Key threshold: If your income is below $22,025 (individual) or $45,540 (family of 4), you likely qualify for WV Medicaid with free or very low-cost coverage. No premiums, no deductibles.
West Virginia Medicaid Income Limits 2026
The following table shows the key income thresholds for West Virginia in 2026:
| Household Size | 100% FPL | 138% FPL (Medicaid Limit) | 400% FPL (Subsidy Limit) |
|---|---|---|---|
| 1 | $15,960 | $22,025 | $63,840 |
| 2 | $21,640 | $29,863 | $86,560 |
| 3 | $27,320 | $37,702 | $109,280 |
| 4 | $33,000 | $45,540 | $132,000 |
| 5 | $38,680 | $53,378 | $154,720 |
| 6 | $44,360 | $61,217 | $177,440 |
If your household income falls below the 138% FPL column, you qualify for WV Medicaid. If your income is between 138% and 400% FPL, you qualify for ACA marketplace subsidies to help pay for private insurance.
About WV Medicaid
Who Qualifies for WV Medicaid
If you're a West Virginia resident trying to understand your health coverage options, you've come to the right place. West Virginia Medicaid, known as WV Medicaid, is an expanded program that provides health insurance to many residents. Adults aged 19-64 can qualify with a household income up to 138% of the Federal Poverty Level (FPL). For a single adult in 2025, this means an annual income up to $21,597. For a household of two, the monthly income limit is $2,432, and for a household of three, it's $3,064. Children, pregnant women, seniors, and individuals with disabilities also have specific income pathways to qualify. As of 2024, over 534,800 people, or about 30.2% of West Virginia's population, were enrolled in Medicaid, demonstrating it's a vital and active program in the state.
If You're Near the Income Line
If your income is just above the WV Medicaid limit, you'll likely transition to the federal marketplace, HealthCare.gov, where you can apply for subsidies to help pay for your health insurance. Because West Virginia's benchmark Silver plan is around $752 per month, which is higher than the national average, these subsidies can significantly reduce what you pay. It's important to remember that your eligibility for either program can change with your income. If your income fluctuates, you might shift between Medicaid and marketplace subsidies. West Virginia saw a decline in Medicaid enrollment during the "unwinding" of pandemic-era continuous coverage rules, with about 118,000 residents removed from Medicaid and CHIP since the eligibility review began. If you were among those who lost coverage, you can reapply at any time if your circumstances change.
What WV Medicaid Covers
WV Medicaid provides comprehensive benefits, often with little to no cost-sharing for you. Covered services include doctor visits, immunizations, wellness visits, specialist visits, urgent and emergency care, hospital care, lab and X-ray services, pregnancy services, family planning, chiropractic services, physical and occupational therapy, speech and hearing services, and behavioral healthcare, including mental health and substance use disorder services. Dental benefits for adults aged 21 and over are limited to $2,000 over a two-year period. West Virginia also has several Home and Community-Based Services (HCBS) waivers, like the Aged and Disabled Waiver, the Intellectual/Developmental Disabilities Waiver, and the Traumatic Brain Injury Waiver, which help individuals receive care in their homes and communities rather than in institutions. Telehealth services are also covered, allowing you to access care remotely through interactive audio and video systems.
Tips for Applying
When applying for WV Medicaid, be prepared to provide documentation such as proof of identity, Social Security numbers, income, and assets. While the state aims to process applications within 45 days, or 90 days if you have a disability, it can take longer if additional information is needed. During the recent unwinding period, many individuals lost coverage due to procedural errors, highlighting the importance of responding promptly to any requests for information. If you have questions about your application or need assistance, you can contact your local Department of Human Services (DoHS) office or Client Services. A concrete action step you can take is to visit the WV PATH website to start your application or check your eligibility.
Marketplace Insurance in West Virginia
West Virginia residents who do not qualify for Medicaid can purchase private health insurance through the federal marketplace at HealthCare.gov. The average benchmark (second-lowest cost Silver) plan in West Virginia costs approximately $752/month for a 40-year-old in 2026.
Premium tax credits (subsidies) are available for households with income between 100% and 400% FPL. Here is what a 40-year-old individual in West Virginia might pay for a Silver plan after subsidies, based on the $752/month benchmark:
| Income Level | Annual Income | Your Cost | Monthly Subsidy |
|---|---|---|---|
| 150% FPL | $23,940 | ~$80/mo | $672/mo |
| 200% FPL | $31,920 | ~$173/mo | $579/mo |
| 250% FPL | $39,900 | ~$277/mo | $475/mo |
| 300% FPL | $47,880 | ~$392/mo | $360/mo |
| 400% FPL | $63,840 | ~$523/mo | $229/mo |
These estimates are for a 40-year-old individual on a benchmark Silver plan in West Virginia. Actual premiums depend on your age, household size, tobacco use, and plan choice. Households with income between 100-250% FPL also qualify for cost-sharing reductions (CSR) on Silver plans, which lower deductibles and copays. West Virginia uses the federal marketplace at HealthCare.gov.
How to Apply for WV Medicaid
Medicaid enrollment is open year-round — there's no deadline. You can apply through any of these channels:
- Online: Apply through HealthCare.gov — the system automatically checks your WV Medicaid eligibility when you enter your income. Or apply directly through WV Medicaid.
- Phone: Call West Virginia's Medicaid helpline for guided help with your application.
- In person: Visit your local human services office or a certified application counselor.
You'll need proof of income (pay stubs or tax returns), proof of West Virginia residency, and Social Security numbers for household members.
Calculate Your Subsidy in West Virginia
Enter your income, age, and household size to see if you qualify for Medicaid or marketplace subsidies in West Virginia.
Frequently Asked Questions
What is the West Virginia Medicaid income cutoff for 2026?
In 2026, the Medicaid income limit in West Virginia is 138% of the federal poverty level: $22,025 per year for an individual, $29,863 for a household of 2, $37,702 for 3, and $45,540 for a family of 4.
Has West Virginia expanded Medicaid under the ACA?
Yes, West Virginia has expanded Medicaid under the ACA. Adults aged 19-64 earning up to 138% of the federal poverty level qualify for WV Medicaid.
How do I get help paying for health insurance in West Virginia?
West Virginia residents with household income between 100% and 400% FPL ($15,960 to $63,840 for an individual in 2026) qualify for premium tax credits that reduce the cost of marketplace health insurance. Apply through HealthCare.gov.
What is the name of West Virginia's Medicaid program?
West Virginia's Medicaid program is known as WV Medicaid. It provides health coverage for eligible low-income residents including children, pregnant women, seniors, and adults up to 138% FPL.
How do I keep my health insurance if I lose Medicaid in West Virginia?
If your WV Medicaid coverage ends due to income changes or redetermination, you qualify for a Special Enrollment Period on the marketplace. This gives you 60 days to sign up for a private plan through HealthCare.gov. If your income is between 100-400% FPL, you'll likely qualify for subsidies to help cover the cost.
Am I eligible for WV Medicaid if I'm employed?
Yes. Medicaid eligibility in West Virginia is based on your Modified Adjusted Gross Income (MAGI), not your employment status. If your household income is at or below 138% FPL ($22,025 for an individual), you qualify for WV Medicaid even if you work full-time. Many WV Medicaid enrollees are working adults.
Should I choose Medicaid or a marketplace plan in West Virginia?
Medicaid (WV Medicaid) is free or very low-cost with no premiums or deductibles. Marketplace plans in West Virginia average $752/month before subsidies — among the highest in the country. If you qualify for Medicaid, it will almost always be the better financial choice. If your income is just above the Medicaid limit, subsidies can still make marketplace coverage affordable.