Health Insurance Resource Center

Open Enrollment Begins November 15, 2014

The Affordable Care Act made it possible for millions of Americans, including thousands of West Virginians, to enroll in affordable health insurance through the Health Insurance Marketplace and West Virginia’s expanded Medicaid program. As we kick off the ACA’s second open enrollment period, we can already see that the law is working for West Virginians. Here’s how:

  • More than 148,000 low-income West Virginians have gained coverage through the state’s expanded Medicaid program.
  • Approximately 25,000 have selected health insurance plans through West Virginia’s Marketplace
  • Eighteen thousand young West Virginians have been able to stay on their parents’ plans until they turn 26 years old.
  • No one can be turned away because of a preexisting condition like cancer, asthma, or diabetes.
  • Important preventive services like cancer screenings, wellness exams, and other services are now free.
  • Seniors in West Virginia saved $40 million on prescription drugs by closing the so-called “donut hole” in Medicare prescription drug coverage. That means Medicare beneficiaries, who are often on a fixed income, have more money to spend on groceries and other bills.
  • West Virginians are getting a better deal on coverage because of the Medical Loss Ratio (MLR) provision of the health care law. MLR requires insurers to spend 80-85% of consumers’ premium dollars on actual health care instead of non-medical administrative costs.

The open enrollment period for West Virginia’s Health Insurance Marketplace begins on November 15, 2014 and ends on February 15, 2015.

To find out more, click the link below that best applies to your circumstances this year:

Enrolling in Health Care Coverage for the First Time
Last year, thousands shopped for and purchased coverage through the Health Insurance Marketplace. You can visit healthcare.gov to explore your insurance options and purchase coverage. You can also find information about the West Virginia Health Insurance Marketplace here or pick up an application at your local library. If you’d rather enroll by phone, you can do so by calling (800) 318-2596. Open enrollment begins on November 15, 2014 and ends on February 15, 2015. If you want coverage that begins on January 1, 2015, you must enroll by December 15, 2014.
Important Dates:
  • November 15, 2014 -   Open Enrollment Begins
  • December 15, 2014 -   Last day to enroll for coverage beginning on January 1, 2015
  • December 31, 2014 -   All 2014 Marketplace Coverage Ends 
  • January 1, 2014      -   Coverage begins for those who applied before Dec. 15 or who automatically enrolled in their 2014 plan or a similar plan.
  • February 15, 2014   -   Final day to enroll in 2015 coverage. 

The Marketplace is available for people who are uninsured and need to purchase coverage. Individuals and families who are uninsured can purchase health insurance in the Marketplace. If you already have a private individual plan, you can still look for more affordable coverage through the Marketplace, or find out if you qualify for tax credits that will help lower your premiums.

If you already have health insurance through your employer, or through a public program like Medicare, Medicaid or Veterans Affairs, you do not need to purchase coverage through the Marketplace. If your employer coverage is costing more than 9.5 percent of your income, the Marketplace will have more affordable options for you to purchase.

There are people trained and certified to help you understand your health coverage options and enroll in a plan. They will be known by different names, depending on who provides the service and where they are located. All of the following will provide similar kinds of Marketplace assistance: navigators, in-person assisters (IPA), certified application counselors (CACs), and government agencies. Insurance agents and brokers can also help you with your application and choices. You can view a map of trained and certified people to help you at the West Virginia Insurance Commission Health Reform County Help or call the main Marketplace number at (800) 318-2596. Please note that all of the official Marketplace in-person assistors mentioned above will be trained to safely handle your personal information. They will need personal information such as your income in order to complete your application, but will not need any private health information. Only provide personal information to the trained professionals, mentioned above. Do not provide information to individuals who contact you by phone or email.

What you'll need to enroll

Keeping Your Marketplace Coverage

If you have health insurance through the Marketplace, you should receive a letter from your health insurance provider explaining changes to your plan, premiums, and benefits for the coming year. You can choose to stay enrolled in your current plan or make changes. Regardless, you should log into your Marketplace account and make updates to your profile that could make a difference in terms of your subsidies and other factors. 

Medicaid and the Children's Health Insurance Program
Medicaid
The same navigators and assisters available to help you enroll in Marketplace plans can also help you determine whether you qualify for Medicaid. You can also turn to healthcare.gov or the toll free Marketplace hotline (800) 318-2596 for help. Medicaid applications are processed by the West Virginia Department of Health and Human Resources.

With the state’s expansion of Medicaid, all West Virginians earning up to 138 percent of the Federal Poverty Level can sign up for coverage through Medicaid. This means you won’t have to fall into a certain category (like seniors or pregnant women) to get Medicaid anymore. Individuals making up to $16,104.60 and families of four making up to $32,913 would be eligible for the program. If you currently have Medicaid and your income level does not change, you will still be eligible for Medicaid in 2015. Click here for more information on eligibility. 

Children's Health Insurance Program 

The Children's Health Insurance Program (CHIP) covers uninsured children up to age 19 in families with incomes too high to qualify them for Medicaid.

Children are eligible if they:

  • Reside in West Virginia;
  • Are under age 19;
  • Aren't eligible for Medicaid;
  • Belong to a family whose income falls within the Income Guidelines;
  • Are U.S. citizens.