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About the Health Plan

West Virginia Senior Advantage

West Virginia Senior Advantage (HMO I-SNP) members get more than what is covered by Original Medicare, plus a dedicated advanced practice clinician (either a nurse practitioner or physician assistant) leading a personalized care plan. West Virginia Senior Advantage is an Institutional Special Needs Plan that covers all the benefits of Original Medicare (Parts A and B) with prescription drug coverage (Part D). 

 

Membership advantages include:

  • Coordinated care and more personal attention.
  • Part D prescription drug coverage.
  • Routine vision, hearing, and foot care plus preventive services and screenings.
  • Regular visits from your advanced practice clinician to your residing nursing center to help avoid unnecessary and often unwanted trips to the hospital.
  • Advanced practice clinician can complete tests and treatments in the nursing center that are normally performed in the hospital.
  • One point of contact for communication with you, your family, your doctors, and the nursing facility staff.

Benefit Highlights Coverage Year 2023

How much is the monthly premium?

$41.10 per month. In addition, you must continue to pay your Medicare Part B premium.

How much is the deductible?

West Virginia Senior Advantage (HMO I-SNP) will provide updated rates as soon as they are released.         
$505 deductible per year for Part D prescription drugs.

Is there any limit on how much I will pay for my covered services?

Yes. Like all Medicare health plans, our plan protects you by having yearly limits on your out-of-pocket costs for medical and hospital care.

Your yearly limit(s) in this plan:

  • $8,300 for services you receive from in-network providers.

If you reach the limit on out-of-pocket costs, you keep getting covered hospital and medical services and we will pay the full cost for the rest of the year.

Please note that you will still need to pay your monthly premiums and cost-sharing for your Part D prescription drugs.

Benefit Highlights Coverage Year 2022

How much is the monthly premium?

$40.60 per month. In addition, you must continue to pay your Medicare Part B premium.

How much is the deductible?

$233 per year for in-network services. (This is the 2021 Original Medicare deductible.)  
$480 deductible per year for Part D prescription drugs.

Is there any limit on how much I will pay for my covered services?

Yes. Like all Medicare health plans, our plan protects you by having yearly limits on your out-of-pocket costs for medical and hospital care.

Your yearly limit(s) in this plan:

  • $7,550 for services you receive from in-network providers.

If you reach the limit on out-of-pocket costs, you keep getting covered hospital and medical services and we will pay the full cost for the rest of the year.

Please note that you will still need to pay your monthly premiums and cost-sharing for your Part D prescription drugs.

Is there a limit on how much the plan will pay?

Our plan has a coverage limit every year for certain in-network benefits. Contact us for the services that apply.

Benefits Coverage
Primary Care Physician (PCP) Visits
$0 Copay
Foot Care
$0 Copay for 6 routine podiatry visits per year
Hearing
$0 Copay for routine hearing exam, hearing aid fitting, and evaluation plus up to $1,300 for hearing aids every three years
Vision
$0 Copay for routine eye exam and glaucoma test every year plus up to $220 for eyewear every year
Preventive Care
$0 Copay for annual preventive screenings and routine physicals
Skilled Nursing
No prior hospitalization required for a skilled nursing stay

Full benefits, plan premiums, and cost sharing information for this plan may be found within the Summary of Benefits.

West Virginia Senior Advantage Plan Rating (Part D only). The Star Ratings Program is based off of CMS’ Quality Strategy of optimizing health outcomes by improving quality and transforming the health care system. View our Star Rating.

West Virginia Senior Advantage Goals

West Virginia Senior Advantage was created in 2016 to deliver compassionate care, specially tailored for those Members residing in a nursing center.

Our goal was to create a Medicare Advantage Plan that meets each individual’s clinical needs and provides preventative, coordinated quality healthcare.

West Virginia Senior Advantage values personalized clinical care, standing in partnership with our physicians, nurse practitioners, and other healthcare providers throughout West Virginia.

ABOUT THE HEALTH PLAN

Want more information about West Virginia Senior Advantage?

Call us at 1-844-854-6888 or TTY 711.
Our trained member service representatives are available from 8:00 a.m. to 8:00 p.m., or fill out this contact me form to have us call you.