Coverage to Care WV
A resource to find doctors and preventive health care in West Virginia
A resource to find doctors and preventive health care in West Virginia
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.
A good first step to finding insurance is to search healthcare.gov to see if you qualify
for the Affordable Care Act coverage.
Click here to go to the healthcare.gov search
Having a provider who knows your health needs and whom you trust and can work with, can help you:
Depending on your coverage and personal circumstances, you might find a primary care provider in:
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:
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.
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.
For more information on West Virginia Medicaid health plans visit: https://mountainhealthtrust.com/
You can also find more information about Medicaid Providers by visiting: https://www.wvmmis.com/MHPViewer.aspx?FID=PDIR
A Network is the facilities, providers, and suppliers your
health insurer has contracted with to provide health care
services.
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.
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.
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.
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.
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.
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.
The following information may be included on your insurance card or another document from your health plan or state Medicaid or CHIP program: