Medicare Advantage in Kentucky

Medicare is provided by the federal government to ensure access to medical coverage for people at least 65 years old or those who have qualifying disabilities. Medicare includes Plan A to cover hospital visits and Plan B to reduce the costs for doctors and medical supplies. In 2003, private insurance companies rolled out Medicare Advantage Plans as an alternative to the traditional Medicare plans that had been standard since 1965. To qualify as Medicare Advantage, or Plan C, these plans had to match the coverage offered through Plans A and B in traditional Medicare. Beyond that, Medicare Advantage Plans differ greatly and can offer seniors several benefits that better match their budget and health needs.

Traditional Medicare plans do not cover prescription costs unless the enrollee adds Plan D and pays an additional premium. Medicare Advantage Plans often include prescription coverage along with several other helpful options, such as vision, dental or hearing. Having this extra coverage included under the same premium can save seniors some cash on their monthly expenses. While original Medicare can be used across the country at any facility or provider that chooses to accept it, Medicare Advantage Plans often require care be given by in-network facilities and providers, which are generally limited to those in the enrolled home state. The extra cost of out-of-state care can erode the savings for seniors who travel frequently.

Kentucky has almost 970,000 senior residents who are eligible for Medicare as of July 2023. Out of these potential enrollees, 51% have chosen coverage through a Medicare Advantage Plan over traditional Medicare. This is slightly higher than the national average of 48% and includes an 8.78% increase in the enrollee percentage from April of 2022. This guide provides an overview of how these plans work, details on some of the providers found in Kentucky and ideas for narrowing down the selections to find the best plan to fit their needs.

The Top 10 Medicare Advantage Plans in Kentucky

There are several Medicare Advantage providers located in Kentucky, and each of them offers multiple plans designed to fit different budget and health care needs. This ensures Kentucky seniors are able to maximize their required coverage while minimizing their out-of-pocket expenses. The following table lists the top nine providers in the state, ordered by the number of enrollees across all the Part C plans they offer. Provider information includes a cost range that covers highest and lowest priced plans as of July 2023. Seniors seeking additional plan information can find more details on Medicare.gov.

How Medicare Advantage Plans Work in Kentucky

Private insurance companies in Kentucky offer a few different types of Medicare Advantage plans: Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee-for-Service (PFFS) and Special Needs Plans (SNPs). Medical savings accounts may be available in some communities. Premiums, deductibles, copays and other costs can vary significantly between types of plans. More information about these coverage options is below.

What Medicare Advantage Plans Cover in Kentucky

With a Medicare Advantage plan, seniors get coverage for preventative screenings, inpatient hospital services, durable medical equipment, skilled nursing facilities, home health care, outpatient care and physician services. These are the same benefits covered under Parts A and B. It’s possible for Medicare Advantage to cover a variety of additional care services, such as dental, hearing and vision. Special Needs Plans may include coverage for health care that treats certain chronic conditions. 

*Select plans offer this coverage

** Most plans offer this coverage

Eligibility for Medicare Advantage in Kentucky

Seniors who have Original Medicare Parts A and B are eligible to switch to a Medicare Advantage plan. To qualify for Original Medicare, a person must be a U.S. citizen or legal immigrant 65 years or older. Younger people with disabilities and end-stage kidney disease may also be eligible. The only other requirement for Part C is to live in the service area for a particular plan. Some HMOs and PPOs may only cover providers in certain counties and cities, so it would not be possible to receive services outside that network. Seniors may need to search for plans by zip codes to see if they live in a provider’s service area. Decisions need to made by the enrollment periods below:

• Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
• Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
• Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.

Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.

How to Find & Choose a Medicare Advantage Plan in Kentucky

Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.

First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.

State-Wide Medicare Advantage Resources

Local Medicare Advantage Resources