Medicare Plans in West Virginia: Coverage and Costs (2026)

If you're turning 65 in West Virginia or helping a family member work through Medicare, you're looking at four parts, dozens of plan choices, and costs that reset every January. The standard Part B premium for 2026 is $202.90 a month, prescription drug spending under Part D is now capped at $2,100 a year, and free one-on-one help is available through WV SHIP, the state's Medicare counseling program run through the West Virginia Department of Human Services (DoHS).1,2,3

This guide walks through every piece of Medicare as it applies to West Virginia residents in 2026: what it costs, how plan choices break down across the state, and how to get help paying for it.

In This Guide

• Key Takeaways
• Original Medicare: Parts A and B
• Medicare Advantage in West Virginia (Part C)
• Medicare Part D: Prescription Drugs
• Medigap in West Virginia
• Help Paying for Medicare in West Virginia
• Medicare Enrollment Periods
• Free Medicare Help: WV SHIP
• Frequently Asked Questions

About these numbers: The premiums and deductibles below come from CMS for calendar year 2026, effective January 1. Medicare costs change every year. For the most current figures, contact Medicare at 1-800-633-4227 (1-800-MEDICARE) or WV SHIP at 1-877-987-4463.

Original Medicare: Parts A and B

Original Medicare is run directly by the federal government and comes in two parts. The mechanics and costs are the same in West Virginia as in every other state.

Part A (Hospital Insurance)

Part A covers inpatient hospital stays, limited skilled nursing facility care, hospice, and some home health care.1

The hospital deductible rose $60 from 2025, to $1,736 per benefit period, and it resets each benefit period.1 A benefit period starts the day you're admitted and ends 60 days after discharge. A readmission after that gap triggers a new deductible.

Part B (Medical Insurance)

Part B covers doctor visits, outpatient care, preventive services, durable medical equipment, and mental health care. It does not cover routine dental, vision, or hearing.1

• Monthly premium: $202.90 (higher if your 2024 income exceeded $109,000 single or $218,000 married, under the income-related adjustment)1
• Annual deductible: $2831
• After the deductible: you pay 20% of the Medicare-approved amount for most services1

Part B is optional in name only. Nearly everyone enrolls. Delay past your initial window without other creditable coverage and you owe a late penalty of 10% for every 12-month period you could have had it, permanently added to your premium for as long as you keep Part B.7

Medicare Advantage in West Virginia (Part C)

Medicare Advantage plans are an alternative to Original Medicare, sold by private insurers. They cover everything Parts A and B do, except hospice, which Original Medicare keeps covering, and most bundle in Part D drug coverage along with extras like dental, vision, and hearing.8

Plan availability in West Virginia varies by geography. The Charleston and Huntington metro areas have the widest selection. Rural Appalachian counties, including much of the eastern panhandle and the southern coalfields, typically have fewer plans, and in some areas only one or two options. Use the Medicare Plan Finder at medicare.gov to see exactly which plans are available in your ZIP code.

How These Plans Work

• You keep paying your Part B premium ($202.90) on top of any plan premium, though many plans charge $0 extra. CMS estimates the average Medicare Advantage premium at about $14 a month in 2026.1,8
• Plans run on networks (HMO, PPO, or HMO-POS). Confirm your doctors and hospitals are in-network before you enroll.8
• Plans usually require prior authorization for certain services, which Original Medicare generally does not.8
• Every plan caps your annual in-network out-of-pocket spending. Original Medicare has no such cap; the federal maximum for in-network Medicare Advantage spending is $9,250 in 2026, and many plans set lower caps.8

Enter your doctors and prescriptions into the Medicare Plan Finder and it shows which plans cover them and your estimated annual cost. A WV SHIP counselor will read the results with you at no charge.

Medicare Part D: Prescription Drugs

Part D covers outpatient prescription drugs. You can get it as a standalone plan paired with Original Medicare, or bundled into a Medicare Advantage plan.

The Inflation Reduction Act eliminated the old coverage gap (the donut hole), so that higher-cost middle stage is gone.2 Part D now moves through three phases:

1. Deductible: you pay full price until you meet your plan's deductible (up to $615 in 2026).9
2. Initial coverage: you pay copays or coinsurance while your plan and drug makers cover the rest.
3. Catastrophic: once your out-of-pocket spending reaches $2,100, you pay $0 for covered drugs the rest of the year.2

That $2,100 cap is the number that matters most in Part D. The national base beneficiary premium that sets the late-enrollment penalty is $38.99 in 2026, and actual standalone plan premiums vary by plan and county, running roughly $40 to $50 a month.1,7 Every plan must also offer the Medicare Prescription Payment Plan, which lets you spread your out-of-pocket drug costs into capped monthly payments across the year instead of paying in full at the pharmacy.2 People who qualify for Extra Help often pay much less, sometimes nothing.

For a deeper look at how the phases work, see our guide to Medicare Part D drug coverage.

Medigap in West Virginia

Medigap policies are sold by private insurers to fill the gaps in Original Medicare: the deductibles, coinsurance, and copays. They work only with Original Medicare, never with Medicare Advantage. In West Virginia, these policies are regulated by the West Virginia Offices of the Insurance Commissioner.

West Virginia offers the federally standardized plans, labeled A, B, C, D, F, G, K, L, M, and N. Plans C and F are closed to anyone who first became Medicare-eligible on or after January 1, 2020.4 Plan G is the popular pick for people newly eligible: it covers the Part A deductible, Part A and Part B coinsurance, and skilled nursing coinsurance, leaving only the $283 Part B deductible on you.4,1

Your One Guaranteed Window

Your strongest opening is the federal Medigap Open Enrollment Period, the six months that begin when you're 65 and enrolled in Part B. During that window an insurer must sell you any plan it offers at the standard rate, no matter your health history.4

West Virginia has no annual "birthday rule" and no other state-created yearly window that lets you switch Medigap plans without health questions, unlike a handful of states such as California and Maryland that do.5 Once your six-month window closes, an insurer in West Virginia can use medical underwriting, meaning it can charge you more or turn you down based on your health, unless a federal guaranteed-issue right applies.4

Medigap or Medicare Advantage?

You can't hold both. Choose Medigap and you stay on Original Medicare with the freedom to see any provider who accepts Medicare nationwide, at a higher monthly premium. Choose Medicare Advantage and you trade some of that flexibility for a network structure and, often, a lower upfront cost. Because West Virginia won't guarantee you a second shot at Medigap once your first six months pass, weigh that trade carefully before your window closes. For a side-by-side look, see our guide to Original Medicare vs. Medicare Advantage.

Help Paying for Medicare in West Virginia

Two programs can significantly reduce Medicare costs for people on fixed incomes.

Medicare Savings Programs

West Virginia administers Medicare Savings Programs through the Bureau for Medical Services (BMS), the state's Medicaid agency within the Department of Human Services. You can apply online through WV PATH or get help from a WV SHIP counselor.6

QMB is the most generous: it covers your Part B premium plus your deductibles and coinsurance, and federal law bars providers from billing a QMB enrollee for that cost-sharing.6 The 2026 resource limit for all three programs is $9,950 for one person and $14,910 for a couple, not counting your home, one car, and up to $1,500 set aside for burial.6 Income limits are tied to the federal poverty level and typically update in the spring, so confirm current figures with West Virginia BMS before ruling yourself in or out.

Extra Help for Part D

Extra Help, also called the Low-Income Subsidy, pays Part D premiums, deductibles, and copays for people with limited income and resources. Since 2024 the partial-subsidy tier is gone, so everyone who qualifies now gets the full subsidy.10

• Income limit (2026): about $1,995 a month for an individual, $2,705 for a couple (150% of the federal poverty level)10
• Resource limits: $16,590 for an individual, $33,100 for a married couple10
• If you qualify for QMB, SLMB, or QI, you're automatically enrolled in Extra Help6

Apply through Social Security at ssa.gov or call 1-800-772-1213.10 WV SHIP counselors can also walk you through the application.

Medicare Enrollment Periods

Miss a deadline and you can face coverage gaps or permanent penalties. These dates are federal and the same in West Virginia as everywhere else.11

Changes made during Annual Open Enrollment take effect January 1 of the following year.11 If you're still working past 65 with coverage from a current employer, you can delay Part B without penalty and use an eight-month Special Enrollment Period to sign up after that job or coverage ends; miss it and you wait for the General Enrollment Period and may owe a late penalty.12 For a full breakdown, see our Medicare enrollment periods guide.

Free Medicare Help: WV SHIP

You don't have to sort this out alone, and you shouldn't pay a broker to help. WV SHIP, the West Virginia State Health Insurance Assistance Program, is the state's free, unbiased Medicare counseling service, operated through the West Virginia Department of Human Services. SHIP counselors don't sell insurance and take no commissions.3

A WV SHIP counselor can help you:

• Understand your Medicare options and what each part covers
• Compare Medicare Advantage, Part D, and Medigap plans side by side
• Apply for Medicare Savings Programs and Extra Help
• Sort out billing disputes, denials, and appeals
• Spot and report Medicare fraud through the Senior Medicare Patrol

Key West Virginia Medicare Contacts

Learn More

Find personalized help with Medicare in West Virginia at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.