Medicare Special Needs Plans in West Virginia
Every Special Needs Plan in West Virginia for 2027, from the CMS plan landscape file. You can join one only if you fit its group: Medicare and Medicaid (D-SNP), a qualifying chronic condition (C-SNP) or nursing-home-level care (I-SNP). Pick your county to see the plans sold there.
Showing all 19 plans.
D-SNPs: Medicare and Medicaid
Sorted by CMS star rating, then by how closely the plan is integrated with West Virginia Medicaid, then by worst-case year. If Medicaid or the QMB program pays your Medicare cost sharing, the out-of-pocket maximum matters less than the network and how well the plan works with Medicaid.
| # | Plan | Premium / month | In-network max out-of-pocket | Worst-case year | Stars |
|---|---|---|---|---|---|
| 1 | PeakPlus Rise (PPO D-SNP)Peak Health · PPO D-SNPCoordination-only · $0 Medicare cost sharing10 of 55 counties | $12.80 | $9,850 | $10,004 | 5★ |
| 2 | UHC Dual Advantage WV-V1 (PPO D-SNP)UnitedHealthcare · PPO D-SNPCoordination-onlyAll 55 counties | $12.80 | $5,900 | $6,054 | 4.5★ |
| 3 | UHC Dual Complete WV-Q1 (PPO D-SNP)UnitedHealthcare · PPO D-SNPCoordination-onlyAll 55 counties | $0 | $9,850 | $9,850 | 4.5★ |
| 4 | UHC Dual Complete WV-S2 (PPO D-SNP)UnitedHealthcare · PPO D-SNPCoordination-only · $0 Medicare cost sharingAll 55 counties | $0 | $9,850 | $9,850 | 4.5★ |
| 5 | Humana Dual Select H5619-126 (HMO-POS D-SNP)Humana · HMO-POS D-SNPCoordination-only42 of 55 counties | $0 | $9,850 | $9,850 | 4★ |
| 6 | Humana Gold Plus SNP-DE H5619-162 (HMO-POS D-SNP)Humana · HMO-POS D-SNPCoordination-only · $0 Medicare cost sharing42 of 55 counties | $0 | $9,850 | $9,850 | 4★ |
| 7 | Humana Gold Plus SNP-DE H5619-179 (HMO-POS D-SNP)Humana · HMO-POS D-SNPCoordination-only · $0 Medicare cost sharing42 of 55 counties | $0 | $9,850 | $9,850 | 4★ |
| 8 | HumanaChoice SNP-DE H5216-220 (PPO D-SNP)Humana · PPO D-SNPCoordination-only · $0 Medicare cost sharing43 of 55 counties | $0 | $9,850 | $9,850 | 4★ |
| 9 | The Health Plan SecureCare SNP (HMO D-SNP)The Health Plan · HMO D-SNPCoordination-only · $0 Medicare cost sharingAll 55 counties | $12.80 | $9,250 | $9,404 | 3.5★ |
| 10 | Aetna Medicare Full Dual (HMO D-SNP)Aetna Medicare · HMO D-SNPCoordination-only · $0 Medicare cost sharingAll 55 counties | $0 | $9,850 | $9,850 | 3.5★ |
| 11 | Aetna Medicare Full Dual Extra (HMO D-SNP)Aetna Medicare · HMO D-SNPCoordination-only · $0 Medicare cost sharing19 of 55 counties | $0 | $9,850 | $9,850 | 3.5★ |
| 12 | Aetna Medicare Partial Dual (HMO D-SNP)Aetna Medicare · HMO D-SNPCoordination-only · $0 Medicare cost sharingAll 55 counties | $0 | $9,850 | $9,850 | 3.5★ |
| 13 | Wellpoint Dual Advantage (HMO D-SNP)Wellpoint · HMO D-SNPCoordination-only43 of 55 counties | $0 | $6,440 | $6,440 | Too new to rate |
| 14 | Wellpoint Full Dual Advantage (HMO D-SNP)Wellpoint · HMO D-SNPCoordination-only · $0 Medicare cost sharing43 of 55 counties | $0 | $9,850 | $9,850 | Too new to rate |
| 15 | Highmark Health Options Duals (HMO D-SNP)Highmark Blue Cross Blue Shield · HMO D-SNPCoordination-only · $0 Medicare cost sharing40 of 55 counties | $12.80 | $9,850 | $10,004 | Too new to rate |
C-SNPs: chronic conditions
Sorted by worst-case year: 12 months of premiums plus the in-network out-of-pocket maximum. Each plan lists the conditions it serves; you need one of them, confirmed by your doctor or another clinician, to join.
| # | Plan | Premium / month | In-network max out-of-pocket | Worst-case year | Stars |
|---|---|---|---|---|---|
| 1 | UHC Complete Care WV-7 (HMO-POS C-SNP)UnitedHealthcare · HMO-POS C-SNPCardiovascular disorders, Chronic heart failure, Diabetes17 of 55 counties | $0 | $7,150 | $7,150 | 4★ |
I-SNPs: institutional care
For people who live, or are expected to live, at least 90 days in a nursing home or similar facility, or who need that level of care at home. Sorted by worst-case year.
| # | Plan | Premium / month | In-network max out-of-pocket | Worst-case year | Stars |
|---|---|---|---|---|---|
| 1 | Humana Together in Health (PPO I-SNP)Humana · PPO I-SNPHybrid (at home or in a facility)All 55 counties | $0 | $9,850 | $9,850 | 4.5★ |
| 2 | CommuniCare Advantage ISNP (HMO I-SNP)Communicare Advantage · HMO I-SNPFacility-basedAll 55 counties | $12.80 | $9,850 | $10,004 | Not rated |
| 3 | WV Senior Advantage (HMO I-SNP)West Virginia Senior Advantage · HMO I-SNPFacility-basedAll 55 counties | $12.80 | $9,850 | $10,004 | 3.5★ |
Worst-case year = 12 × monthly plan premium + in-network maximum out-of-pocket, for covered Part A and B services. Many D-SNP members pay $0 in premiums with Extra Help. Star ratings are CMS’s 2027 overall ratings for the contract behind each plan. Plans under CMS sanction aren’t listed. How we sort
Before you enroll: check the plan’s network and drug list in the official Medicare Plan Finder, and ask the plan whether you qualify. Free one-on-one help: your State Health Insurance Assistance Program.
Questions
How many Special Needs Plans are in West Virginia for 2027?
CMS lists 19: 15 D-SNPs (Medicare and Medicaid), 1 C-SNPs (chronic conditions) and 3 I-SNPs (institutional), from 8 parent companies. Not every plan is sold in every county; use the county filter.
Which D-SNPs in West Virginia are integrated with Medicaid?
All 15 D-SNPs in West Virginia are coordination-only plans: they coordinate with Medicaid, but your Medicaid benefits come separately.
Do Special Needs Plans include drug coverage?
Yes. Every Special Needs Plan must include Part D drug coverage.
Can I stay in a Special Needs Plan if I no longer qualify?
Only while you still meet the plan's rules. If you lose eligibility, you may get a Special Enrollment Period to join another plan.
Sources
- CMS, CY 2027 Medicare Advantage and Prescription Drug Plan Landscape (CY2027_Landscape_202609.csv), Special Needs Plan rows — cms.gov; star ratings from the CMS 2027 Star Ratings Data Tables — cms.gov.
- Medicare.gov, “Special Needs Plans” — medicare.gov.
Educational information, not a recommendation to join any plan. We are not an insurance agent or broker, and we are not connected with or endorsed by the U.S. government or the federal Medicare program. Plan details can change; confirm with the plan or Medicare.gov. · Advertiser disclosure
Keep going
- How Special Needs Plans work →
- General Medicare Advantage plans in West Virginia →
- Medicare Savings Programs →
- Extra Help with drug costs →
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