West Virginia Health Insurance 2026

West Virginia has the least competitive ACA marketplace among expansion states, with only 10–20 plans available statewide. Highmark WV and CareSource are the primary carriers. Silver premiums average $600–$645/month for a 40-year-old before subsidies, making West Virginia one of the most expensive states in the nation for individual coverage. The state's aging, high-need population, combined with declining employer-sponsored coverage in the post-coal economy, creates a challenging risk pool. Network adequacy is a serious concern, with many rural counties having limited in-network providers for specialist care. West Virginia uses Healthcare.gov for marketplace enrollment.

West Virginia expanded Medicaid in 2014 and saw one of the largest declines in uninsured rates of any state, given how high its rate had been. Medicaid enrollment in West Virginia covers a very large share of the population — approximately 30% of residents — reflecting the state's high poverty rate. The state has invested in community health worker programs and telehealth to address rural access challenges. West Virginia has no state-based exchange or reinsurance program. The combination of high marketplace premiums and high Medicaid enrollment means federal subsidies are critical for the small group of residents who fall in the ACA marketplace income range.