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, Part D drug spending 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 at the West Virginia Bureau of Senior Services.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 Plans in West Virginia (Part C)
• Medicare Part D: Prescription Drugs
• Medigap Plans in West Virginia (Medicare Supplement Insurance)
• 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 2026, effective January 1 through December 31.1 Medicare costs reset every year, so in 2027 take the figures from that year's CMS fact sheet or medicare.gov's costs pages. To reach a person about your own coverage, call 1-800-MEDICARE at 1-800-633-4227 (TTY 1-877-486-2048), staffed 24/7 except some federal holidays.8 A WV SHIP counselor at 1-877-987-4463 can go through your own plan with you.3

Original Medicare: Parts A and B

Original Medicare is run directly by the federal government and comes in two parts.

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 and resets each benefit period.1 A benefit period starts the day you're admitted and ends once you've gone 60 days in a row without inpatient hospital care or skilled care in a skilled nursing facility.

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.1,9

• 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

Delay past your initial window without qualifying for a Special Enrollment Period or a Medicare Savings Program 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. Creditable drug coverage is the Part D exception, not the Part B one.10

Medicare Advantage Plans 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.11

Plan availability 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, often have only one or two options. Use the Medicare Plan Finder to see 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. Some plans go further and help pay all or part of your Part B premium.1,11
• Plans run on networks (HMO, PPO, or HMO-POS). Confirm your doctors and hospitals are in-network before you enroll. Emergency care, out-of-area urgent care, and temporary out-of-area dialysis are covered whether you get them inside or outside the plan's network.11
• Plans usually require prior authorization for certain services, which Original Medicare generally does not.11
• Every plan caps your annual in-network out-of-pocket spending. Original Medicare has no such cap on its own, and CMS's sentence adds the condition: no yearly limit on what you pay out of pocket unless you have supplemental coverage, like Medigap, Medicaid, employer, retiree, or union coverage. What each covers varies by policy. The federal maximum for in-network Medicare Advantage spending is $9,250 in 2026, and many plans set lower caps.11

Medicare Part D: Prescription Drugs

Part D covers outpatient prescription drugs. You can get it as a standalone plan, 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).12
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

The national base beneficiary premium that sets the late-enrollment penalty is $38.99 in 2026, and standalone plan premiums vary by plan and county, running roughly $34.50 a month.1,10 Every plan must also offer the Medicare Prescription Payment Plan, which spreads your out-of-pocket drug costs into capped monthly payments across the year instead of paying in full at the pharmacy.2 The $615 is a ceiling, not everyone's bill: some plans set a lower deductible or none, and Extra Help lowers Part D deductibles for people with limited income and resources.12

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

Medigap Plans in West Virginia (Medicare Supplement Insurance)

Medigap policies are sold by private insurers to fill the gaps in Original Medicare: the deductibles, coinsurance, and copays. 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, 2020.13 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.5,1

Your Guaranteed Windows

Your strongest opening is still 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.5

West Virginia added a second opening in 2026. Under W. Va. Code § 33-15F-1, created by House Bill 4869, you get 60 days beginning the first day of your birth month, once per calendar year, to replace the Medigap policy you already hold. Your insurer cannot deny you, underwrite you, or apply a pre-existing condition exclusion or waiting period. The section covers policies delivered, issued, reissued, or extended in the state on or after June 1, 2026, and picks up an older policy at its next term change or premium adjustment. If you aren't enrolled in a Medigap policy on your birthday, it isn't open to you.4

Two conditions decide whether you can use it, and West Virginia is stricter here than most birthday-rule states.

Your policy has to be 24 months old. The right applies only if your current policy has been continuously in force for at least 24 months as of the day the replacement takes effect, and every replacement restarts that same clock. The window is annual on paper, but in practice about every other year. A policy your insurer reissued, or that an affiliate assumed without a gap, still counts as continuously in force.4

The new policy has to come from your own insurer. It must come from the same insurer that issued your policy or an affiliate, and offer the same or lesser standardized benefits, so you cannot shop the whole state with it and cannot move up to a richer plan letter. The one way out is narrow: if neither your insurer nor an affiliate has accepted applications for a same-or-lesser plan for at least 12 months, you may buy a same-or-lesser plan from any insurer authorized in the state. That widens which insurers you can approach and nothing else: the 24 months still applies, and a richer plan is still barred.4

The 60 days is an application deadline, not a coverage deadline. Your new policy need not take effect inside the window, and on request the insurer can delay the effective date up to 90 days after you apply so you're not paying two premiums.4

Outside these windows, an insurer here can still underwrite you, meaning it can charge you more or turn you down based on your health, unless a federal guaranteed-issue right applies.5

If You Lose Medicaid, You Get 63 Days

The same 2026 law created a second right that has nothing to do with your birthday. If you are 65 or older on the date your Medicaid eligibility ends, are entitled to Medicare, and lose medical assistance under Title XIX, including full or partial dual eligibility, you have 63 days from that date to buy a Medigap policy.4

It is far wider than the birthday window: any policy an insurer is actively offering to new enrollees, from any insurer authorized in the state, with no 24-month requirement, no same-insurer limit, and no equal-or-lesser cap. The insurer cannot deny you, underwrite you, or impose a pre-existing condition exclusion or waiting period. It applies whether or not you ever held Medigap before, and whether or not you were on Medicaid when you first became entitled to Medicare. It does not arise from leaving a Medicare Advantage plan on its own.4

If your only Medicaid help came through a Medicare Savings Program and you're not sure whether that counts, a WV SHIP counselor can tell you for free, before your 63 days run out.3

Medigap or Medicare Advantage?

You can't use both at once. A Medigap policy can't pay your Medicare Advantage copayments, coinsurance, deductibles, or premiums, and while you're in an Advantage plan it's illegal for anyone to sell you one unless you're switching back to Original Medicare.11 That lock isn't permanent: return to Original Medicare within 12 months of joining your first Advantage plan and federal law gives you a trial right to buy a Medigap policy and a separate drug plan.11 Medigap keeps you on Original Medicare, free to see any provider nationwide who accepts Medicare, at a higher monthly premium. Advantage trades some of that flexibility for a network and, often, a lower upfront cost. West Virginia's birthday rule gives you only a limited second shot, so weigh the trade before your six-month window closes.4 For a side-by-side look, see our guide to Original Medicare vs. Medicare Advantage.

Help Paying for Medicare in West Virginia

Medicare Savings Programs

West Virginia runs the Medicare Savings Programs through the West Virginia Department of Human Services (DoHS), whose Bureau for Family Assistance lists the benefit as Medicare Premium Assistance.6

Federal law bars providers from billing a QMB enrollee for that cost-sharing.6 The 2026 federal 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. West Virginia's own pages disagree on this number: the state's program brochure still prints the earlier $9,660 and $14,470 limits, and a Bureau for Family Assistance fact sheet prints lower figures again, $9,090 and $13,630. None of them says which figure caseworkers actually apply.6 Apply anyway, even if your resources look higher than whichever figure you found. Social Security tells its own staff to encourage people to apply in exactly this situation, because a state can raise or drop its resource test and the published number won't show it.6 The income figures above build in the $20 monthly SSI general income exclusion, and the dollar levels move each year with the state's poverty-level update. Confirm current figures with West Virginia DoHS.6

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.14

• Income limit (2026): about $1,995 a month for an individual, $2,705 for a couple (150% of the federal poverty level), in the 48 contiguous states and DC; Alaska and Hawaii limits run higher14
• Resource limits: $16,590 for an individual, $33,100 for a married couple, or $18,090 and $36,100 if you tell SSA you expect to use some of your resources for burial expenses14
• If you qualify for QMB, SLMB, or QI, you're automatically enrolled in Extra Help6

Apply through Social Security at ssa.gov or call 1-800-772-1213.14

Medicare Enrollment Periods

These dates are federal and the same in West Virginia as everywhere else.15

Changes made during Annual Open Enrollment take effect the following January 1.15 If you're still working past 65 with group health coverage based on that current employment, you can delay Part B without penalty and use an eight-month Special Enrollment Period to sign up, counted from the month that job or coverage ends, whichever comes first; miss it and you wait for the General Enrollment Period and may owe a late penalty. COBRA and retiree coverage do not count as coverage based on current employment, if you're self-employed or your plan isn't open to everyone at the company, ask your insurer whether it qualifies before you delay; if not, sign up at 65. This Special Enrollment Period does not apply if you're eligible for Medicare based on End-Stage Renal Disease (ESRD).16 For a full breakdown, see our Medicare enrollment periods guide.

Free Medicare Help: WV SHIP

WV SHIP, the West Virginia State Health Insurance Assistance Program, is the state's free, objective Medicare counseling service, based at the West Virginia Bureau of Senior Services (not DoHS, which runs the Medicare Savings Programs). Unlike most SHIPs, which run on volunteers, its 80-plus counselors are paid professionals employed by the Bureau, the Area Agencies on Aging, or county aging providers.3 SHIPs are not connected to any insurance company or health plan, and federal guidance bars anyone holding an insurance license from serving as a SHIP counselor at all.7,17

A WV SHIP counselor can help you:

• Compare Medicare Advantage, Part D, and Medigap plans side by side
• Review the programs that reduce your out-of-pocket costs, and apply for 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.