Medicare & Medicaid in West Virginia (WV)
2026 healthcare costs, coverage, and spending data for West Virginia.
$11,172
Spending/Capita
2,255,467
Medicare Enrollees
3,040,623
Medicaid Enrollees
4.8%
Uninsured Rate
Medicare Premiums in West Virginia
Part B Premium
$353/mo
Part D Premium (Avg)
$56/mo
Medigap Premium (Avg)
$348/mo
Medicaid Expansion: Yes - West Virginia expanded Medicaid under the ACA
Procedure Costs in West Virginia
Hospital
| Procedure | Avg Cost | Medicare Pays | You Pay |
|---|---|---|---|
| Kidney Transplant | $156,367 | $125,093 | $31,273 |
| Liver Transplant | $132,829 | $106,264 | $26,566 |
| Heart Valve Replacement | $80,408 | $64,326 | $16,082 |
| Coronary Artery Bypass Graft (CABG) | $69,089 | $55,271 | $13,818 |
| Spinal Fusion | $49,046 | $39,237 | $9,809 |
| Defibrillator Implantation (ICD) | $44,408 | $35,526 | $8,882 |
| Total Knee Replacement | $39,592 | $31,674 | $7,918 |
| Total Hip Replacement | $36,203 | $28,962 | $7,241 |
| Sepsis Treatment | $29,909 | $23,927 | $5,982 |
| Hip Fracture Repair | $29,808 | $23,847 | $5,962 |
| Colectomy | $28,873 | $23,099 | $5,775 |
| Laminectomy | $25,808 | $20,647 | $5,162 |
| Mastectomy | $24,879 | $19,904 | $4,976 |
| Pacemaker Implantation | $23,254 | $18,603 | $4,651 |
| Carotid Endarterectomy | $22,947 | $18,358 | $4,589 |
Outpatient
| Procedure | Avg Cost | Medicare Pays | You Pay |
|---|---|---|---|
| Arthroscopic Knee Surgery | $9,688 | $7,750 | $1,938 |
| Bunionectomy | $7,113 | $5,690 | $1,423 |
| Lithotripsy (Kidney Stones) | $6,963 | $5,570 | $1,393 |
| Dialysis Access Surgery | $6,349 | $5,079 | $1,270 |
| TURP (Prostate) | $6,132 | $4,906 | $1,226 |
| Endoscopic Sinus Surgery | $5,951 | $4,761 | $1,190 |
| Septoplasty | $5,691 | $4,553 | $1,138 |
| Nasal Polyp Removal | $5,602 | $4,481 | $1,120 |
| Tonsillectomy | $4,896 | $3,917 | $979 |
| Hemorrhoid Surgery | $4,716 | $3,773 | $943 |
| Pilonidal Cyst Surgery | $4,432 | $3,546 | $886 |
| Cataract Surgery (Outpatient) | $3,850 | $3,080 | $770 |
| Adenoidectomy | $3,713 | $2,971 | $743 |
| Trigger Finger Release | $3,666 | $2,933 | $733 |
| Carpal Tunnel Release | $3,250 | $2,600 | $650 |
Imaging
| Procedure | Avg Cost | Medicare Pays | You Pay |
|---|---|---|---|
| PET Scan | $2,804 | $2,243 | $561 |
| Nuclear Stress Test | $2,298 | $1,838 | $460 |
| CT Angiography | $1,549 | $1,239 | $310 |
| MRI Spine (Lumbar) | $1,495 | $1,196 | $299 |
| MRI Spine (Cervical) | $1,362 | $1,089 | $272 |
| MRI Hip | $1,357 | $1,086 | $271 |
| MRI Shoulder | $1,339 | $1,071 | $268 |
| CT Scan Abdomen/Pelvis | $1,280 | $1,024 | $256 |
| MRI Brain | $1,152 | $921 | $230 |
| MRI Knee | $1,135 | $908 | $227 |
| Bone Scan | $1,114 | $891 | $223 |
| CT Colonography (Virtual) | $982 | $786 | $196 |
| CT Scan Chest | $843 | $674 | $169 |
| CT Scan Head | $770 | $616 | $154 |
| Fluoroscopy | $644 | $516 | $129 |
Physician/Office
| Procedure | Avg Cost | Medicare Pays | You Pay |
|---|---|---|---|
| Sleep Study Consultation | $398 | $319 | $80 |
| Mammogram (Screening) | $288 | $288 | $0 |
| Psychiatry Visit | $286 | $229 | $57 |
| Allergy Testing | $257 | $205 | $51 |
| Annual Wellness Visit | $252 | $252 | $0 |
| Mental Health Counseling | $244 | $195 | $49 |
| Wound Care Visit | $218 | $174 | $44 |
| Bone Density Test (DEXA Scan) | $211 | $169 | $42 |
| Shingles Vaccination | $196 | $196 | $0 |
| Occupational Therapy Session | $181 | $145 | $36 |
| Office Visit (New Patient) | $175 | $140 | $35 |
| Skin Cancer Screening | $168 | $135 | $34 |
| Office Visit (Established Patient) | $138 | $110 | $28 |
| Podiatry Visit | $136 | $109 | $27 |
| Speech Therapy Session | $136 | $109 | $27 |
Laboratory
| Procedure | Avg Cost | Medicare Pays | You Pay |
|---|---|---|---|
| Vitamin D Level | $56 | $45 | $11 |
| Blood Culture | $49 | $39 | $10 |
| PSA (Prostate-Specific Antigen) | $49 | $39 | $10 |
| Blood Type and Crossmatch | $47 | $38 | $9 |
| Thyroid Panel (TSH) | $45 | $36 | $9 |
| Glucose Tolerance Test | $44 | $35 | $9 |
| Iron Studies (Ferritin) | $43 | $35 | $9 |
| Liver Function Panel | $43 | $34 | $9 |
| Troponin Level | $42 | $33 | $8 |
| Lipid Panel | $41 | $33 | $8 |
| Comprehensive Metabolic Panel | $41 | $33 | $8 |
| BNP (Heart Failure Marker) | $39 | $31 | $8 |
| Urine Drug Screen | $36 | $29 | $7 |
| Complete Blood Count (CBC) | $34 | $27 | $7 |
| Hemoglobin A1C | $32 | $25 | $6 |
Compare West Virginia With Other States
Frequently Asked Questions
How much does Medicare spend per person in West Virginia?
In 2026, the average Medicare spending per beneficiary in West Virginia is $11,172.
How many people are enrolled in Medicare in West Virginia?
West Virginia has approximately 2,255,467 Medicare beneficiaries.
Did West Virginia expand Medicaid?
Yes, West Virginia expanded Medicaid under the Affordable Care Act.
What is the uninsured rate in West Virginia?
The uninsured rate in West Virginia is 4.8%.
What is the average Medigap premium in West Virginia?
The average Medigap (Medicare Supplement) premium in West Virginia is $348 per month.