Medicaid in West Virginia
West Virginia expanded Medicaid in 2014, covering adults aged 19 to 64 with household incomes up to 138% FPL (about $22,025 for a single person for 2027 coverage). Over 175,000 West Virginians enrolled through expansion, a substantial number for a state of about 1.8 million people. The expansion was especially impactful in coal-country counties with high poverty rates and limited employer-sponsored coverage.
West Virginia's overall Medicaid enrollment (including traditional categories and expansion) covers roughly 30% of the state's population, one of the highest Medicaid dependency rates in the nation. The state's older, sicker population drives higher healthcare utilization.
West Virginia's uninsured rate is approximately 5.8%, with about 105,000 residents lacking coverage. This is a significant improvement from the pre-ACA era when the rate was above 14%.
What plans cost in 2027
West Virginia marketplace premiums are among the highest in the country, reflecting the state's older population and high disease burden. KFF puts the state's average benchmark Silver premium for a 40-year-old at $1,185 a month for 2027, up from $1,073 in 2026 (about 10% higher). That is the price before any tax credit.
Despite high sticker prices, most West Virginia marketplace enrollees pay much less thanks to subsidies. Over 90% of enrollees received premium tax credits in 2025. West Virginia had roughly 40,000 marketplace enrollees in 2025. The enhanced subsidies expired after 2025 and were not extended, so for 2027 there is no premium tax credit above 400% FPL (about $86,560 for a household of two). Given West Virginia's low median income, most marketplace enrollees will still qualify for subsidies, but the amounts are smaller than during 2021-2025.
Open Enrollment for 2027 coverage runs from November 1, 2026, through January 15, 2027, on HealthCare.gov. Enroll by December 15 for coverage that starts January 1.
Carriers in West Virginia (2027)
Two insurers offer individual marketplace plans in West Virginia for 2027. CareSource left the West Virginia marketplace, and Peak Health joined:
- Highmark Blue Cross Blue Shield West Virginia is the dominant carrier, offering plans statewide. Highmark has the broadest provider network in the state, including virtually all major hospitals and most physicians. For many West Virginia counties, Highmark is the only marketplace option available.
- Peak Healthis new to the marketplace for 2027. It is owned by health systems including WVU Medicine and offers a small number of plans in 45 of the state's 55 counties, including Kanawha, Cabell, Monongalia, and Berkeley.
Carrier competition is limited. Ten counties, including McDowell, have only Highmark as an option. If you had a CareSource plan in 2026, you need to choose a new plan for 2027.
Key regions
Charleston metro
Kanawha County (Charleston) is the state capital and largest metro area. CAMC (Charleston Area Medical Center) and Thomas Health System are the major hospitals. Both Highmark and Peak Health sell 2027 plans here. Charleston has the best healthcare infrastructure in the state and relatively more competitive premiums.
Huntington-Ashland area
Cabell County (Huntington) is home to Marshall University's Joan C. Edwards School of Medicine and Cabell Huntington Hospital. The Huntington area has been heavily impacted by the opioid crisis, which has driven up healthcare costs and insurance premiums. Both Highmark and Peak Health sell 2027 plans in Cabell County.
Eastern Panhandle (Martinsburg, Charles Town)
Berkeley and Jefferson counties in the Eastern Panhandle are the fastest growing part of West Virginia, with many residents commuting to the Washington, D.C. metro area. WVU Medicine East is the major local provider. Highmark and Peak Health both sell 2027 plans in Berkeley County. Residents should check whether plans cover providers in Maryland and Virginia if they receive care across state lines.
Southern coalfields
McDowell, Mingo, Wyoming, and surrounding counties face the most severe healthcare access challenges. Hospital closures, physician shortages, and the opioid epidemic have created a healthcare crisis. Many residents rely on Medicaid or community health centers. For 2027, Highmark is the only marketplace insurer in ten southern counties: Boone, Lincoln, Logan, McDowell, Mercer, Mingo, Monroe, Raleigh, Summers, and Wyoming.
Estimate your subsidy
Subsidy Estimator
Enter your info below to get a rough estimate of your monthly premium tax credit for a 2027 marketplace plan.
West Virginia-specific things to know
High premiums, but subsidies help most people.West Virginia's sticker-price premiums are among the nation's highest, but the subsidy formula actually works in enrollees' favor: higher benchmark premiums mean larger subsidy amounts for those who qualify. If your income is under 400% FPL, you may pay less out-of-pocket than you expect.
Medicaid covers a large share of the population.With about 30% of West Virginians on Medicaid, the program is a critical part of the state's healthcare system. If your income is under 138% FPL, check Medicaid eligibility first. Medicaid has no premiums and comprehensive benefits.
Navigator help is important here. West Virginia has certified navigators and community health centers that provide free enrollment assistance. Given the complexity of subsidy calculations and the high baseline premiums, getting help with your application can make a significant financial difference. West Virginia Healthy Kids and Families and local community action agencies are good starting points.
Resources
- HealthCare.gov for marketplace enrollment (West Virginia uses the federal marketplace)
- WV Bureau for Medical Services for Medicaid eligibility and enrollment
- WV Health Connection for enrollment assistance and navigator services