When people work hard their entire lives and scrimp a little bit to save money for a comfortable retirement, they deserve to live a life that is free from all financial strains. But with the soaring healthcare costs and inaccessible health insurance plans, even a lifetime of diligent saving cannot save people from medical debt.
Several surveys reveal that approximately 16 million adults in the US are currently going through medical debt and owe more than $10,000. This debt isn’t limited to a certain group of people but affects people across all demographics. People suffering from chronic ailments and disabling characteristics are more vulnerable to facing excessive medical expenses and often end up bankrupt. 1 in 3 US families usually opts out of seeking a medical professional’s help because of the exorbitant medical expenses.
This is why the US government initiated the Medicare health insurance programs to finally give their people a chance to receive medical treatments without the fear of being indebted or going bankrupt.
Medicare is a reliable government-backed healthcare program that offers comprehensive coverage for a wide range of medical expenses for millions of US citizens nationwide. People automatically become enrolled in Medicare when they reach the age of 65. Other people who qualify for Medicare must have been diagnosed with amyotrophic lateral sclerosis (ALS), had renal failure, or have been receiving disability benefits from Social Security or the Railroad Retirement Board.
With a well-rounded health insurance plan, you will never have to worry about paying any excessive out-of-pocket expenses at the time of a medical emergency ever again.
But finding a robust healthcare plan that covers all your primary needs and requirements can be overwhelming. Even the process of signing up for Medicare is lengthy and might look intimidating. This is where our Medicare insurance agents come in.
At Integrity Now Insurance Brokers, our highly-qualified Medicare insurance agents are annually accredited by America’s Health Insurance Plans (AHIP) and have extensive experience in the insurance industry. Our Medicare specialists will take you step-by-step through the lengthy process of signing up for Medicare and are committed to simplifying things as much as possible.
We have access to West Virginia’s top-rated Medicare insurance agencies that we meticulously selected after studying their proven track record and comprehensive healthcare policies. Get in touch with us today by giving us a call and our independent Medicare insurance brokers will provide you with all the details that you require.
A Guide on the Different Medicare Options Available in West Virginia
Every person who is enrolling themselves in the Medicare program must choose between one of the following different ways to receive benefits from Medicare.
Original Medicare
The Original Medicare or the traditional Medicare is a federal law-regulated program that is one of the most popular healthcare options among the people of West Virginia.
The Original Medicare plan consists of two parts: Medicare Part A and Part B.
Medicare Part A plans include coverage for services like specialized nursing facilities, inpatient hospital care (excluding custodial or long-term care), inpatient care in a non-medical religious healthcare facility, psychiatric care, home health care, and hospice care.
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Part B plans provide coverage for laboratory tests, certain medical equipment, physician services, blood work, mental health services, diagnostic X-rays, outpatient hospital services, and physical, occupational, and speech therapy.
Medicare also has recently started to provide ample coverage for patients who have been diagnosed with a cognitive impairment like Alzheimer’s disease and other various forms of dementia.
This healthcare treatment enables patients to go through clinical trials, get medical and non-medical treatments, and receive other medical benefits that promote a higher quality of life.
These benefits include cognition evaluation, measurement of neuropsychiatric symptoms, prescription medications, identifying caregivers and their needs, assessing care directives, and providing referrals to community services for the beneficiary and the caregiver.
The Original Medicare Plan does not include coverage for prescription drugs which is why many Medicare beneficiaries in West Virginia like to purchase a drug plan separately.
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Medicare Advantage – Part C
The Medicare Advantage plan or Medicare Part C is offered by private insurance agencies that work under contract with Medicare.
This comprehensive healthcare plan will pay companies who offer Medicare a fixed amount every month to cover your medical expenses. Medicare Advantage is an all-in-one solution for people who are looking to combine their Part A, Part B, and Part D benefits into a single policy. This plan also offers coverage for additional benefits like dental, vision, hearing, and other targeted treatments.
As of 2022, there are 38 Medicare Advantage Plans available for eligible enrollees in West Virginia. To make sure you have all the details about the new Medicare Advantage plans in West Virginia before applying, browse through the Medicare website to learn more.
West Virginia’s Medicare Advantage program offers four different types of plans.
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Health and Maintenance Organization (HMO)
The HMO is a popular insurance structure in West Virginia that offers comprehensive health coverage through a network of physicians and hospitals for a monthly or annual fee.
This collective of medical insurance providers offers adequate health coverage plans through a recommended network of healthcare providers and charges higher charges and premiums when their subscribers opt for out-of-network providers.
- Primary care provider (PCP) and a specialty referral required
- Prescription drug coverage is included in most plans
- Lower costs and premiums for in-network healthcare providers.
Preferred Provider Organization (PPO)
The PPO includes a network of recommended healthcare providers that Medicare beneficiaries can choose from without paying any extra premiums.
- PCP and a specialty referral are not required
- Prescription drug coverage is included in most policies
- Higher premiums and charges apply for out-of-network healthcare providers
Private Fee-For-Service (PFFS)
This healthcare program is offered by State-licensed organizations that work under the terms and conditions of Medicare & Medicaid Services.
- No PCP or specialty referral required
- Drug coverage is included in most plans but can also be purchased separately
- Beneficiaries have to pay higher premiums when opting for out-of-network providers
Special Needs Plan (SNP)
The SNP only allows membership to people who have been diagnosed with specific chronic conditions and disabling characteristics. This healthcare program includes tailored benefits, drug formularies, and provider choices that are specifically designed to meet the special needs of these people.
To qualify for the SNP, you need to be enrolled in Medicare Part A, or Part B plans, or have a chronic condition like cancer, HIV/AIDs, cardiovascular diseases, dementia, diabetes mellitus, autoimmune disorders, or a neurological disorder.
- PCP and a specialist’s referral are required
- Plans include coverage for prescription medication
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Medicare Part D
If your base health insurance plan does not provide coverage for prescription drugs, you have the option to sign up for a separate drug plan called Medicare Part D. Like other health insurance plans, Part D plans also include a monthly premium, an annual deductible, and other out-of-pocket expenses like copayments and coinsurances.
All drug plans vary in terms of premiums, the pharmacies you can use, and the formulary. It’s important to choose a drug plan that includes all the prescription medications that you’re regularly prescribed.
The costs of Part D depend on the plan you subscribe to.
Part D Deductible
A lot of the Part D policies charge an annual deductible. The maximum deductible you’ll be charged in 2022 is $480.
Initial Coverage Limit
Medicare beneficiaries will be responsible for 25% of the cost-sharing and 75% will be covered by the plan.
Coverage Gap
Medicare Part D coverage gap begins right after your drug plan has paid a certain amount for your prescription drugs. In 2022, this limit is $4,430. This amount changes almost annually and you will be expected to pay 25% of the plan’s cost for any brand-name drugs enlisted in your plan’s formulary.
Medigap – Supplemental Healthcare
Medigap or supplemental healthcare is a secondary healthcare option that is funded by private insurance agencies to help cover all the gaps in the Original Medicare plans. Each policy in this program is labeled from A to N and each letter has a certain level of coverage.
Medigap provides all the basic benefits of the traditional Medicare, including ample coverage for all Part A and Part B coinsurances, hospice care copayments and coinsurances, Medicare preventive care deductibles, and the first three pints of blood.
Additional benefits include skilled nursing facilities care deductibles, Part B excess charges, out-of-pocket yearly limit, and foreign travel emergency coverage.
Medigap insurers use three methods to calculate premiums.
Issue Age Rating
The premiums are calculated based on the enrollee’s age at the time they apply. Enrolment premiums are less costly for people who are under 65 compared to people who are signing up for Medigap after the age of 80. The overall rates may go up due to inflation and other factors but never because of your age.
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Attained-age Rating
The premiums are based on the enrollee’s current age, and the premiums go higher as the person grows older. This premium is less costly for younger subscribers.
Community Rating
This approach to calculating premiums is unaffected by the enrollee’s age. Many insurers are likely to avoid this approach unless it is mandated. Many West Virginia-based insurance companies like to use the issue-age rating method unless mandated to do otherwise.
Being first-time Medicare enrollees in West Virginia, many residents find the process of researching and selecting the perfect healthcare plain intimidating. But at Medicare Hope, our Medicare insurance agents are committed to helping you find simple healthcare solutions at the most competitive rates. We promise to go above and beyond for our clients and help them find comprehensive health insurance policies that are best suited to their needs.
To learn more about the different Medicare plans available in West Virginia, you can go through our resources and find comprehensive guides on how to sign up for Medicare.
You can also use our Medicare plan finder tool to check out all the Medicare Advantage plans available in your area.
Who Can Get Medicare?
To be eligible for Medicare, you must be 65 years old or older or qualify for disability.
- You must be a permanent and legal resident in the US
- Must be receiving Social Security or Railroad Retirement benefits
- You and your spouse must be government employees or a retiree who has paid all the Medicare payroll taxes
- You’re entitled to Social Security disability benefits for at least 24 months
- You collect disability pension from the Railroad Retirement Board
- You have been diagnosed with amyotrophic lateral sclerosis (ALS), end-stage renal disease, or require regular dialysis or had a kidney transplant
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Medicare Enrolment in West Virginia
Medicare will immediately register you when you reach the age of 65 or have received at least four Social Security or Railroad Retirement Board payments before your 65th birthday. If not, you can always reach out to your local Social Security office and apply online.
You can sign up for Medicare in the following time frames.
Initial Enrolment
The initial enrolment period starts three months prior to and ends three months after your 65th birthday. You can also switch or upgrade your Medicare plans during this period if you started receiving Medicare benefits at a younger age.
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General Enrolment
The general enrolment period begins from January 1 to March 31 and is for people who missed the initial enrolment period. You can enroll yourself in the Original Medicare (Part A and Part B), Medicare Advantage (Part C), Medigap, and Part D plans.
Open Enrolment
You get a three-month window from October 15 to December 17 each year to switch between Original Medicare and Medicare Advantage Plans or make changes to your current plan. You can also sign up for Part D plans during this time frame.
Special Enrolment
You may be eligible for the special enrolment period if you lose your coverage because of an unforeseen event like moving out of the coverage area or getting unemployed.
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Why Trust Medicare Insurance Agents at Integrity Now Insurance Brokers?
At Integrity Now Insurance Brokers, our Medicare insurance agents are well-versed with the complexities and dynamics of the insurance industry and have years of experience when it comes to devising reliable healthcare plans.
We have assisted countless of our clients get comprehensive Medicare health insurance plans, and with our top-tier network of Medicare insurance providers across the US, we assure you that your health coverage policies will be the best fit for your specific situation.
Give us a call today to talk to one of our licensed representatives and we will help you compare quotes and streamline well-rounded Medicare health insurance plans at competitive rates.
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