Medicare in Kentucky

Medicare is a government-backed insurance program that provided medical coverage to over 952,000 residents of Kentucky in 2021, which represents 21% of the state’s population. That number grew from only 18% in 2007. Medicare is offered to retirees over the age of 65, and to all adults with qualifying disabilities. Of those enrolled in Medicare in Kentucky, roughly 418,000 have chosen Medicare Advantage plans. Annual state funding for Medicare in Kentucky is more than $10 billion. 

Original Medicare is made up of Medicare Part A and Part B. Medicare Advantage plans are often known as Medicare Part C. Part A covers inpatient care in a hospital , skilled nursing care, hospice care and some home health services while Medicare Part B pays for preventative care, diagnostic testing, medical equipment and other outpatient services. While Medicare Part A is free to those who made contributions to Medicare during their careers for a number of years, Part B costs a minimum of $170.10 per month in 2022.

Medicare Advantage allows retirees to choose a plan that’s managed by a private insurance company and may offer additional coverage options. All Advantage plans must cover the same benefits offered by Part A and Part B aside from hospice care (which Medicare Part A covers). Many Advantage plans cover vision, dental and prescription drug care. Part D is drug coverage, and it allows Original Medicare users who enroll to choose what level of coverage they prefer. Most Medicare Advantage plans cover prescription drugs (Part D). The last type of Medicare coverage available for Original Medicare users is Medigap coverage, also referred to as Medicare supplement plans.

This guide covers seniors’ Medicare options and ways they can customize their coverage to their needs and offers additional resources to help them make more informed choices regarding their healthcare

Options for Medicare Coverage in Kentucky

Original Medicare is sufficient for many Kentuckians, but some people may need more comprehensive coverage. Residents of Kentucky can build policies that meet their individual needs while limiting out-of-pocket expenses. In addition to the federally funded Medicare program, other options are available from private insurers. 

Original Medicare (Parts A & B)

Original Medicare is administered by the Centers for Medicare & Medicaid Services (CMS) and is open to seniors aged 65 and over, along with those under 65 years old, but with certain disabilities or end-stage kidney disease. It includes two parts. Part A covers inpatient hospital care, nursing home and skilled nursing care, hospice and home health care. Part B, or medical coverage, pays for medically necessary goods and services such as durable medical equipment, mental health services and emergency medical transportation. 

Unlike most private Medicare plans, Original Medicare’s provider network isn’t limited to the beneficiary’s geographic region, making it easier to obtain services while traveling within the country. In most cases, Medicare doesn’t pay for health services the individual receives outside the United States. 

Under this program, seniors pay for services as they receive them. They must pay an annual deductible, which is $1,556 for Part A and $233 for Part B in 2022. After they’ve paid this amount, Medicare covers all eligible services at 80%. Beneficiaries pay the remaining 20% out of pocket.

Who Should Consider Original Medicare

Original Medicare may be a good option for those who:

• Travel frequently within the United States
• Don’t need extra benefits such as home-delivered meals and coverage for over-the-counter medication
• Want to choose their own prescription drug coverage

Medicare Advantage (Part C)

Medicare Advantage is an alternative to traditional Medicare coverage for seniors in Kentucky. Advantage plans are sold and managed by private insurance companies with a federal subsidy that covers a portion of enrollees’ premiums. They cover everything that’s included in Medicare Part A and Part B except for hospice care and allow retirees to add custom coverage options for things like vision care and dental. Many of these plans offer drug coverage, fitness programs, transportation services and coverage for over-the-counter medications. 

There are four types of Medicare Advantage plans. They are Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee for Service (PFFS) and Special Needs Plans (SNPs). Coverage details such as eligibility, premiums, deductibles, copays, coinsurance limits and network coverage all vary by the insurance company or individual plan. 

Who Should Consider Medicare Advantage?

An Advantage plan may be ideal for Kentuckians who:

• Need greater control over their out-of-pocket expenses
• Don’t have any serious medical conditions
• Wish to add vision or dental coverage
• Want more control over their prescription coverage
• Are seeking lower premiums

The Top 10 Medicare Advantage Plans in Kentucky

There are many Advantage plans to choose from in Kentucky and this can make it difficult to find the one that suits each person’s needs. The table below includes the top Medicare Advantage providers based on enrollment and affordability. It also gives cost estimates that have been updated as of April 2022. More information can be found on the Medicare Advantage Plans in Kentucky page.

Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t pay for most prescription drugs through Part A or B coverage. Instead, seniors purchase separate prescription drug policies, also called Part D coverage. Medicare contracts with private health insurance companies to provide this coverage. There are multiple plans to choose from with varying monthly premiums, which beneficiaries pay in addition to their Original Medicare premiums. While seniors don’t have to purchase prescription drug coverage when they’re first eligible for Medicare, not obtaining this coverage at this time may result in late enrollment penalties they pay for as long as they have Medicare if they enroll later.

Each prescription drug plan has its own formulary, or list of covered drugs. Formularies are typically split up into tiers. The tier a medication is in determines how much the insurance company pays and how much the beneficiary pays for it. Lower-level tiers are usually made up of generic and low-cost brand name drugs, while higher tiers are composed of more expensive brand name and specialty drugs. In most cases, the lower the tier, the lower the policyholder’s cost-sharing responsibility.

Who Should Consider Medicare Prescription Drug Coverage

Seniors who may benefit from prescription drug coverage include those who:

• Currently take prescription medication or expect to in the future
• Want to avoid late enrollment penalties
• Want to reduce out-of-pocket prescription drug expenses

Medicare Supplement Insurance (Medigap)

While Original Medicare provides coverage for many medical costs, seniors may still have significant out-of-pocket expenses. These may include copays, coinsurance and deductibles. Seniors may be able to reduce their cost-sharing obligations by purchasing a Medigap plan. These plans can only be used with Original Medicare. It’s illegal for private insurance companies to sell Medigap plans to those with Medicare Advantage plans.

In Kentucky, there are 10 types of Medigap plans, eight of which are available to new enrollees. Plans are standardized, meaning policyholders get the exact same coverage from a given plan regardless of the health insurance provider they buy it from. For more information on Medigap plans, seniors can refer to the Best Medicare Supplement Companies of 2022 page.

Who Should Consider Medicare Supplement Insurance

Good candidates for Medigap may be those who:

• Have ongoing health issues and expenses
• Travel overseas often
• Want to access an expanded network of health care providers
• Expect to need health services not covered by Original Medicare

Medicare Resources in Kentucky

Enrolling in Medicare can be a cumbersome and confusing process, but Kentuckians do have access to several state and national resources that can help them understand Medicare benefits, find coverage options that work for them, apply for Medicare and obtain financial assistance. The following resources can also help Medicare beneficiaries research Medicare Advantage plans, enroll in prescription drug plans and find Medicare Supplement plans to reduce out-of-pocket costs.