Medicare Plan Options
Once you qualify for Medicare, you have a few different options to choose from, depending on your budget and health needs. Original Medicare may be a good fit if you have limited medical needs. If you’re managing a chronic condition or want more robust coverage, Kentucky’s Medicare Advantage program might be right for you.
Original Medicare is the basic fee-for-service health plan that’s subsidized by the federal government. It’s made up of two parts. Part A is the hospital insurance, which helps cover home health care, hospice, nursing home care, and inpatient care in hospitals. Part B helps cover routine and preventative care that you get in your doctor’s office, durable medical equipment, such as wheelchairs or hospital beds, and outpatient care. If you receive health services, you pay a deductible before your insurance kicks in. After you meet your deductible, you pay for a predetermined portion of your costs, and your policy covers the rest.
Medicare Advantage Plans
Medicare Advantage is an alternative to Original Medicare and may be a good option if you want built-in coverage for vision and dental services or prescription drugs. These plans, also called Medicare Part C, are provided by private insurance companies that work with the federal government to provide Medicare benefits. Medicare Advantage Plans cover the services in Original Medicare Parts A and B but may also include services, such as transportation for medical visits, over-the-counter and prescription drugs, and hearing or dental care. There are several types of Medicare Advantage Plans, including HMOs, PPOs, PFFS plans, and SNPs. Costs and rules regarding choosing primary care doctors and getting referrals to see specialists vary.
Medicare Prescription Drug Coverage Plans
Original Medicare doesn’t automatically cover prescription drugs, so if you want this coverage when you sign up for Medicare or expect to need it in the future, you may want to add prescription drug coverage when you first enroll to avoid penalties. This coverage, also called Part D, covers the medications you’re most likely to need. There are several plans available, each with its own list of covered drugs and cost-sharing responsibilities.
Medicare Supplement Insurance Plans
Original Medicare is a great option for those who don’t need regular health care services, but if you’re managing a chronic condition or are admitted to a hospital or nursing home, your out-of-pocket costs add up significantly. Medicare Supplement Insurance, also called Medigap, helps fill in the gaps to make your medical expenses more affordable. Medigap plans help cover health care costs that Original Medicare Part A doesn’t, such as copayments and deductibles.
Medicare in Kentucky by the Numbers
|People enrolled in Original Medicare||Average plan cost||Annual state spending per beneficiary||Spending per beneficiary compared to the national average|
|572,674||Plan A: $0 to $471 per month*
Plan B: $148.50 per month**
|$10,096||0% (consistent with the national average)|
*Most people pay no premium, but this can vary depending on how long they paid Medicare taxes.
**This is the average number, but it can vary based on income.
Medicare Resources in Kentucky
If you’re enrolling in Original Medicare for the first time or you’re thinking about switching back to Original Medicare from a Medicare Advantage Plan, there are agencies that can help you build a plan that meets your needs. Getting expert assistance can help you understand your benefits, recognize gaps in your coverage, and ensure that your health care dollars are well spent.
Kentucky State Health Insurance Assistance Program
The Kentucky State Health Insurance Assistance Program, also known as SHIP, is a free, volunteer-staffed program that provides free, objective options counseling. Counselors aren’t affiliated with any insurance providers and aren’t licensed to sell policies, but they can answer any questions you have about your Original Medicare benefits, out-of-pocket expenses, and options for prescription drug coverage. Counselors can also help you sort and understand your medical bills, dispute billing errors, and recognize and address Medicare fraud.
Contact Information: Website | (502) 564-6930
Area Agencies on Aging and Independent Living
Kentucky has a network of 15 Area Agencies on Aging, each of which serves seniors within their service area. These nonprofit agencies are funded through the Older Americans Act and serve as a single point of contact for those accessing services and benefits, such as Medicare. Through your local agency, you can connect with a SHIP counselor who can answer your Medicare questions and help you assess your health care needs. AAAs also provide services, such as transportation, home-delivered and congregate meals, health and wellness services, and legal assistance.
Contact Information: Website | (502) 564-6930
Kentucky Legal Aid
Kentucky Legal Aid is a statewide program that provides free civil legal services to those aged 60 and over. Through this legal agency, you can connect with SHIP counselors who can help you make informed decisions about your health insurance. Benefits counselors can represent you if your Medicare policy is terminated, your benefits are reduced, a claim is denied, or you’re overcharged for benefits. Counselors can also help you access public benefits that you’re eligible for, including Supplement Security Income, Medicaid, and Social Security.
Contact Information: Website | (270) 782-5740 or (800) 782-1924
Kentucky Department of Insurance
The Kentucky Department of Insurance governs the insurance market in the state and enforces regulations to protect consumers. Through this department, you can get in-depth information on available Medigap policies, Medicare Advantage Plans, and long-term care insurance. You can also file complaints with the department for denied claims or report suspected insurance fraud or abuse.
Contact Information: Website | (502) 564-6154
Learn More from Our Sources
- Medicare | Medicare Costs at a Glance | Last accessed June 2021
- Medicare | How Do Medicare Advantage Plans Work? | Last accessed June 2021
- Medicare | Part D Late Enrollment Penalty | Last accessed June 2021
- Medicare | What Medicare Part D Drug Plans Cover | Last accessed June 2021
- Medicare | What’s Medicare Supplement Insurance (Medigap)? | Last accessed June 2021