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Medicare Part D in West Virginia


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Medicare Part D in West Virginia is coverage for prescription drugs for Medicare beneficiaries. Medicare Part D is offered by private insurance companies approved by Medicare.

Why would I need Medicare Part D in West Virginia?

Original Medicare (Part A and Part B) doesn’t cover most prescription medications that you take at home. Medicare Part A may cover medications you receive as an inpatient at a hospital or skilled nursing facility and Medicare Part B may cover injections you receive at an outpatient clinic. However, if you take daily medications orally at home to manage a chronic condition, Medicare Part A and Part B generally won’t cover it. Medicare Part D in West Virginia is optional. However, without Part D prescription drug coverage, you’re at risk of potentially significant out-of-pocket costs for medication.

What are my options for Medicare Part D in West Virginia?

There are two ways to get Medicare Part D in West Virginia, which depend on how you get your Medicare Part A and Part B benefits.

If you get your Medicare Part A and Part B benefits through Original Medicare, you can sign up for a stand-alone Medicare Part D Prescription Drug Plan. According to the Centers for Medicare and Medicaid Services (CMS), over 197,000 Medicare beneficiaries in West Virginia were enrolled in stand-alone Prescription Drug Plans in 2018.

If you get your Medicare Part A and Part B benefits through Medicare Advantage, you may be able to get Part D coverage through the same Medicare Advantage plan. Medicare Advantage plans cover everything that Original Medicare covers with the exception of hospice care, which is still covered by Part A. Most Medicare Advantage plans include prescription drug coverage.

How much will I pay for Medicare Part D in West Virginia?

Medicare Part D Plans in West Virginia have some flexibility setting premiums, deductibles, copayments, and coinsurance amounts, although plan deductibles cannot exceed the cap set by Medicare each year ($415 in 2019).

Plans may put different medications on different “tiers” in their formularies (lists of covered medications).  Prescription drugs on lower tiers may have lower copayments than prescription drugs on higher tiers. A plan’s formulary may change at any time. You will receive notice from your plan when necessary.

How do I enroll in Medicare Part D in West Virginia?

You can generally sign up for a Medicare Advantage Prescription Drug plan, or a stand-alone Medicare Prescription Drug Plan, during your regular Medicare Initial Enrollment Period (IEP). For most people, the IEP it is the seven-month period that starts 3 months before your 65th birthday, includes your birthday month, and goes for 3 months after that. You can also enroll during the annual Open Enrollment period, which runs from October 15 to December 7 each year.

Learn more about enrollment periods for Medicare Part D.

Enter your zip code on this page to find a plan that may cover the prescription drugs you are currently taking. Do keep in mind you can only enroll in one Medicare Prescription Drug Plan at a time. If you have a Medicare Advantage Prescription Drug plan, and you enroll in a stand-alone Medicare Part D Prescription Drug Plan, you might be unenrolled from your Medicare Advantage plan and returned to Original Medicare.

What else should I know about Medicare Part D in West Virginia?

If you take prescription drugs on a daily basis, it’s a good idea to check the formulary of each plan you are interested in to be sure they are covered. The formulary is the list of covered medications, which may change at any time, but you will receive notice when necessary. You should also pay attention to any special rules your plan may require. For instance, some require prior authorization to fill certain medications. Others may limit the amount of medication you can get at one time.

If you’d like to talk to someone today about Medicare Part D in West Virginia, enter your zip code on this page.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

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