State Guides

West Virginia

Pivot Health is proud to offer quality health insurance plans to West Virginians. These plans, described below, offer West Virginia individuals and families the ability to choose the benefit structure that best meets their insurance coverage needs and budget.

  • Short Term Health Insurance – Temporary health insurance, also known as short term medical, provides comprehensive benefits coverage for physician visits, in-hospital care, urgent care facility visits and much more. With no provider network restrictions, you have the freedom to seek treatment from any doctor or hospital to access benefits. Thanks to Pivot Health’s fast, user-friendly online application process, you’ll know within minutes of applying if you’ve been approved for coverage. And qualified applicants may choose coverage to start as soon as 24 hours after applying.
  • Supplemental Insurance Coverage – If your major medical insurance plan’s high deductibles and costly coinsurance rates are a drain on your budget, then supplemental insurance may provide you the financial support you need. Supplemental coverage provides you cash benefits that you may use to help pay out-of-pocket medical costs, such as insurance deductibles, copayments, coinsurance, or any other expenses you incur due to a serious illness or accident. Designed to work with your primary major medical coverage – whether you have an individual plan or employer-sponsored coverage – a supplemental insurance plan helps you protect your financial security from costly expenses related to medical care.

With your Pivot Health plan, you also will receive many non-insurance benefits, such as:

Unlimited access to discounted telehealth doctor consultations.
Don’t spend your valuable time sitting in a waiting room to speak to a health care provider. Instead, connect directly with a doctor at whatever time of day works for you – telehealth is available 24/7. And it saves money compared to a standard office or urgent care facility visit.
Discounts on eye care and eyewear.
Save between 15 to 40 percent on eye exams, eyeglass lenses, frames for eyeglasses and contact lenses. It’s never been so affordable to maintain good eye health!
Savings on prescription drugs.
Enjoy valuable discounts of up to 75 percent on prescription medications at thousands of pharmacies across the nation.

Health Insurance Market Challenges in West Virginia

According to a recent County Health Rankings report, approximately 17 percent of West Virginia residents under the age of 65 have no health insurance – almost twice the national average uninsured rate of 9.1 percent. Uninsured rates vary by county: Putnam County has the lowest rate at 13 percent, while Hampshire County’s uninsured rate is even higher at 22 percent.

The individual health insurance exchange in West Virginia has experienced several challenges, which point to the need for affordable alternative health insurance options for uninsured residents. In 23 of the state’s counties, only one insurance carrier provides individual exchange plans, leaving enrollees with limited plan selection. Exchange enrollees in West Virginia’s other 32 counties have only two insurance carrier choices.

In addition to limited carrier and plan choices, West Virginians are dealing with whopping premium rate increases for 2017. The West Virginia Department of Insurance approved average premium adjustments ranging from 35.81 to 49.8 percent, which is significantly higher than the national average premium increase of 25 percent.

Nearly 88 percent of West Virginians receive federal premium subsidies to help pay for their exchange plan premiums. Those subsidies are adjusted each year to compensate for coverage pricing increases. However, West Virginians who purchase exchange plans but don’t qualify for federal premium subsidies, as well as those who buy off-exchange plans, will have to cover the entire rate hike amount on their own.

The two insurers who offer individual exchange plans in West Virginia point to several factors driving up premium rates. High claim costs for the individual major medical plans are outpacing premiums paid at a rate of $1.19 paid for every $1 received. Insurers are also finding that exchange enrollees, who are no longer subject to pre-existing condition limitations, are sicker and using more health care services than anticipated. Adverse selection – enrolling, using health care services, and then dropping coverage before paying premiums – also is driving up insurer costs. And finally, a lower-than-anticipated exchange participation rate of younger, healthy millennial consumers has not provided needed stabilization for the individual exchange market.

A much higher-than-national-average rate of uninsured residents, limited insurance carrier and plan options, and skyrocketing premium rates all underscore the importance of offering West Virginians access to a broader range of health insurance choices.

  • Pivot Health’s short term health insurance provides West Virginia residents the opportunity to buy comprehensive coverage at a fraction of the cost of major medical insurance coverage – with no provider network restrictions.
  • Pivot Health’s supplemental health insurance offers West Virginians supplemental insurance designed to provide financial support for the costly expenses associated with high deductible major medical insurance plans. This type of “gap” coverage helps insureds pay for high deductibles, out-of-pocket costs, coinsurance, copayments, and other costs that they typically incur before their high deductible major medical plan begins to pay benefits.

A Report on Well-Being in West Virginia

The recent Gallup-Healthways State of American Well-Being report examined how well-being varies by state. West Virginia ranked last out of the 50 states, based on survey responses to questions covering different categories of well-being.

West Virginians reported the lowest ratings (each ranked 50th) for the following categories:

Purpose
liking what you do each day and being motivated to achieve your goals
Financial
managing your economic life to reduce stress and increase security
Physical
having good health and enough energy to get things done daily

Ranking slightly higher at 49th was well-being for Community: liking where you live, feeling safe and having pride in your community. The most positive ranking for West Virginia was 45th for well-being in Social: having supportive relationships and love in your life.

The State of Health in West Virginia

The 2017 Commonwealth Fund’s Scorecard on State Health System Performance gave West Virginia an overall ranking of 38 out of 51 (the 50 states plus the District of Columbia). This is the most recent version of the organization’s scorecard of its comparison for states in the U.S.

The Commonwealth Fund’s Scorecard rated West Virginia in several areas, including:

  • Uninsured adults aged 19 to 64: 8th ranking (8 percent in West Virginia, compared to U.S. average of 13 percent)
  • Uninsured children ages 0 to 18: 3rd ranking (3 percent, compared to the U.S. average of 5 percent)
  • Adults who went without care because of cost in the previous year: 33rd ranking (14 percent in West Virginia, compared to the U.S. average of 13 percent)
  • Individuals under age 65 with high out-of-pocket costs relative to annual household income: 41st ranking (17 percent, compared to U.S. average of 14 percent)
  • At-risk adults who did not have a routine doctor visit in the previous two years: 7th ranking (10 percent in West Virginia, compared to U.S. average of 13 percent)
  • Adults that did not visit a dentist in the previous year: 48th ranking (20 percent, compared to U.S. average of 16 percent)
  • Adults with age- and gender-appropriate cancer screenings: 39th ranking (65 percent in West Virginia, compared to the U.S. average of 68 percent)
  • Hospitalized people who said the hospital staff managed pain well, were responsive to calls for help and who explained medications and their side effects: 33rd ranking (67 percent, compared to U.S. average of 68 percent)
  • Breast cancer deaths per 100,000 females: 40th ranking (22.4 in West Virginia, compared to U.S. average of 20.6)
  • Colorectal cancer deaths per 100,000 people: 49th ranking (18.8 percent, compared to the U.S. average of 14.3 percent)
  • Suicide deaths per 100,000: 40th ranking (18.1 percent in West Virginia, compared to U.S. average of 13 percent)
  • Adults who report fair or poor health or activity limitations: 51st ranking (34 percent, compared to the U.S. average of 26 percent)
  • Adults who smoke: 50th ranking (26 percent in West Virginia, compared to the U.S. average of 17 percent)
  • Adults who are obese: 48th ranking (37 percent, compared to the U.S. average of 29 percent)
  • Children (ages 10-17) who are overweight or obese: 37th ranking (34 percent in West Virginia, compared to U.S. average of 31 percent)
  • Percent of adults who have lost 6 or more teeth due to decay or disease: 51st ranking (22 percent, compared to U.S. average of 10 percent)

West Virginia scored positively in these key health categories:

  • Children with medical and dental preventive care visits in the past year
  • Children with emotional, behavioral, or developmental problems who received needed mental health care in the past year
  • Home health patients who improved at walking or moving around

2017 Health Insurance Plans in West Virginia

Individual plans on the West Virginia exchange in 2017 are available through these insurance companies:

  • CareSource (offered in 32 of West Virginia’s 55 counties)
  • Highmark (offered in all 55 West Virginia counties)

Pivot Health offers in West Virginia:

  • Short term health insurance
  • Supplemental health insurance

Medicaid in West Virginia

West Virginia expanded its Medicaid program effective January 1, 2014. All non-disabled adults with incomes at or below 138 percent of the Federal Poverty Level (FPL) are now eligible to enroll in Medicaid.

There are more than 554,000 Mountain State residents enrolled in the program – approximately 3 in every 10 West Virginians. The 30 percent Medicaid enrollment rate in West Virginia is significantly higher than the U.S. average of 23.4 percent, and only six states have a higher Medicaid enrollment rate than West Virginia. The high percentage of program participation is attributed to West Virginia having the lowest workforce participation rate and the 6th highest unemployment rate in the nation.

Because West Virginia expanded its Medicaid program under the terms of the Affordable Care Act, the federal government agreed to pay all costs for new program enrollees through 2016. Starting in 2017, the government began scaling back its funding portion and will plateau to a 90 percent funding rate by 2020, with states funding the remaining 10 percent of program costs.

Despite the current level of federal funding, West Virginia’s costs for funding the state’s Medicaid program have increased by almost 25 percent since 2012, according to a joint report from the West Virginia Center on Budget and Policy, and West Virginians for Affordable Health Care. Already facing a potential $400 million budget deficit for 2018, West Virginia lawmakers are becoming increasingly concerned about the estimated $40.8 million necessary for additional Medicaid funding in the coming year.

The uncertainty of how Washington will proceed with any changes to the Affordable Care Act and related Medicaid funding issues makes it critical that low-income West Virginians have access to affordable health insurance options.

Your Health Care Coverage Choices

If you live in West Virginia and do not have health insurance: Pivot Health’s short term health insurance offers you the choice of comprehensive medical coverage to meet your benefit and budget needs.

If you are a West Virginian and have a high deductible health insurance plan: Pivot Health’s supplemental insurance can provide you financial support for costly out-of-pocket expenses, such as deductibles, coinsurance, copayments and more.

Pivot Health: offering you choices and flexibility that pivot with your insurance needs over time.