West Virginia health insurance questions, answered.

West Virginia uses the federal Marketplace at HealthCare.gov, not a state-run exchange. Open enrollment for 2027 coverage runs November 1, 2026 to January 15, 2027, and you need to enroll by December 15 for coverage that starts January 1.

Full-price premiums here are among the highest in the country. KFF puts the 2026 benchmark Silver plan at an average of $1,073 a month for a 40-year-old, compared with $625 nationally. Most enrollees get a tax credit that covers a large share of that.

No. The enhanced premium tax credits expired at the end of 2025, and no extension has passed. Help is again generally limited to households between 100% and 400% of the poverty level, and payments went up for many people.

Most early retirees buy a Marketplace plan and use the premium tax credit. Because the 400% of poverty limit is back, keeping your reported income below that line can make a large difference in what you pay each month.

They can. West Virginia's community engagement rules start January 1, 2027 and apply to some members ages 19 to 64, with exemptions. If you might qualify for Medicaid on a low retirement income, check whether an exemption applies to you.

With the enhanced credits expired, households above 400% of the poverty level are not eligible for a premium tax credit and pay full price. In West Virginia, full prices are high, so crossing that line by even a small amount can be costly.

West Virginia has no state cap. Since August 2025, federal agencies have not prioritized enforcing the 2024 four-month limit, so some insurers again sell plans renewable up to 36 months. Each insurer sets its own terms.

Usually not. Short-term plans are not ACA coverage, so they can decline applicants or exclude existing conditions. If you have ongoing health needs, a Marketplace plan is the safer choice.

Generally no. Short-term coverage is not ACA-qualified coverage, so ending a short-term plan does not by itself open a special enrollment period. Plan to switch during open enrollment, November 1 to January 15.

For 2026, Highmark Blue Cross Blue Shield West Virginia and CareSource sold Marketplace plans. For 2027, CareSource is leaving, Highmark returns, and Peak Health, based in Morgantown, is offering Bronze, Silver and Gold plans.

CareSource is leaving West Virginia's individual market at the end of 2026, so you need to pick a new plan during open enrollment, November 1, 2026 to January 15, 2027. Enroll by December 15 to avoid a gap on January 1.

Highmark asked for an average increase of 18.3% for 2027 full-price premiums. If you get a tax credit, your own change depends on the benchmark plan in your county, so compare plans again this fall.