Your Insurance Detective › West Virginia, private health insurance
What Are My Private Health Insurance Options in West Virginia, and What Do They Cost?
Written and reviewed by Dick Tracy, licensed health insurance broker (NPN 20414610) · Published October 6, 2026
Private health insurance in West Virginia is any coverage you buy yourself instead of getting it from a job or a government program. On healthcare.gov, the marketplace the state uses, the 2026 average list price for a 40-year-old ran from $775 a month (lowest-cost Bronze) to $1,073 (benchmark Silver), before any subsidy, among the highest marketplace averages in the country, and the two companies filing for 2027 proposed average increases of 13.59% and 18.33%, still pending review. You have several kinds to choose from: a marketplace plan, the same kind of plan bought direct, a private plan priced on your own health, a fixed-benefit plan, and for people with business income, a pre-established ERISA group plan. I'm Dick Tracy, a licensed health insurance broker, licensed in West Virginia and based in Buffalo, NY. I educate, you decide.
My license number is NPN 20414610, I hold licenses in 25 states, and I work with 80+ carriers. My office is in Buffalo, New York, so I work with West Virginians by phone or Zoom with the plan documents on the screen. This page is for anyone in West Virginia without job coverage: you are between jobs, you retired before 65, you work for yourself, or you earn too much for a subsidy and the marketplace price made you blink. In this state, it makes a lot of people blink.
per month before any subsidy
pending review
one of them new (a third leaves after 2026)
Sources: KFF, 2026 marketplace premiums; federal rate review site (ratereview.healthcare.gov), search for West Virginia, Individual market, plan year 2027; healthinsurance.org, West Virginia marketplace guide (all checked October 6, 2026).
What "private health insurance" actually means
People type "private health insurance" when they mean "insurance I buy on my own." That is the right instinct. Health coverage in this country comes from three places: a government program (Medicare, Medicaid, WVCHIP), a job, or the private market where you buy it yourself. If it is not from the government and not from an employer, it is private.
One thing surprises people. A plan on healthcare.gov is private health insurance too. The government runs the store, but the plans on the shelf come from private insurance companies. So the real question is not "marketplace or private." It is "which kind of private coverage fits my health, my income, and my doctors." In West Virginia that question matters a lot, because the marketplace list is two companies for 2027 and the prices on it are among the highest in the country.
The kinds of private coverage a West Virginia resident can buy
| Kind of coverage | What sets the price | Tax credit possible? | Who it tends to fit |
|---|---|---|---|
| Marketplace plan on healthcare.gov | Age, county, tobacco use, plan level | Yes, if your income qualifies | Anyone who qualifies for a credit, and anyone with a health condition |
| The same kind of plan bought direct from the company | Age, county, tobacco use, plan level | No | Someone who wants that company's plan and gets no credit either way |
| Private plan priced on your own health | Your own health, plus age and location | No | Healthy people with no credit coming who want a broad PPO network |
| Fixed-benefit plan | Mostly the benefit amounts you choose | No | Healthy people who want a low premium and are comfortable shopping for care |
| Pre-established ERISA group plan | Group rates | No | People with self-employment or business income, especially with a family on the policy |
| COBRA (keeping your old job plan) | The full group premium, which you now pay yourself | No | Someone mid-treatment who needs the exact same plan for a while |
Marketplace plans, and the same plans bought direct, take everyone with no health questions. Other private plans can be priced on your own health, which means health questions, and not everyone qualifies. I sort out which is which for you on the call.
COBRA is a continuation of a job plan, not a new private plan. It is in the table because it is usually the first price a person between jobs sees.
A marketplace plan on healthcare.gov
West Virginia uses the federal marketplace at healthcare.gov instead of running its own. Every plan on it takes everyone, and charges the same price for the same plan, age, county and tobacco status. No health questions. It is also the only place a premium tax credit applies. The trade-offs are real: the price is built on everyone in the pool, not on you, the company lineup is two companies for 2027, and the credit is tied to an income estimate you have to get right. Guess low and you may owe some of it back at tax time.
Fits: anyone whose income qualifies for a credit, and anyone whose health would not pass health questions.
The same kind of plan, bought direct from the insurance company
The companies that sell on the marketplace can also sell plans directly. The rules are the same: no health questions, same rating factors. The difference is that no tax credit applies. For most people there is little reason to pay full price this way without first pricing the other kinds.
Fits: a narrow group. I mention it so you know it exists.
A private plan priced on your own health
This is the kind most people have never been shown. Outside the marketplace, and outside the Affordable Care Act rules, an insurance company can price a plan on your own health instead of the average of everyone in the pool. These plans usually run on large national PPO networks, so you are not tied to one hospital system, which matters when the right specialist is in Pittsburgh, Columbus, or Winchester instead of in state. They are not marketplace plans. They ask health questions and not everyone qualifies, so I walk you through the plan documents before anyone signs.
Fits: healthy people with no credit coming who want to pick their own doctors. Does not fit: anyone with a health condition that keeps them from qualifying. That is arithmetic, not a judgment, and it is one reason the marketplace takes everyone.
A fixed-benefit plan
A fixed-benefit plan pays a set dollar amount per service: this much for an office visit, this much per hospital day, this much for a surgery. It does not pay a percentage of the bill. In my experience the premiums usually run below a major medical plan. I explain these honestly because they get oversold: they are a foundation, not a roof. Pair one with catastrophic protection, or use it as the everyday layer on top of something bigger. Which specific products are approved for West Virginia residents changes, so I confirm what is on the table for you on the call.
Fits: healthy people who want a low premium and are comfortable shopping for care. Does not fit: anyone expecting a big surgery or a chronic-condition year who wants one plan to carry the whole load.
A pre-established ERISA group plan
There are group plans that already exist, and a person with self-employment or business income can be merged into one. If you qualify, you get group rates and a PPO network without needing employees or a payroll of your own. I confirm eligibility on the call. In West Virginia this is one option among several, not the automatic answer. If you are retired or between jobs with no business income, it is likely off the table, and I will tell you that on the call. The West Virginia self-employed page covers this route in detail.
Fits: owners and 1099 earners who want a group-style PPO, especially with a spouse or children on the policy.
A word on supplemental plans. Accident and critical illness plans pay set dollar amounts when something happens. They are useful add-ons on top of a medical plan, not a replacement for one.
How much does private health insurance cost in West Virginia?
Here are the published averages, so you have an honest anchor. These are 2026 marketplace prices for a 40-year-old buying on their own, before any subsidy:
| 2026 marketplace average (age 40, before any subsidy) | West Virginia | US average |
|---|---|---|
| Lowest-cost Bronze plan | $775/month | $456/month |
| Benchmark Silver plan | $1,073/month | $625/month |
| Lowest-cost Gold plan | $961/month | $615/month |
Source: KFF analysis of marketplace data, 2026 plan year.
I can only publish marketplace prices here. The other kinds are priced on the person or the group, so there is no honest average to print. That number comes from a quote, and a quote takes one call.
Those West Virginia numbers are among the highest marketplace averages in the country, hundreds of dollars a month over the US average at every tier. The final 2026 increases on the federal rate review site were 13.40% for Highmark Blue Cross Blue Shield West Virginia, 7.58% for CareSource West Virginia, and 7.88% for The Health Plan of West Virginia, and healthinsurance.org puts the average 2026 increase for the marketplace at 12.2%. It also counts 55,879 people who picked a marketplace plan for 2026 during open enrollment.
What the companies have proposed for 2027
| Company (name on the filing) | Proposed 2027 average change | Filing status on October 6, 2026 | On the marketplace for 2027? |
|---|---|---|---|
| Highmark Blue Cross Blue Shield West Virginia | +18.33% | Pending review | Yes |
| The Health Plan of West Virginia, Inc. | +13.59% | Pending review | Not listed on October 6, 2026 |
| Peak Health | New company, no prior rate to change | No rate review filing shown | Yes, new for 2027 |
| CareSource West Virginia Co. | No 2027 filing shown | Leaving at the end of 2026 | No |
Sources: federal rate review site (ratereview.healthcare.gov), search for West Virginia, Individual market, plan years 2026 and 2027, and healthinsurance.org, West Virginia marketplace guide (updated September 30, 2026), both checked October 6, 2026. These are proposed averages, not approved rates. ACA Signups puts the weighted average request at 17.3% across the individual market, with Highmark's filing ranging from 15.1% to 21.8% across its plans, based on the preliminary filings. Final 2027 rates had not been approved when I checked. I will update this table when they are.
Now the part averages hide. Those are marketplace prices, and by law the marketplace cannot ask about your health. A healthy 40-year-old and a 40-year-old on three prescriptions pay the same rate. Your own number moves with your age, your county, tobacco use, the network you pick, and the kind of plan. That last one is the lever, and in a state with numbers like these it matters a lot. A plan priced on your own health is where the averages stop applying. Anyone who quotes your premium without asking about you first is guessing.
And if a subsidy is in play: for 2026 coverage, the premium tax credit ends at 400% of the poverty level, which is $62,600 for one person and $128,600 for a household of four. For 2027 coverage the line is 400% of the 2026 poverty guideline: $63,840 for one person and $132,000 for a household of four, unless Congress changes the rule. One dollar over and the whole credit is gone. In a state where the benchmark plan costs $1,073 a month, that cliff is a long drop. Every line by household size is on the West Virginia self-employed page.
Which companies sell individual health insurance in West Virginia?
For 2026, two companies sell individual plans on the West Virginia marketplace, here in alphabetical order: CareSource West Virginia and Highmark Blue Cross Blue Shield West Virginia. For 2027 the shelf changes. Per healthinsurance.org, checked October 6, 2026, CareSource leaves West Virginia's individual market at the end of 2026, and a new company, Peak Health, joins Highmark on the marketplace. If you are on a CareSource plan now, you will be picking a new plan for January, so do not wait for a letter to start.
A third company, The Health Plan of West Virginia, has a 2027 individual market rate filing on the federal site (13.59% proposed, pending review) but was not on the marketplace list when I checked, so I confirm what it sells, and where, on the call. Lists like this can change before open enrollment starts, so I confirm what is actually sold in your county on the call.
That is the marketplace list. Outside it, other companies sell private plans on national PPO networks to West Virginia residents who qualify. I do not rank companies on this page, because the right one depends on your county, your doctors, and your health. On a call I put both lists side by side for your zip code.
Sources: healthinsurance.org, West Virginia marketplace guide (2026 and 2027 companies, the CareSource exit, Peak Health); federal rate review site (ratereview.healthcare.gov), search for West Virginia, Individual market, plan years 2026 and 2027. All checked October 6, 2026.
Which route fits you?
Between jobs, and the COBRA price made you sit down
Price everything against COBRA before you sign it. COBRA keeps your exact plan, but you pay the full cost because your former employer stops contributing. Losing job coverage is also a life event that lets you buy a marketplace plan outside open enrollment. If you are in the middle of treatment, keeping the same plan may be worth the price. Here are the alternatives to COBRA, side by side.
Retired before 65, waiting on Medicare
Health first, then income. If you are healthy, a private PPO priced on your own health may carry you to 65, and I check the renewal terms with you first. If you are not, the marketplace takes you with no questions. Retirement income is often easier to plan than a paycheck, which matters if a tax credit is on the table.
Self-employed or 1099
You have the most routes of anyone on this page. On top of the others, a pre-established ERISA group plan is open to people with business income. It is one option among several in West Virginia, so I price them side by side. Your premiums may be deductible on your federal return through the self-employed health insurance deduction if you show a net profit and were not eligible for a subsidized plan through any employer, yours or a spouse's. The IRS spells out the conditions in the Form 7206 instructions, and your tax preparer makes the call. The West Virginia self-employed page walks through it. In Charleston? Here is the Charleston version.
Healthy, and you earn too much for a tax credit
Start with a plan priced on your own health. With no credit, a marketplace plan is full price, built on the whole pool, and in West Virginia that is one of the highest full prices in the country. A plan priced on your own health can come in lower, and the network is often broader. I price both and show you the two numbers side by side. Private vs. marketplace, compared.
Your doctors are in Pittsburgh, Columbus, or Northern Virginia
Check the network map twice. A marketplace plan built around a West Virginia network may not cover an out-of-state hospital. A plan on a national PPO network usually does. Give me the names of your doctors and the hospital you would want to be taken to, and I check every plan against them before anything is signed.
A serious diagnosis in the last five years
A guaranteed-issue Affordable Care Act plan, for now. It cannot turn you down or charge you more for your health. Stay on a plan like that, get the care you need, and we look at the other routes down the road.
Income on the lower side
Check the subsidy math first. If your income is low enough, a subsidized marketplace plan or West Virginia Medicaid may be the best deal you can get, and I will tell you so.
Sources for the COBRA and life event rules: healthcare.gov, COBRA coverage.
How to buy private health insurance in West Virginia
Bring five facts: your age, your county, tobacco use, a rough household income for the year, and how you use care. That means your doctors, your prescriptions, and anything planned. With those I can tell you which kinds of coverage you qualify for and price them from the companies I work with, usually the same day.
Timing is the other piece. Marketplace plans are sold during open enrollment, which healthcare.gov runs from November 1, 2026 through January 15, 2027 for 2027 coverage, with December 15 the last day to pick a plan that starts January 1, or after a life event such as losing coverage. If you are reading this outside that window with no coverage, do not assume you are stuck until November. Call me and I will tell you what you can apply for today.
Using a broker does not add to your premium. The price of a plan is the same whether you buy it through me or on your own. What you get is someone who reads the plan documents with you before you sign and who picks up the phone after.
Source for enrollment dates: healthcare.gov, dates and deadlines.
Common questions about private health insurance in West Virginia
What are my private health insurance options in West Virginia?
Private health insurance is any coverage that is not a government program and not a plan from your job. In West Virginia that means five main kinds: a plan on healthcare.gov, the federal marketplace the state uses, which asks no health questions and is the only place a premium tax credit applies; the same kind of plan bought directly from the insurance company with no credit; a private plan priced on your own health, usually on a national PPO network; a fixed-benefit plan that pays set dollar amounts per service; and, if you have self-employment or business income, a pre-established ERISA group plan. Supplemental plans such as accident or critical illness coverage are add-ons to one of those, not a substitute for one.
How much is private health insurance in West Virginia?
For a 40-year-old in 2026, West Virginia marketplace averages before any subsidy were $775 a month for the lowest-cost Bronze plan, $1,073 for the benchmark Silver plan, and $961 for the lowest-cost Gold plan, per KFF. Every one of those is hundreds of dollars a month above the US average. For 2027, the two companies that filed individual market rates proposed average increases of 18.33% and 13.59%, both still pending review on October 6, 2026. Those are marketplace prices, which cannot ask about your health. Outside the marketplace, a private plan can be priced on your own health, so a healthy person who gets no subsidy may pay less than those averages. The only way to know is to price it. Your real number depends on your age, county, tobacco use, network, and the kind of plan.
What is the best private health insurance in West Virginia?
There is no single best plan. There is a best fit. If you are healthy and your income is too high for a premium tax credit, a private plan priced on your own health, with a national PPO network, is usually where the value is, because a plan that is not a marketplace-style plan can be priced on your health and the marketplace averages here are among the highest in the country. If your income qualifies you for a premium tax credit, the credit changes the math and has to be priced first. If you have had a serious diagnosis in the last five years, a guaranteed-issue Affordable Care Act plan is the right fit for now, because it cannot turn you down or charge you more for your health.
Which companies sell private health insurance in West Virginia?
For 2026, two companies sell individual plans on the West Virginia marketplace: CareSource West Virginia and Highmark Blue Cross Blue Shield West Virginia. For 2027, per healthinsurance.org on October 6, 2026, CareSource leaves the state's individual market at the end of 2026 and a new company, Peak Health, joins Highmark on the marketplace. A third company, The Health Plan of West Virginia, has a 2027 individual market rate filing on the federal rate review site but was not on the marketplace list when I checked. I confirm what it sells, and where, on the call. Beyond those, other companies sell private plans on national PPO networks to West Virginians who qualify. I work with 80+ carriers and put both lists side by side for your county.
How do I buy private health insurance in West Virginia?
Start with five facts: your age, your county, tobacco use, a rough household income for the year, and how you use care, meaning doctors, prescriptions, and anything planned. Those five facts decide which kinds of coverage you qualify for and what they cost. Timing matters too. Marketplace plans are sold during open enrollment, which healthcare.gov runs from November 1, 2026 through January 15, 2027 for 2027 coverage, with December 15 the last day for coverage that starts January 1, or after a qualifying life event such as losing coverage. A broker does not add to your premium and can price every route in one conversation. The next step is a call, a text, or my short details form.
Are private health insurance prices going up in West Virginia in 2027?
The proposals say yes for marketplace plans and the same plans bought direct. The other kinds on this page are priced on the person or the group and are not in these filings. For 2027, Highmark Blue Cross Blue Shield West Virginia proposed an average increase of 18.33% and The Health Plan of West Virginia proposed 13.59%, according to the federal rate review site. Both were listed as pending review on October 6, 2026, so they are proposed, not approved. ACA Signups puts the weighted average request at 17.3%. That would come on top of 2026, when the final increases on the same site were 13.40% for Highmark, 7.58% for CareSource, and 7.88% for The Health Plan, and the benchmark Silver premium for a 40-year-old reached $1,073 a month.
Can I be turned down for private health insurance in West Virginia?
It depends on the kind. A marketplace plan, and the same kind of plan bought directly from the company, cannot turn you down or charge more because of your health. A private plan priced on your own health asks health questions, and not everyone qualifies. That is why a healthy person may pay less on one, and why someone with a serious diagnosis in the last five years belongs on a plan that cannot turn them down for now.
Is a healthcare.gov plan private health insurance?
Yes. West Virginia uses the federal marketplace at healthcare.gov instead of running its own, but the plans sold on it come from private insurance companies. The government runs the store and funds the premium tax credit. The insurance itself is private. West Virginia Medicaid and WVCHIP, which people can also apply for through healthcare.gov, are government programs and are not private insurance.
Thirty minutes on the phone or Zoom, no fee, no hard sell. Bring your age, county, tobacco status, a rough income number, and how you use care. I price the routes that fit you and put them side by side. I educate, you decide.
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