Health Insurance in West Virginia

Medicaid in West Virginia

West Virginia expanded Medicaid in 2014, covering adults aged 19 to 64 with household incomes up to 138% FPL (about $20,780 for a single person in 2026). Over 175,000 West Virginians enrolled through expansion, a substantial number for a state of about 1.8 million people. The expansion was especially impactful in coal-country counties with high poverty rates and limited employer-sponsored coverage.

West Virginia's overall Medicaid enrollment (including traditional categories and expansion) covers roughly 30% of the state's population, one of the highest Medicaid dependency rates in the nation. The state's older, sicker population drives higher healthcare utilization.

West Virginia's uninsured rate is approximately 5.8%, with about 105,000 residents lacking coverage. This is a significant improvement from the pre-ACA era when the rate was above 14%.

What plans cost in 2026

West Virginia marketplace premiums are among the highest in the country, reflecting the state's older population and high disease burden. A benchmark Silver plan for a 40-year-old can range from $550 to $800 per month before subsidies, depending on the county. Southern and central counties tend to have the highest premiums.

Despite high sticker prices, most West Virginia marketplace enrollees pay much less thanks to subsidies. Over 90% of enrollees received premium tax credits in 2025. West Virginia had roughly 40,000 marketplace enrollees in 2025. With enhanced subsidies expiring after 2025, the subsidy cliff returns at 400% FPL (about $62,160 for a family of two). Given West Virginia's low median income, most marketplace enrollees will still qualify for subsidies, but the amounts will be smaller.

Carriers in West Virginia (2026)

Two insurers offer individual marketplace plans in West Virginia for 2026:

• Highmark Blue Cross Blue Shield West Virginia is the dominant carrier, offering plans statewide. Highmark has the broadest provider network in the state, including virtually all major hospitals and most physicians. For many West Virginia counties, Highmark is the only marketplace option available.
• CareSource entered the West Virginia marketplace and offers plans in select counties. CareSource, an Ohio-based nonprofit, provides an alternative to Highmark in the areas where they operate. Their networks are typically narrower but premiums can be competitive.

Carrier competition is limited. Many rural counties have only Highmark as an option. The counties where CareSource operates have the benefit of at least two carriers, which helps moderate pricing.

Key regions

Charleston metro

Kanawha County (Charleston) is the state capital and largest metro area. CAMC (Charleston Area Medical Center) and Thomas Health System are the major hospitals. Both marketplace carriers typically serve this area. Charleston has the best healthcare infrastructure in the state and relatively more competitive premiums.

Huntington-Ashland area

Cabell County (Huntington) is home to Marshall University's Joan C. Edwards School of Medicine and Cabell Huntington Hospital. The Huntington area has been heavily impacted by the opioid crisis, which has driven up healthcare costs and insurance premiums. Both carriers may be available here.

Eastern Panhandle (Martinsburg, Charles Town)

Berkeley and Jefferson counties in the Eastern Panhandle are the fastest growing part of West Virginia, with many residents commuting to the Washington, D.C. metro area. WVU Medicine East is the major local provider. Residents should check whether plans cover providers in Maryland and Virginia if they receive care across state lines.

Southern coalfields

McDowell, Mingo, Wyoming, and surrounding counties face the most severe healthcare access challenges. Hospital closures, physician shortages, and the opioid epidemic have created a healthcare crisis. Many residents rely on Medicaid or community health centers. Marketplace options are typically limited to Highmark only, and premiums are among the highest in the state.

Estimate your subsidy

West Virginia-specific things to know

High premiums, but subsidies help most people. West Virginia's sticker-price premiums are among the nation's highest, but the subsidy formula actually works in enrollees' favor: higher benchmark premiums mean larger subsidy amounts for those who qualify. If your income is under 400% FPL, you may pay less out-of-pocket than you expect.

Medicaid covers a large share of the population. With about 30% of West Virginians on Medicaid, the program is a critical part of the state's healthcare system. If your income is under 138% FPL, check Medicaid eligibility first. Medicaid has no premiums and comprehensive benefits.

Navigator help is important here. West Virginia has certified navigators and community health centers that provide free enrollment assistance. Given the complexity of subsidy calculations and the high baseline premiums, getting help with your application can make a significant financial difference. West Virginia Healthy Kids and Families and local community action agencies are good starting points.

Resources

• HealthCare.gov for marketplace enrollment (West Virginia uses the federal marketplace)
• WV Bureau for Medical Services for Medicaid eligibility and enrollment
• WV Health Connection for enrollment assistance and navigator services