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West Virginia

Coverage to Care WV

A resource to find doctors and preventive health care in West Virginia

Don't wait until you're sick to get a family doctor. Waiting until you're sick can mean expensive emergency services. Costs at the ER can greatly outweigh the cost of good preventative measures.

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Healthcare 101

Welcome to Healthcare 101. This section is designed to give you a place to start asking and answering questions when exploring your health care options. Below are a few of the most frequently asked questions we run across when talking with people about their health care. We’ve also included a few medical insurance definitions you may or may not be familiar with to help guide you along the way.

I have insurance. Now what?
I don't have insurance. Where do I go?
Why should I get preventive health care versus emergency services?
Where can I find a doctor?
How do I prepare for an appointment?
What/who is a provider?
Common questions for your insurance plan
Are you new to Medicaid? You may be enrolled in one of the following health plan organizations.
Glossary: Network
Glossary: Deductible
Glossary: Co-insurance
Glossary: Co-payment
Glossary: Premium
Glossary: Out-of-pocket Premium Maximum
Glossary: Explanation of Benefits (EOB)
Glossary: Insurance Card
Glossary: Deductible

I have insurance. Now what? - back to top

Once you have insurance, you should focus on getting a primary care doctor. Preventive services include health care like screenings, checkups, and patient counseling that are used to prevent illnesses, disease, and other health problems or to detect illness at an early stage when treatment is likely to work best. Getting recommended preventive services and making healthy lifestyle choices are key steps to good health and well-being.
Click here to find a primary care doctor in WV.

I don't have insurance. Where do I go? - back to top

A good first step to finding insurance is to search to see if you qualify for the Affordable Care Act coverage.
Click here to go to the search

Why should I get preventative healthcare versus emergency services? - back to top

Having a provider who knows your health needs and whom you trust and can work with, can help you:

Where can I find a doctor? - back to top

Depending on your coverage and personal circumstances, you might find a primary care provider in:

Click here to find a primary care doctor in WV.

How do I prepare for an appointment? - back to top

When you make your appointment, have your insurance card or other documentation handy and know what you want. Here are some things you should mention when you call and what you might be asked for:

You should also ask:

What/who is a provider? - back to top

A primary care provider is who you’ll see first for most health problems. He or she will also work with you to get your recommended screenings, keep your health records, help you manage chronic conditions, and link you to other types of providers if you need them. If you’re an adult, your primary care provider may be called a family physician or doctor, internist, general practitioner, nurse practitioner, or physician assistant. Your child or teenager’s provider may be called a pediatrician. If you’re elderly, your provider may be called a geriatrician.

In some cases your health plan may assign you to a provider. You can usually change providers if you want to. Contact your health plan for how to do this.

Common questions about your insurance plan - back to top

Insurance plans can differ by the providers you see and how much you have to pay. Medicaid and CHIP programs also vary from state to state. Check with your insurance company or state Medicaid and CHIP program to make sure you understand what services and providers your plan will pay for and how much each visit or medicine will cost. Ask them for a Summary of Benefits and Coverage document that summarizes the key features of the plan or coverage, such as the covered benefits, cost-sharing provisions, and coverage limitations and exceptions.

Are you new to Medicaid? You may be enrolled in one of the following health plan organizations: - back to top

For more information on West Virginia Medicaid health plans visit:

You can also find more information about Medicaid Providers by visiting:

Glossary: Network - back to top

A Network is the facilities, providers, and suppliers your health insurer has contracted with to provide health care services.

Glossary: Deductible - back to top

A Deductible is the amount you owe for health care services your health insurance or plan covers before your health insurance or plan begins to pay.

For example, if your deductible is $1,000, your plan won’t pay anything until you’ve met your $1,000 deductible for covered health care services subject to the deductible. The deductible may not apply to all services.

Glossary: Co-insurance - back to top

Co-insurance is your share of the costs of a covered health care service, calculated as a percent (for example, 20%) of the allowed amount for the service. You pay co-insurance plus any deductibles you owe.

For example, if the health insurance or plan’s allowed amount for an office visit is $100 and you’ve met your deductible, your co-insurance payment of 20% would be $20. The health insurance or plan pays the rest of the allowed amount.

Glossary: Copayment - back to top

A Copayment or copay is an amount you may be required to pay as your share of the cost for a medical service or supply, like a doctor's visit, hospital outpatient visit, or prescription drug. A copayment is usually a set amount, rather than a percentage.

For example, you might pay $10 or $20 for a doctor's visit, lab work, or prescription. Copayments are usually between $0 and $50 depending on your insurance plan and the type of visit or service.

Glossary: Premium - back to top

A Premium is the amount that must be paid for your health insurance or plan. You and/or your employer usually pay it monthly, quarterly, or yearly. It is not included in your deductible, your copayment, or your co-insurance. If you don’t pay your premium, you could lose your coverage.

Glossary: Out-of-pocket Premium Maximum - back to top

Out-of-pocket maximum is the most you pay during a policy period (usually one year) before your health insurance or plan starts to pay 100% for covered essential health benefits. This limit includes deductibles, co-insurance, copayments, or similar charges and any other expenditure required of an individual for a qualified medical expense. This limit does not have to include premiums or spending for non-essential health benefits.

The maximum out-of-pocket cost limit for any individual Marketplace plan for 2014 could be no more than $6,350 for an individual plan and $12,700 for a family plan.

Glossary: Explanation of Benefits (EOB) - back to top

Explanation of Benefits (or EOB) is a summary of health care charges that your health plan sends you after you see a provider or get a service. It is not a bill. It is a record of the health care you or individuals covered on your policy got and how much your provider is charging your health plan. If you have to pay more for your care, your provider will send you a separate bill.

Glossary: Insurance Card - back to top

The following information may be included on your insurance card or another document from your health plan or state Medicaid or CHIP program:

  1. Member name and date of birth. These are usually printed on your card.
  2. Member number. This number is used to identify you so your provider knows how to bill your health plan. If your spouse or children are also on your coverage, your member numbers may look very similar.
  3. Group number. This number is used to track the specific benefits of your plan. It’s also used to identify you so your provider knows how to bill your insurance.
  4. Plan type. Your card might have a label like HMO, PPO, HSA, Open, or another word to describe the type of plan you have. These tell you what type of network your plan has and which providers you can see who are “in-network” for you.
  5. Copayment. These are the amounts that you will owe when you get health care.
  6. Phone numbers. You can call your health plan if you have questions about finding a provider or what your coverage includes. Phone numbers are sometimes listed on the back of your card.
  7. Prescription copayment. These are the amounts that you will owe for each prescription you have filled.

FULL GLOSSARY - back to top

A full glossary of terms is available on glossary website