Medicare Advantage (Part C) plans in West Virginia and Virginia

Medicare Advantage in West Virginia for 2027

For 2027, West Virginia residents have 70 Medicare Advantage plans to choose from, up from 69 in 2026, according to CMS. CMS reports that every person with Medicare in the state has access to a Medicare Advantage plan, including one with a $0 monthly premium. You still pay your Part B premium with any Medicare Advantage plan. The average Medicare Advantage premium in West Virginia rose from $13.21 a month in 2026 to $15.36 in 2027. In Virginia, 148 plans are available, and the average premium fell from $8.80 to $6.67.

A statewide count does not tell you what is offered where you live. Plans are approved county by county, and the same insurer can offer different networks and benefits in Raleigh County, Kanawha County and across the line in Tazewell County. Plans can change or leave a county each year, so check your Annual Notice of Change even if you are happy with your plan. Source: CMS 2027 state fact sheets, September 28, 2026.

What Medicare Advantage (Part C) is

Medicare Advantage, also called Part C, is offered by Medicare-approved private insurers as another way to receive your Part A and Part B benefits. Instead of Original Medicare paying your doctors and hospitals directly, the plan pays them under its own rules. Most plans include Part D prescription coverage. Many add dental, vision or hearing benefits, but those extras have their own networks, allowances and limits.

Every Medicare Advantage plan has a yearly limit on what you pay for covered Part A and Part B services. Once you reach it, you pay nothing for covered Part A and Part B services for the rest of the year. In a PPO, there is an in-network limit and a higher combined limit for in- and out-of-network care. Drug costs and extra benefits such as dental do not count toward it. Each plan sets its own limits up to a federal maximum, so compare them in each plan's Summary of Benefits. Original Medicare has no yearly limit unless you add a Medicare Supplement policy.

Plan types you will see in West Virginia

• HMO: you generally use the plan's network except for emergency care, out-of-area urgent care and out-of-area dialysis. Many HMOs ask you to choose a primary care doctor and get referrals for specialists.
• PPO: you can see out-of-network providers who accept the plan, usually at a higher cost. PPOs are often worth a look if you split your care between West Virginia and Virginia or see specialists far from home.
• Special Needs Plans (SNPs): limited to people who qualify. Dual Eligible SNPs are for people with both Medicare and Medicaid. Chronic Condition SNPs are for people with certain conditions, such as diabetes or heart failure. Institutional SNPs are for people living in a nursing home or needing that level of care at home.

Read more about each type on Medicare.gov.

Check doctors and hospitals first

In southern West Virginia, the network question usually decides the plan. List every doctor, specialist and hospital you use or expect to use. That might mean a Beckley primary care office, a cardiologist in Charleston, cancer care at WVU Medicine or a Carilion specialist in Virginia. Ask about the exact plan name for 2027, because one insurer can have several networks.

Include the pharmacy you use, any home health or medical equipment supplier, and where you would go for planned surgery. If you travel or spend part of the year out of state, ask how the plan covers routine care away from home. Do not assume an out-of-state specialist is covered because a local office is.

Compare prescriptions with the 2027 drug rules

For 2027, the standard Part D deductible is $700 and yearly out-of-pocket costs for covered drugs are capped at $2,400, up from $615 and $2,100 in 2026. Each plan can set a lower deductible. The cap applies to drugs on the plan's formulary, so a plan that does not cover one of your medications can still cost you more.

Bring your full medication list with doses and how often you fill each one. We compare the formulary, tiers, prior authorization and quantity limits of plans we represent for your actual drugs. Source: CMS CY 2027 Rate Announcement, Part D benefit parameters.

Compare a full year, not just the premium

Put the monthly premium beside what you would pay for office visits, specialists, hospital stays, outpatient surgery, imaging and prescriptions. Estimate two years: one with your usual care and one with a hospital stay or major treatment. A $0 premium plan with higher copays can cost more than a plan with a small premium. Ask which services need prior authorization, because that affects how quickly you can get care.

Value dental, vision and hearing benefits at what you would actually use. Check the dollar allowance, which dentists participate and how often a service is covered.

Situations to raise before you enroll

• PEIA retirees: PEIA provides its Medicare-eligible retirees a group Medicare Advantage PPO through Humana. PEIA states that if you enroll in another Medicare Advantage plan, you will be disenrolled from the PEIA plan. Talk to PEIA before changing. PEIA 2027 open enrollment.
• Other employer, union or retiree coverage: joining a Medicare Advantage plan can end or change those benefits, sometimes for a spouse or dependents too. Confirm in writing first.
• Veterans: VA health care generally covers care at VA facilities or care VA authorizes. Medicare or a Medicare Advantage plan can cover care outside the VA. You choose which coverage to use each time you get care. VA guidance.
• Medicaid or Extra Help: if you have Medicaid, you may qualify for a Dual Eligible Special Needs Plan. Since 2025, people with Medicaid or Extra Help can generally change once a month only to a stand-alone drug plan or certain integrated plans, not to any Medicare Advantage plan.
• Thinking about leaving a Medicare Supplement: if this is your first time in a Medicare Advantage plan, federal trial rights generally let you return to a Medigap policy within 12 months. After that, you may have to answer health questions and could be denied.

When you can join or change plans

• Open Enrollment, October 15 – December 7, 2026: join, switch or drop a Medicare Advantage plan for coverage starting January 1, 2027.
• Medicare Advantage Open Enrollment, January 1 – March 31, 2027: if you are already in a Medicare Advantage plan, you can switch to another Medicare Advantage plan, or drop it and return to Original Medicare and add a drug plan, once during this period.
• Initial Enrollment: the seven-month window around your 65th birthday. See our Turning 65 guide.
• Special Enrollment Periods: certain events, such as moving out of your plan's area, losing employer coverage or your plan leaving your county, create a chance to change outside these dates.

Bring this to your review

• Your Medicare card and any current plan's 2027 Annual Notice of Change
• A list of doctors, specialists, hospitals and your pharmacy
• Your medications, with doses and how often you fill them
• Any employer, PEIA, union, VA or Medicaid coverage
• Your county, and anywhere you regularly get care outside it

Please do not send your Medicare number or medical records through the website form. Steven Songer, REBC® and the Songer team compare plans we represent from our Beckley office, by phone or by video. Call 304-252-2158 or use the form above to request a no-cost Medicare Advantage review. You can also compare plans yourself on Medicare Plan Finder.

General educational information. Coverage, eligibility and plan terms vary. Updated October 20, 2026.