The West Virginia Health Plan takes a leading role in increasing access to health care for residents. The managed care organization health plan for members in West Virginia Medicaid must follow state standards that dictate coverage, quality, and accountability. West Virginia Medicaid provides health coverage for many adults, families, older adults, and qualifying people.
Members are covered by the health plans that are approved by West Virginia Medicaid to coordinate care, manage enrollment, and help members access providers. The West Virginia Health Plan works in partnership with the state to provide services that meet federal Medicaid requirements and also meet the needs of West Virginia residents. Enrollment is open through the state Medicaid program and members can see how to enroll, update account information, or explore plan options by visiting the state’s resources.
Members have access to coverage for hospitalization, doctor appointments, medications, and preventive care. The program is designed to help reduce barriers to care and receive care in a timely manner throughout the year.
At BENEFITRA, we believe comprehensive healthcare should be accessible, transparent, and tailored to your needs. That’s why every member receives a complete benefits package (medical, dental, vision, and life benefits) designed to give you peace of mind and real value.
BCBS PPO National Network
(In-network only). Medications: see SBC for more details. See Health Plan Outline for More Details.
Principal PPO Dental Network
| Service | Annual deductible network | Coinsurance network pays |
|---|---|---|
| Preventative | $0 | 100% |
| Basic | $50 | 80% |
| Major | $50 | 50% |
New BenefitImplant coverage (see SBC for details).
Out-of-Network Coverage Available (Click Here to See Claim Example)
VSP Vision
10K Death Benefit
West Virginia plans and their associated health benefits provide support for short and long-term health needs. Common health benefits cover primary care and specialty services, hospitalization, mental health and wellness, prescriptions, and medically necessary drugs. Dental benefits may be included as well, depending on eligibility and the program’s offerings.
Some services, medications, or procedures may require prior authorization. By doing so, this process can help ensure proper use of health care services and products, while also protecting the safety of members. Providers can submit the appropriate documentation to aid in supporting diagnoses and treatment, while members can also view the status of prior authorization requests on their account or by contacting plan resources.
Coverage provided by West Virginia Medicaid plans also includes access to care. Members can visit in-network providers and receive preventive screenings, manage chronic disorders through coordinated care programs, and prescription drug coverage to help patients afford necessary medications and support treatment adherence.
| Features | H&W 125 | Dental 125 | Vision 125 | Accident | Life 10K | Admin125 | Union | Total |
|---|---|---|---|---|---|---|---|---|
| Employee Only | $746.00 | $75.00 | $15.00 | $12.00 | $10.00 | $100.00 | $27.00 | $985.00 |
| Employee + Spouse | $1,530.00 | $150.00 | $30.00 | $12.00 | $10.00 | $200.00 | $27.00 | $1,959.00 |
| Employee + (Children) | $1,169.00 | $150.00 | $30.00 | $12.00 | $10.00 | $200.00 | $27.00 | $1,598.00 |
| Employee + Family | $1,669.00 | $220.00 | $45.00 | $12.00 | $10.00 | $200.00 | $27.00 | $2,183.00 |
| Waived Employees | · | · | · | · | $10.00 | · | $27.00 | $37 |
Medicaid is a critical part of the puzzle when it comes to health coverage in West Virginia, but it is not the only option. People who are not eligible for Medicaid still have choices and may be able to purchase private health insurance. Some may also qualify for Medicare depending on their age and circumstances. Medicare is a federal program that helps cover health costs for older adults, as well as people of all ages who meet certain conditions. Medicare can help pay for hospital care, outpatient care, and prescription drugs.
Business owners and individuals who are self-employed can help employees and family members take control of their health care options with the assistance of BENEFITRA. Through BENEFITRA, people can access group health and welfare options. BENEFITRA is not a carrier but can help members access compliant options and connect with trusted providers. In some cases, plans through organizations like UnitedHealthcare are available.
Families also have the option of coordinated coverage, where both children and adults can get the care they need through the same plan structure. This can make it easier for them to enroll and use their benefits, as well as address needs over time.
Book your free consultationSelecting the most suitable health plan in West Virginia is a decision that impacts care, health, and financial stability. Coverage determines who patients can visit, how medications are filled, and what steps are needed for prior authorization or referrals for services.
Reviewing plan information helps members understand benefits, covered services, deadlines, and required documentation. Members can also keep their account data current to avoid delays in care and gaps in coverage. Learning how to access member portals, submit forms, and receive plan updates streamlines health care access.
State and federal resources provide individuals with accurate information, question support, and education on available options. Whether enrolling in Medicaid, Medicare, or commercial coverage, selecting the right plan supports positive health care experiences and long-term well-being for West Virginia residents.
Read how employers and families found the right coverage and hear their success stories.
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Alexandra EstradaOperations Manager at FOUR PAWS Without changing payroll or going through underwriting, we saved over 50% on our medical plan while upgrading to a PPO, improving benefits, and reducing expected renewal increases. The savings allowed us to add dental and vision coverage and hire a new full-time employee to support our business growth.
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