Medicare in Kentucky

Medicare is a federally funded and administered health insurance program that provides affordable coverage to retirees. The program is open to Kentucky residents aged 65 and over, an age group that makes up about 18% of the state’s population, along with younger people who have certain disabilities or permanent kidney failure. In Kentucky, approximately 969,131 people are eligible for Medicare coverage, which is a 1.61% increase over the number of eligible enrollees in 2022. This growth is beyond the national increase of 2.66% of Medicare-eligible individuals.

Original Medicare provides hospital and medical coverage through two parts. Part A covers inpatient hospital services, along with home health care, nursing home care and hospice. This coverage is free for most seniors, assuming either they or their spouse paid Medicare taxes for at least a decade. Those who don’t qualify for free coverage must pay a monthly premium of either $278 or $506, depending on their income, and they must enroll in Part B coverage. Part B pays for medical services outside of a hospital setting, including doctor’s office visits, diagnostic services, screenings and medical transportation. The premium for this coverage is $164.90. Neither program pays for medications, but beneficiaries can add this coverage by enrolling in Part D.

As an alternative to Original Medicare, beneficiaries may be able to enroll in a Medicare Advantage Plan. These plans are serviced by private health insurance companies and include the same coverage and, in some cases, additional benefits, such as annual out-of-pocket maximums and prescription drug coverage. In Kentucky, 51% of those eligible for Medicare are enrolled in Medicare Advantage, compared to 48% nationwide. Statewide, the number of Medicare Advantage policies grew by 10.53% between 2022 and 2023, outpacing the national growth of 9.75%.

This guide educates seniors on various topics including Medicare coverage options, Medicare Advantage, who should consider Medicare Advantage, top Medicare Advantage Plans, prescription drug coverage, Medigap, and additional Medicare resources, empowering them to tailor their healthcare coverage to meet their individual needs.

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, and it’s open to those aged 65 and over, as well as younger people with certain disabilities or health conditions. The program is split into two parts, including Part A hospital coverage and Part B medical coverage. These parts have separate deductibles beneficiaries must meet before their coverage kicks in. For Part A, beneficiaries must pay a $1,600 deductible for each inpatient stay, plus a co-pay for each day past the first 60 days. The Part B deductible is $226, and there’s a 20% coinsurance for covered services.

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)

Like Original Medicare, Medicare Advantage provides hospital and medical insurance. However, instead of being administered by the federal government, this insurance is available through private health insurance companies that comply with the program’s terms. In addition to providing Parts A and B benefits, Medicare Advantage Plans often have prescription drug coverage and vision and dental benefits. On top of this, many plans have low or $0 deductibles and annual out-of-pocket maximums, helping many seniors control their medical costs. While plan availability is based on zip code, there are four types of plans available, including HMOs, PPOs, PFFS plans and SNPs.

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 August 2023. 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 2023 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.