Updated: January 28, 2026
Advertising & Editorial Disclosure
Twelve Medicare Advantage plans from six carriers serve residents, featuring HMO, HMO-POS, PPO, PFFS and Regional PPO coverage. Premium-free options exist for four plans, while maximum costs reach $145 monthly.
The Health Plan is top in West Virginia's HMO market, with Humana and Peak Health providing the sole HMO-POS and leading PPO plans respectively.
Compare monthly premiums, out-of-pocket maximums, provider networks and prescription coverage when selecting plans. Verify your doctors and medications are covered before you enroll.
Based on CMS star ratings, premiums, MOOP costs and coverage features, we identified the best Medicare Advantage plans in West Virginia. The Health Plan offers the strongest HMO options with $0 average monthly premium and $6,678 average MOOP, earning a 3.5 CMS star rating.
Humana leads for HMO-POS plans while Peak Health ranks highly for PPO coverage, with Humana holding a 3.0 star rating and Peak Health maintaining 3.5 stars. All providers deliver competitive pricing and broad benefits.
| HMO | The Health Plan | 3.50 | $0 | $6,678 | The Health Plan SecureCare Capitol Plan (HMO) |
| HMO-POS | Humana | 3.00 | $0 | $8,050 | Humana Gold Plus H5619-113 (HMO-POS) |
| PPO | Peak Health | 3.50 | $8 | $6,350 | Peak Advantage Summit (PPO) |
Medicare Advantage plans bundle hospital stays, doctor visits and prescription drugs into comprehensive packages that serve as alternatives to Original Medicare. These Part C plans must cover everything Original Medicare does while adding dental, vision and hearing benefits.
Best HMO
CMS Star Rating
Plan Types
Best HMO-POS
CMS Star Rating
Plan Types
Best PPO
CMS Star Rating
Plan Types
West Virginia has just five HMO Medicare Advantage plans. All earn 3.5-star CMS ratings. Two providers offer these plans, and every option charges $0 monthly premiums with a median of $0. Maximum out-of-pocket costs become the main difference between plans, ranging from $6,500 to $9,250 and averaging $7,720 annually.
| The Health Plan | 3.50 | $0 | $6,678 | 2 | 4.75 |
| Aetna | 3.50 | $0 | $8,365 | 3 | 4.50 |
HMO plans work well for seniors who want their care coordinated through one primary doctor and don't mind smaller provider networks. You'll need referrals to see specialists, but these plans offer the lowest premiums and out-of-pocket costs in West Virginia.
West Virginia's HMO-POS Medicare Advantage market offers limited choices, with no plans earning 4-star CMS ratings and just one plan rated at 3 stars. One provider offers a single HMO-POS plan in the Mountain State, and it costs $0 monthly. The maximum out-of-pocket cost sits at $8,050.
| Humana | 3.00 | $0 | $8,050 | 1 | 5.00 |
Looking for lower premiums than PPO plans while keeping more flexibility than standard HMOs? HMO-POS plans offer that balance, giving you a network of providers plus the option to see out-of-network doctors when you need specialized care that's not available locally. You'll pay more for those out-of-network visits, but your monthly premiums stay affordable compared to PPO coverage.
West Virginia's 25 PPO Medicare Advantage plans let you bypass referrals and see specialists directly, though this flexibility increases costs beyond HMO rates. Monthly premiums start at $0 and climb to $145, with most residents paying around $15. Annual spending caps range from $5,300 to $9,250, around $7,302. The state's PPO quality lags behind national standards. Only one plan earned 4.5 stars, with another reaching 4 stars. Most plans have 3.5 stars (20 total), while three sit at 3 stars.
| Peak Health | 3.50 | $8 | $6,350 | 2 | 4.75 |
| Humana | 3.76 | $21 | $8,162 | 9 | 4.35 |
| Blue Cross Blue Shield | 3.50 | $12 | $7,533 | 4 | 4.25 |
| UnitedHealthcare | 3.00 | $19 | $6,700 | 3 | 4.22 |
| The Health Plan | 3.50 | $51 | $6,167 | 3 | 4.04 |
| Aetna | 3.50 | $41 | $7,935 | 4 | 3.87 |
Yes, PPO plans cost more than other Medicare Advantage options, but they're worth it if you want complete provider freedom without referral hassles. You can see any specialist directly and even visit out-of-network doctors when needed, though staying in-network saves money.
Selecting Medicare Advantage coverage in West Virginia means understanding what you pay versus what you get in doctor access and benefits.
Get plan names from insurers and verify each one directly with your doctors' billing offices. Plans under the same insurance brand maintain separate provider agreements across West Virginia, so coverage by one plan doesn't guarantee acceptance by another from the same company.
Zero-premium plans shift costs to your medical visits through copays and deductibles. Track how many times you visit doctors, specialists and pharmacies yearly. A plan charging $25 monthly with $10 copays costs less annually than a free plan at $45 per visit when you need frequent medical care.
Drug formularies place your medications into pricing tiers determining pharmacy costs. Lower-numbered tiers cost less per prescription. Certain drugs require authorization from your plan before the pharmacy can fill them, adding wait time of several days. Look up each medication you take on plan formularies during shopping, not after enrollment.
West Virginia offers HMO plans requiring referrals from your primary doctor before seeing specialists but charging lower monthly costs. HMO-POS plans blend this structure with occasional out-of-network access at higher rates. PPO plans remove referral restrictions entirely, and understanding these plan types helps you pick coverage matching how you prefer accessing medical care.
Plans earn 1 to 5 stars from Medicare, measuring service quality and member outcomes. West Virginia plans rated 4 or 5 stars handle claims more efficiently and respond to customer issues faster than lower-rated plans.
Supplemental coverage varies widely across West Virginia Medicare Advantage plans. Dental packages range from preventive cleanings to restorative work like crowns and vision coverage might include exams only or extend to glasses and contacts.
Spending caps limit your total costs when serious health issues arise. After reaching your out-of-pocket maximum, West Virginia Medicare Advantage plans pay all remaining covered expenses until the year resets. Plans with lower spending limits provide stronger financial protection during hospitalizations or major procedures but charge higher monthly premiums throughout the year.
Plan type affects Medicare Advantage costs across West Virginia. With $0 median and average monthly premiums, HMO plans deliver the most affordable option. These plans come with $7,720 average out-of-pocket maximums. HMO-POS coverage also maintains $0 monthly premiums while pushing MOOP limits to $8,050 on average. At $15 median and $29 average monthly costs,
PPO plans top the expense list. But their $7,302 average out-of-pocket maximums actually run lower than HMO options. PPOs let you see specialists without referrals and visit out-of-network providers.
| HMO | $0 | $0 | $7,720 |
| HMO-POS | $0 | $0 | $8,050 |
| PFFS | $0 | $0 | $7,100 |
| PPO | $15 | $29 | $7,302 |
| Regional PPO | $52 | $52 | $6,700 |
Get answers about how to enroll in Medicare Advantage, what's covered and enrollment timing for West Virginia residents.
You must have Medicare Parts A and B, then compare plans on Medicare.gov and enroll during open enrollment (Oct. 15 to Dec. 7) or other qualifying periods.
Medicare Advantage plans cover everything Original Medicare does, plus most include prescription drugs and extras like dental, vision, and fitness benefits.
Medicare Advantage replaces Original Medicare with bundled coverage from private insurers, while Medicare Supplement (Medigap) works alongside Original Medicare to help cover deductibles and copays.
Medicare Advantage open enrollment in West Virginia runs Oct. 15 through Dec. 7 annually. Current enrollees can also make changes from Jan. 1 to March 31.
Our analysis of Medicare Advantage plans uses a scoring methodology and three key factors:
This scoring system helps you compare plans objectively while accounting for what matters most: what you'll pay and the quality of care you'll receive.
About Mark Fitzpatrick
Mark Fitzpatrick, a Licensed Property and Casualty Insurance Producer, is MoneyGeek's resident Personal Finance Expert. He has analyzed the insurance market for over five years, conducting original research for insurance shoppers. His insights have been featured in CNBC, NBC News and Mashable.
Fitzpatrick holds a master’s degree in economics and international relations from Johns Hopkins University and a bachelor’s degree from Boston College. He's also a five-time Jeopardy champion!
He writes about economics and insurance, breaking down complex topics so people know what they're buying.
