Read on to learn the basics of Medicare—from what your coverage options are to how and when to enroll in Medicare.
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There are 952,000 Medicare beneficiaries in Kentucky, making up 21% of Kentucky’s total population. 20% of Kentucky Medicare beneficiaries have dual eligibility and are on both Medicare and Medicaid.
When you first sign up for Medicare, you enroll in Original Medicare (Parts A & B). Once enrolled, you can choose to stay on Original Medicare with the option to add a Medigap plan and/or a prescription drug plan. You can also choose to switch from Original Medicare to a Medicare Advantage (Medicare Part C) plan. Which coverage options are best for you depends on your unique healthcare needs. It’s best to speak with a licensed Medicare agent who can help you understand the pros and cons of your Medicare options available in Kentucky.
56% of Kentucky Medicare recipients are on Original Medicare (with or without additional coverage) and the other 44% are on a Medicare Advantage plan (source).
44% of Kentucky Medicare beneficiaries have enrolled in one of the 73 Medicare Advantage plans available in the state. The number available to you depends on the county you live in. For example, in 2023, Jefferson County, Kentucky has 37 Medicare Advantage plans and Kenton County has 44. To hear about Medicare Advantage plans, schedule a free consultation with one of our licensed Kentucky Medicare agents or call us today at (888) 604-0055.
Medicare Advantage plans provide a bundled approach to Medicare. They cover at least the same amount as Original Medicare (Parts A & B). Unlike Original Medicare, they have out-of-pocket limits to protect beneficiaries against catastrophic costs.
Additionally, these plans often come with low or no premiums (but you do still need to pay your Part B premiums). They also offer additional benefits, like:
Dental, vision, and hearing benefits
Over-the-counter cash cards
Transportation services for doctor appointments
If you’re considering one of the Kentucky Medicare Advantage plans, be careful. Make sure the plan you choose covers your healthcare needs first, including the doctors you prefer and the prescriptions you take. You should also be aware of some of the common Medicare Advantage complaints. These include:
Limited provider networks
Higher out-of-pocket costs when compared to coverage from Original Medicare + Medigap
Original Medicare only covers about 80% of your healthcare costs. Many Medicare beneficiaries choose to enroll in a Medicare Supplement (also known as Medigap) plan to help cover the 20% of costs that Original Medicare doesn’t. These plans sit on top of Original Medicare. They don’t provide coverage for additional healthcare services, but significantly reduce your out-of-pocket costs and enable better financial predictability.
Medigap plans have some great benefits that you won’t get on Medicare Advantage, including:
No restrictive networks. You can see one of the 90% of doctors who accepts Medicare nationwide
You won’t need to get prior authorization for covered services
Your out-of-pocket costs are significantly reduced (for example, on a Plan G, you’ll only be responsible for your Part B deductible)
The best time to enroll in a Medicare Supplement plan is during the Medigap Open Enrollment period. The Medigap Open Enrollment Period occurs during the first six months after your Part B effective date. During this period, you cannot be denied coverage. Outside of this time, insurance companies can ask you questions about your health history and deny you coverage.
Kentucky Medicare beneficiaries can get prescription drug coverage through a Medicare Advantage plan that includes Part D coverage or through a stand-alone prescription drug plan (PDP). There are 24 stand-alone Part D plans available in Kentucky, with an average monthly premium of $36.19. The exact number of plans available to you will vary based on the county you live in.
Prescription coverage varies by plan, so check the list of covered drugs when comparing prescription drug plans! And even if you don’t currently have any prescription coverage needs, you should enroll in one of the cheaper prescription drug plans to avoid the Part D late enrollment penalty later on.
If you have limited income and resources, you may be eligible for the federal Extra Help program that helps with Part D costs. If you meet any of the following conditions, you’ll qualify for Extra Help automatically:
You receive full Medicaid coverage from Kentucky
Kentucky helps pay your Part B premium
You get Supplemental Security Income (SSI) benefits
If you don’t automatically qualify for Extra Help, you can learn more about eligibility here. If you need help, you can speak with one of our Kentucky Medicare Advisors who will help you understand eligibility and assist with the application process.
In addition to Extra Help, there are two government programs that help low-income individuals pay for Medicare-related expenses.
Medicaid is a joint federal and state program that’s operated by each state. Each state runs its Medicaid program differently, but has Medicare Savings Programs to help low-income Medicare beneficiaries with healthcare expenses.
Kentucky has four Medicare Savings Programs available to individuals with low incomes and resources.
The Qualified Medicare Beneficiaries (QMB) Program
Eligible Medicare beneficiaries will receive Medicaid payments for their Part A and B premiums as well as Medicare coinsurance and deductibles. The income limit (in 2023) is $1,235 for individuals and $1,663 for couples.
Specified Low-Income Medicare Beneficiaries (SLMB) Program
Eligible Medicare beneficiaries will receive Medicaid payments for their Part B premium. The income limit (in 2023) is $1,478 for individuals and $1,992 for couples.
Qualified Individuals (QI) Program
Eligible Medicare beneficiaries will receive Medicaid payments for their Part B premium. The income limit (in 2023) is $1,660 for individuals and $2,239 for couples.
Qualified Disabled Working Individuals (QDWI) Program
Eligible Medicare beneficiaries will receive Medicaid payments for their Part A premium for up to 48 months. The income limit is $4,945 for individuals and $6,650 for couples.
Eligible US citizens receive monthly payments from the SSI program. You’re considered eligible if you meet the following criteria:
You are 65 and older, blind, or have a disability
You have limited income and limited resources
Medicare eligibility is the same for all American citizens. If you meet one of the following conditions, you are eligible to enroll in Medicare:
You’re 65 or older
You have certain disabilities, like End-Stage Renal Disease or ALS
Enroll in Original Medicare (Part A & Part B)
Choose your supplemental coverage
Medicare Supplement (Medigap)
Medicare Advantage (Part C)
Part D (drug coverage)
Find doctors, share your plan information with your pharmacy, and set up additional benefits that come with your coverage.
You first become eligible for Medicare during your Initial Enrollment Period (IEP), which is a 7-month period around your 65th birthday. Your IEP begins three months before the month you turn 65, includes your birth month, and extends til months after you turn 65. If you’re planning to work after you turn 65, you may choose to delay your Part B enrollment. Learn more about the right time to enroll in Medicare here. If you have any questions, schedule a free consultation with one of our licensed Kentucky Medicare Advisors or give us a call today at (888) 604-0055.