West Virginia Health Insurance Plans and Policies
In 2016, an all-time high of 37,284 enrollees through the West Virginia public exchange selected a medical insurance plans. The increase is most likely due to the fact that 86% of West Virginians actually qualify for a subsidy, which helps to offset the out-of-pocket costs of a private plan. With so many enrolling for the first time, it probably makes you wonder what the best choice is for you!
Common WV Health Insurance Plans and Policies
Below are the most common types of West Virginia health insurance plans and policies offered through the various exchanges:
Individual Health Insurance
Individual medical insurance policies are those that are not affiliated to a place of employment. If you do not feel that your employer's benefits package covers your needs, you can decline coverage and opt for an individual health insurance plan instead. You may also purchase an individual health insurance plan if you are not offered individual health insurance through your employer. Enroll in health insurance in West Virginia.
Learn more about individual health insurance quotes and options.
Group Health Insurance
Group West Virginia medical insurance policies can be affiliated in one of two ways. They are most commonly affiliated with a place of employment or to groups of individuals based on professional, religious or social ties who decide to create their own group health insurance plan for increased negotiating power.
Short Term Health Insurance
Short term health insurance is a temporary option for coverage when you find yourself in a small window or lapse in coverage. This plan is beneficial to safeguard against well-known or unknown medical bills that may pile up during a lapse in coverage. Short term health insurance, unfortunately, does not meet the minimum requirements of the Affordable Care Act, so you may have to pay a penalty for the time you are using it.
Learn more about Short Term health insurance rates and options.
Self-Employed Health Insurance
If you are self-employed with a fluctuating income, self-employed health insurance may be the route to take for your health insurance. This type of coverage is a great option for those who may need to modify their coverage during the year based on how well their personal business and finances do. Learn more about Self-Employed health insurance options.
Learn more about Self-Employed health insurance quotes and options.
COBRA is a federal law that temporarily allows you to continue the health insurance coverage that was provided by a previous employer. This may be helpful if you were let go from a previous position and need insurance coverage to tie you over until you can find a new job with employer-sponsored insurance benefits, can enroll in Short Term insurance, or until you can enroll in a different insurance plan through the Marketplace because of your Qualifying Life Event. The downside of COBRA is it requires that you pay 100% of your plan’s premiums in addition to an administrative fee.
Common West Virginia Health Insurance Plans and Policies
Thanks to the Affordable Care Act, otherwise known as Obamacare, the minimum benefits and coverage available through West Virginia private health insurance plans are the same as what you would find in the federal Marketplace. Health insurance West Virginia plans meet mandated essential healthcare benefits, in addition to the Federal guidelines outlined in the Affordable Care Act, that apply to consumer choice plans and employer plans. Find a plan that best fits your needs and enroll in health insurance in WV.
Learn more about health insurance rates and options .
What Is A PPO plan?
A PPO (Preferred Provider Organization) is a health plan that allows you to seek West Virginia healthcare services from outside the network, but it requires you to pay an additional out-of-pocket cost for that ability.
Pros And Cons Of PPO Plans
The benefit of utilizing a PPO is that it gives you the ability to see a specialist without a primary physician's referral. Unfortunately, this option is typically more expensive for all parties involved and is generally being phased out due to the overall financial impact to the West Virginia healthcare industry.
What Is An HMO Plan?
An HMO (Health Maintenance Organization) is a plan that requires you to seek care from within the HMO provider group. With an HMO plan, you must get a referral from your primary care doctor to see a specialist.
Pros And Cons Of HMO Plans
HMOs are very focused on integrated care and normally have great coverage on preventative care or maintenance such as vaccines, well-woman exams, and physicals. Seeing your primary care doctor on a regular basis is a responsible patient activity as it lends to a prevention vs. treatment focus for both patient and physician. Unfortunately, with an HMO plan, you are only allowed to see those physicians who are within the HMO provider group and seeing a specialist will require a primary physician's referral.
Difference Between HMO And PPO
HMOs are very focused on reducing the cost of healthcare by having the primary care doctor be the gatekeeper to other more expensive points of entry into the healthcare system. A PPO, on the other hand, allows a patient to seek care outside the network and offsets the healthcare system cost through an additional out-of-pocket cost to the patient.
What Is An EPO Plan?
An EPO (Exclusive Provider Organization) is a managed care plan that requires you only use doctors, hospitals, or specialists who are within the plan’s network.
Pros And Cons Of EPO Plans
An EPO allows you to see a specialist without a referral, but they must be in the EPO network. That being said, this is unlike a PPO where you can still seek care outside of the network and only be expected to pay a higher out-of-pocket percentage. With an EPO, even with a referral, outside network care would not be covered and you would be financially responsible for the entire amount due, with the exception of emergency care.
What Is A POS Plan?
A Point Of Service (POS) plan requires you to seek care from within the network (but a referral can be requested to see a doctor outside of network). If you would like to see a specialist, a referral is required from your primary care doctor.
Pros And Cons Of POS Plans
POS plans are generally cost effective as long as you remain within the network. It is a compromised option because if necessary, care can be obtained out of network with a referral. Many patients dislike having to wait for a referral from their primary doctor in order to see a healthcare specialist, but POS does lower the overall cost of West Virginia healthcare by attempting to utilize the lowest cost resource for items that do not require specialized knowledge.
See What Health Insurance Plans Are Available in the Private Health Insurance Marketplace in West Virginia. Get a Quote.
FSA Plans - Flexible Spending Accounts Or Arrangements
What Is An FSA Plan?
A Flexible Spending Account (FSA) will be set up through an employer-provided insurance that allows you to contribute pre-taxed wages from your paycheck into an account that can be used for out-of-pocket medical expenses like copays and deductibles.
Pros And Cons Of FSA Plans
The benefit of using an FSA is the ability to budget medical care with wages that will not be taxed. Unlike an HSA account, however, you cannot carry FSA funds over into the next year or to a new job. You either use it or lose it so there is little benefit to being over-prepared with the amount of money you put into an FSA account. Additionally, if you know you will incur costs in January of the upcoming year, some medical offices will allow you to pre-pay for scheduled or planned services with your FSA so you do not lose those funds.
Flexible Benefits Plan (Cafeteria Plan Or IRS 125 Plan)
What Is A Cafeteria Plan?
A Flexible Benefits Plan, also commonly referred to as a Cafeteria Plan, enables you to contribute pre-taxed wages into an account that can be used for dependent care expenses (e.g. day care, disability services or care, or elderly care services). A dependent is any child under the age of 13 or adults or children who are older than 13 who are incapable of independent self-care. To qualify, dependents must also reside with the insured for a majority of the year.
Pros And Cons Of A Cafeteria Plan
The benefit of a Cafeteria Plan is it allows an individual to create their own benefits package in a way that is reflective of their life situation, whether that is contributing pre-taxed wages to the Cafeteria Plan for additional dental coverage or for child care services.
HSA Plans - Health Savings Account Plans
What Is An HSA Plan?
A Health Savings Account (HSA) gives you the ability to contribute pre-taxed wages into an account that can be used for out-of-pocket qualified medical expenses like prescription drugs, medical care, copays, and deductibles. An HSA does not have to be set up through your employer. It can be done through any financial institute. An HSA is a great supplement for high-deductible health insurance plans.
Pros And Cons Of HSA Plans
The benefit of using an HSA is that it allows you to take advantage of the lower premiums that come with high-deductible insurance plans and still be able to pay the out-of-pocket financial commitment required of those plans. An added benefit of the HSA (unlike the FSA plan) is that you can maintain the funds that you contribute, regardless of time and employment; you can roll over balances contributed in one year into the next year and you can transfer your HSA funds it to a new HSA account if you have a change in employment.
Medical Savings Accounts (MSA)
What Is An MSA?
A Medical Savings Account gives self-employed individuals the ability to contribute pre-taxed wages into an account that can be used for out-of-pocket medical expenses like copays and deductibles. Just like an HSA, it is a great supplement for high-deductible insurance plans. There are two specific kinds of MSA accounts. The most common one is the Archer MSA, but for those that qualify for Medicare, Medicare Advantage MSA should be used.
Pros And Cons of An MSA
The benefits of an MSA are very similar to those of an HSA in that you can take advantage of the lower premiums that come with high-deductible plans and MSA funds, which can be rolled over and maintained year-after-year. The downside to an MSA is only one family member can contribute to the MSA account.
What Are Indemnity Plans?
Indemnity plans are no longer a common health care plan, but they were prevalent in the days before HMO and PPO plans. Indemnity plans were often called Fee-For-Service and the insurer and the insured would split a percentage of the total healthcare charges. For example, if a procedure was $1,000, you might be responsible for 20% and the insurance company would then be responsible for 80%. This means you would pay $200. If the facility decided to increase their prices, you would be expected to pay more out-of-pocket.
Why Would I Need An Indemnity Plan?
Because HMO and PPO plans have become more popular, Indemnity plans are not commonly available and are not be recommended for most people.
West Virginia Health Insurance FAQs
- How much does group health insurance cost?
The cost of group health insurance will depend on the negotiated contract between the group applying for health coverage and the insurance company. Group rates typically vary based on the number of participants in your group, location, demographics, the insurance carrier, desired plan coverage, plan structure, and the availability of providers. According to a study by Kaiser Family Foundation (KFF), group policies in 2015 averaged $6,251 annually with the employer paying 83% of the premium costs ($5,179). This left the employee with 17% of the cost ($1,071). The average annual family premium cost is $17,545. All premiums for single and family coverage have increased about 4% between 2014 and 2015.
- Can I get group insurance without an employer?
Yes, you can get group insurance without going through an employer-sponsored program. There are many professional groups that offer insurance options such as alumni groups, the AARP, the Small Business Service Bureau, and more.
- What is small business health insurance?
Small businesses that have two or more employees have the ability to apply for group insurance. To qualify, at least one other employee (other than the owner) must be a non-relative or non-household dependent. The maximum employees for small business health insurance categorization is often capped at 50-100 employees, depending on the current state regulations. Small businesses benefit by enrolling into a small business health insurance plan as they often qualify for special tax breaks.
- How do I know if my private health insurance satisfies the Obamacare requirement?
Verify with your insurance provider that your health insurance plan meets the standards for an Obamacare or Affordable Care Act, qualified health plan and has been certified by the Health Insurance Marketplace.
- Do I have to have health insurance if I'm in college?
Yes, even college students are required to have health insurance. If you are a college student and do not have health insurance, you will face paying a penalty. There are several options for college students that are affordable, some of which are offered through college health centers.
- How long can I stay on my parent's insurance plan as a dependent?
If your parent's plan allows you to be covered as a dependent, you can stay on their plan until your 26th birthday. This is the case even if you are not claimed as a dependent on their state or federal taxes, are married, or are not in school.