both at the start of coverage and at renewal.

West Virginia Health Insurance for Families (WV)

When buying a health plan for your family, make sure you take into account the medical needs that each member of your family has. One way to make sure everyone’s needs are covered is to get an individual plan that will be customized for you. But if you don’t want to spend as much money, group networks such as HMOs, PPOs, POSs, and HSAs are fairly comprehensive.

Your family cannot be denied coverage as long as you are eligible for group coverage. If you go through life changes such as marriage, adoption, or job loss, you may receive special opportunities to enroll in group coverage in West Virginia. If you have a preexisting condition, you may be subject to an exclusion period of up to 12 months. Creditable coverage is available to people who have had continuous coverage with breaks no longer than 63 days.

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Pre-Existing Conditions and West Virginia Health Insurance

Any health insurance company offering individual coverage in West Virginia must accept every eligible individual who wishes to enroll. That means, in effect, that the insurance company may not decline to offer coverage or deny enrollment, or impose any preexisting condition exclusion.

Yet, applicants with preexisting conditions in West Virginia still face higher premiums than those without, as well as facing limitations. In addition to waiting periods, which can cause individuals to seek short-term alternatives in the interim, state laws do not protect individual policies. Private companies can accept applicants with preexisting conditions on their own accord and charge them high premiums.

The good news about West Virginia health insurance is the fact that the policies are guaranteed issue, meaning that you cannot be turned down because of your age or health, and guaranteed renewability, meaning that the coverage cannot be cancelled if you get sick. Your coverage can only be cancelled if you don’t pay your premiums, move out of the coverage area or provide the insurance company with fraudulent information.

Switching Health Insurance Policies in West Virginia (WV)

Here are a few additional pieces of information if you need to change health plans:

  • If you leave your job, you will not be able to take your employee health plan, but COBRA (a.k.a. state continuation coverage) can help you to keep some of the benefits you had at your previous employer.
  • Some non-federal public employers (such as municipal governments) may follow a different set of regulations, so check with the West Virginia Department of Insurance for more information.
  • If your new employer offers a health plan, you may be subject to a waiting period before your benefits begin.