Updated: May 27, 2026
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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 | 4.5 |
HMO plans work well for seniors who want 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 market offers limited choices; no plans earn 4-star CMS ratings and only one plan hits 3 stars. That single plan charges $0 monthly with an $8,050 out-of-pocket maximum.
Humana is the only HMO-POS option in West Virginia, earning a MoneyGeek score of 5.0 by default. Its one plan has a three-star CMS rating, a $0 monthly premium and an $8,050 out-of-pocket maximum. No premium means higher exposure if you need major care during the year.
| Humana | 3.00 | $0 | $8,050 | 1 | 5 |
HMO-POS plans cost less than PPOs and give more flexibility than standard HMOs. You get in-network pricing most of the time, with the ability to see out-of-network providers when specialized care isn't available locally. Out-of-network visits cost more, but monthly premiums stay below PPO levels.
West Virginia has 25 PPO plans. Premiums start at $0 and reach $145, with most residents paying around $15 a month. Annual spending caps average $7,302, ranging from $5,300 to $9,250. PPO quality in West Virginia is below national standards, where one plan has 4.5 stars, one has four stars, 20 have 3.5 stars and three have three 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 |
PPO plans cost more than HMO and HMO-POS options. The difference pays for direct specialist access without referrals and the ability to see out-of-network providers when needed. In-network visits still cost less, but the referral requirement is gone entirely.
Selecting Medicare Advantage coverage in West Virginia means understanding what you pay versus what you get in doctor access and benefits.
Verify each plan directly with your doctors' billing offices. In other words, don't rely on the insurer's general directory. Plans under the same insurance brand maintain separate provider agreements in West Virginia, so acceptance by one plan doesn't mean acceptance by another from the same company.
The premium is the smallest part of what you might spend in a year. Compare the full picture: expected annual premium plus your realistic out-of-pocket exposure based on how much care you typically use.
A $0-premium plan with a $9,250 out-of-pocket maximum can cost far more than a $15-a-month plan capped at $5,300 if you have a hospitalization or a serious procedure mid-year.
Drug formularies assign medications to pricing tiers, where lower tiers mean lower per-prescription costs. Some drugs also require prior authorization, which adds days to fill time. Check each medication against plan formularies before enrolling.
West Virginia has three plan structures. HMO plans cost the least but require specialist referrals. HMO-POS plans add occasional out-of-network access at higher cost. PPOs drop the referral requirement entirely at the highest premium. Your preference for provider access determines which structure fits.
Medicare rates plans one to five stars on service quality and member outcomes. Four- and five-star plans in West Virginia handle claims and resolve issues faster than lower-rated options.
Dental and vision coverage vary widely across West Virginia plans. Some dental packages cover only cleanings, but others include crowns and restorative work. Vision may be exam-only or extend to glasses and contacts.
Your out-of-pocket maximum is the most you'll pay for covered care in a year. Once you hit it, the plan covers everything else until the year resets. Lower caps cost more per month. Higher caps lower your premium but increase your exposure if you need major care.
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.
Plans are scored on three factors:
About Mark Fitzpatrick
Mark Fitzpatrick, a Licensed Property and Casualty (P&C) Insurance Producer in Connecticut, is MoneyGeek's resident insurance expert. He has spent nearly a decade analyzing the market, first at LendingTree and now at MoneyGeek, where he produces original research on hundreds of carriers and millions of rates across auto, home, renters, health and life insurance.
He covers economics and insurance at MoneyGeek, and his work has been featured in The Washington Post, The New York Times and NPR, among other outlets.
Like all MoneyGeek analysts, he draws on independent cost and consumer experience data. No insurance company partnership influences his recommendations.
Fitzpatrick earned his degrees from Johns Hopkins University (M.A. Economics and International Relations) and Boston College (B.A.). His career began in financial risk management at State Street. He's also a five-time “Jeopardy!” champion.
