West Virginia, the Mountain State, is located entirely within the Appalachian Mountain range and 75 percent of the state is covered in forest. Despite the high density of nature, there are still over 1.8 million people living in West Virginia. The state has an abundance of caves, as well as endless outlets for outdoor activities such as hiking, biking, fishing, whitewater rafting, and hunting. The largest city, Charleston, has a variety of cultural attractions as well as industry, professional sports, and higher education.
Residents of West Virginia have access to a few national and worthwhile health insurance companies: Celtic, Coventry, and UnitedHealthOne. Availability of these companies varies based on your area. East Coast Health Insurance has knowledgeable, medical insurance professionals who can be reached at 888.803.5917 to answer any questions regarding plans or anything else. To find the best plan for you and your family, enter your zip code in the quote box below.
The overall health of West Virginia has increased gradually over the past five years, though it remains one of the less healthy states. Though most states have seen a decrease in smoking, West Virginia remains the highest population of smokers in the US at nearly 27 percent and 393,000 adults. The number of obese individuals has also increased, which is now 33 percent of all adults. Diabetes is also a concern, moving up by ten percent over the last ten years and now affecting 171,000 residents of West Virginia.
Air pollution is very high compared to the rest of the country, which is also a contributor of poor health. Some positives in West Virginia are the low occurrence of infectious disease and one of the most well-funded public health systems in the nation. Improvements to West Virginia health could be made by using services either through health insurance or public health programs. By taking preventative actions to address and maintain good health, or treating illnesses and conditions if necessary, the state will continue on its upward course to healthiness.
Health Insurance Plans
- Celtic Basic plans offer health coverage for an affordable rate, with the option of 70 or 80 percent coverage after deductible. Choose from $2,500, $3,500, $5,000, or $7,500 for individual deductibles, and low premiums, members can receive preventive care for no charge in network as soon as the plan begins. Also available immediately are generic prescriptions and the first two visits to a primary care physician or specialist for a $30 copay. Once the deductible is met, these plans offer hospital stays, outpatient surgery, emergency care and lab work for an additional deductible of $350 – $500 with coinsurance after deductible.
- CeltiCare Preferred plans provide comprehensive major medical coverage to individuals and families with multiple options to customize your care. Based on the deductible you choose, these plans give you 80 or 100 percent coverage on major medical care after deductible with in-network providers. Deductibles range from $1,000 to $10,000 for individuals, and have an incredibly low rate for physician office visits at $15 for primary care or specialists. Doctor’s office visits are limited to two for that rate, followed by coinsurance after deductible. Pharmacy coverage is fair, with generics for a $10 copay without considering the deductible, and brand names are $40 after the separate $500 pharmacy deductible.
- CelticSaver HSA plans come in a range of high deductibles, from $1,500 to $5,000 for individuals, and give members the option of opening a health savings account. From your plan’s start date, preventive care is available for no charge in-network. Celtic’s many covered physician and hospital services are available for 20 percent coinsurance or no cost after deductible. Prescriptions are included in the annual deductible, and covered at the chosen level of coinsurance after it has been met. If you choose to connect an HSA to your plan, tax advantages such as a deduction on yearly income tax returns can be made. HSA funds are specifically designated for health care use, and are not taxed.
- Copay plans are available in Classic and Value options, which allow West Virginians to choose a basic, economy plan or a benefit-rich money saver. Copay plans come in deductibles from $500 to $5000 for individuals. Classic plans offer the choice of 20 or 0 percent coinsurance after deductible, and Value plans have 40 percent. Office visits with a Classic plan are $30, and $20 with a Value plan. Value plans will offer generic only and Classic plans cover a greater number of prescriptions for an additional $200 deductible. Either option is a great way to receive instant benefits for a reasonable price.
- PPO plans also offer immediate benefits for a copay, with $25 doctor’s office visits and prescription coverage. Ranging in deductible from $500 to $2,500, these plans cover 70 percent of inpatient and outpatient hospital care after meeting your chosen annual amount. With no separate prescription deductible, pharmacy benefits begin with your plan, starting at $5 for generics. Out-of-network coverage is also offered for a $5,000 deductible, and your plan will cover 50 percent of major medical costs.
- QHDHP plans provide members with the ability to choose a high deductible health plan for the lowest monthly premium and 100 percent coverage after deductible. Though you have to meet all of your costs out-of-pocket in order to reach the deductible, starting an HSA to assist and grow interest is worth the investment. Preventive care is offered immediately for no cost with in-network doctors and facilities, including child immunizations, well-women care, prostate cancer screenings, and more.
- Copay plans have deductibles ranging from $1,000 to $10,000 for individuals. Available in Select or Select Value, you can receive physician services, prescription drugs and urgent care for a copay as soon as your plan begins, as well as preventive care for no cost in-network. Value plans, as is typical among all carriers, coverage on generics only and up to four office visits for a copay. Select plans have unlimited visits with a primary care doctor or specialist, and all tiers of prescription drugs. After you meet the deductible, Value plans offer in-network hospital services for 30 percent coinsurance after deductible, and Select plans have options of 30, 20, or 0 percent.
- High Deductible plans cover everything you will ever need from a doctor or hospital after meeting the deductible. These plans come in three types: Plan 100, Plan 80 and Saver 80, each indicating the amount your plan covers. Plan 100 has the most benefits for higher premiums and deductibles and no cost sharing once you have met the deductible, while Plan 80 has lower premiums and higher coinsurance. Saver 80 plans are more limited for a lower premium, and no prescription drug coverage.
- Health Savings Account plans provide a way for plan members to control their medical expenses with a separate savings account which helps contribute to the deductible or can be saved. HSA 100 Value and HSA 100 offer a vast number of covered services for 100 percent after deductible with in-network providers. Covered care includes inpatient and outpatient hospital care, physician services, diagnostic test and labs, and more. Annual costs for HSA 100 plans range from $2,500 to $5,000. Both types of plans include prescription coverage in the deductible.
Public Health Options
West Virginia has one of the most well funded public health systems in the nation, and therefore it is worthwhile to look through the state’s services is you are unable to afford health insurance. The most important place to look first is Medicaid if you are eligible for the program. West Virginia residents of all ages who have a low income can benefit from coverage through the largest source of medical assistance for the uninsured. For specific conditions as well as preventive care, clinics and specific programs are offered throughout the state. To view a complete guide to options for the uninsured and medically needy, visit the West Virginia Department of Health and Human Resources.
- Medicaid: health insurance for children, families, elderly individuals, pregnant women, disabled persons and more living in West Virginia without coverage.
- CHIP: the West Virginia Children’s Health Insurance Program for uninsured youth under age 19 of any income level.
- Immunization: offering free vaccines for preventable illnesses for uninsured children in West Virginia.
- PCIP: Pre-Existing Condition Insurance Plan for West Virginia residents who are uninsured and have health problems that make them ineligible for a private policy.
Health Insurance Laws
Individual health insurance is governed by several laws in West Virginia that give insurers the ability to be selective when they sell plans. Due to limits on high-risk individuals and pre-existing condition laws, health insurers are protected by being able to reject an individual who does not have an ideal medical history. Pre-existing conditions are judged by any condition an applicant has or could have received care for in the two years before enrolling in a plan. If the insurance company does not deny coverage to an individual with such a condition, they can issue an exclusion period of up to one year.
Law also permits the use of elimination riders, which allows the insurance company to never pay for cost of medical care to treat the pre-existing condition. A useful alternative to those who have been denied a private health policy is the Pre-Existing Condition Insurance Plan. PCIPs are operated by the US Department of Health and Human Services (HHS), and offer an affordable option for people who qualify. These plans will expire in 2014 when all health insurance companies and state-run health exchanges will be required to accept all adults regardless of their health status and medical history. The health care law forbids the use of elimination riders and exclusion periods after this point.
For individuals who are insured in the private market, an important protection stands in your favor. Guaranteed renewal acts as a reinforcement of health insurance and holding onto one’s coverage. At the end of a term, an insurer must ask if you wish to have your plan renewed. Insurers are required to abide by this law to avoid any gaps in coverage. Some types of plans do not apply to this law. This law also prevents your carrier from cancelling your plan because of illness acquired after the plan started. Guaranteed renewability makes sure people stay insured if they are a respectful, paying customer.