- In 2019, there were 53 Medicare Advantage Plans available in Kentucky.
- 29% of the total Medicare population in Kentucky is enrolled in Medicare Advantage Plans as of 2018.
- In 2018, Original Medicare spent an average of $10,096 per beneficiary in Kentucky, the same as the national average.
- Available Medicare Advantage Plans range from 10 to 35 across Kentucky’s 120 counties.
Medicare Advantage Plans typically have annual out-of-pocket maximums, making it easier to control medical expenses. Depending on your plan, you may have an annual deductible that you must meet before your plan pays anything towards your medical bills. Different types of plans also have varying rules regarding choosing a primary doctor, seeing network providers, or getting a referral to see a specialist.
Medicare Advantage Plans in Kentucky
Types of Medicare Advantage Plans
While Original Medicare provides the same coverage to all enrollees, Medicare Advantage Plans have varying scopes of coverage, letting you choose a plan that meets your unique needs. Some plans rely on network providers to help control costs and pass the savings on to you, providing you with affordable coverage. Other plans are tailored for enrollees with certain conditions or circumstances. Understanding the different types of Medicare Advantage options available is the first step in finding a plan that fits your needs and lifestyle.
Health Maintenance Organization (HMO)
With an HMO plan, your medical care is provided through a network of doctors, specialists, and hospitals that are under contract with the plan. You choose a primary doctor who manages your care and gives you referrals to see specialists. If you obtain medical services outside of your plan’s network, you are responsible for the entire bill except for in the event of an emergency. Because these plans only cover services from providers within the network, HMOs are generally the most affordable option.
Preferred Provider Organization (PPO)
Like HMOs, PPO Plans have networks of providers under contract to provide services for a negotiated rate. Getting care from these providers ensures the lowest copays. However, these plans also cover care that you get outside of your plan’s network, though you generally pay a higher copay. PPOs typically have higher premiums than HMOs because the plans are more expensive to manage, but if you’re looking for flexibility, a PPO may be a good option.
Private Fee-For-Service Plans (PFFS)
PFFS Plans are a less popular option, with only about 50 plans available nationwide. These plans are similar to Original Medicare in that the insurance company determines what the plan pays for a given service and what you pay. While many PFFS Plans have provider networks of doctors, specialists, and hospitals who agree to always treat enrollees, you’re free to choose any provider that agrees to the plan’s payment terms.
Special Needs Plans (SNP)
SNPs are special Medicare Advantage Plans that are available to those who meet certain qualifications. There are three basic types of SNPs, including plans for people with chronic conditions such as dementia or chronic lung disorders, people who need a nursing home level of care, and people who are dually eligible for Medicare and Medicaid. These plans tailor benefits, provider networks, and drug formularies to the populations they serve.
Enrollment and eligibility for Medicare Advantage Plans in Kentucky
In Kentucky, you qualify for Medicare Advantage if you’re at least 65 years old and enrolled in or eligible for Medicare Parts A and B. Medicare is also available to those who’ve been getting disability benefits from Social Security for at least 24 months. If you’re switching to Medicare Advantage from Original Medicare and you have a Medigap plan, you must cancel your plan. You must also live within your selected plan’s service area. If you split your time between two states, find out whether your plan covers you in both places.
If you’re not automatically enrolled in Medicare or you want to switch to Medicare Advantage, there are certain times you can do that, including:
- Initial Medicare Enrollment Period, which opens for a seven-month period that begins three months before your birth month. Generally, if you don’t sign up for Medicare Part B when you’re first eligible for it, you may have to pay a late enrollment penalty.
- Open Enrollment Period, which is open to everyone from October 16th to December 7th.
- Medicare Advantage Open Enrollment Period, which runs from January 1st to March 31st. During this time, you can switch to Medicare Advantage, a different Medicare Advantage Plan, or back to Original Medicare one time.
- Special Enrollment Periods, which open up if you have special circumstances.
Prescription drug coverage
The best time to get prescription drug coverage is when you first become eligible for Medicare. Unless you have this coverage through a valid source, such as an employer-sponsored health plan, you pay a late enrollment fee if you add this coverage later on. Most Medicare Advantage Plans, including all SNPs, have this coverage. If you have a PFFS Plan, you can purchase a separate Part D policy. You can’t add a separate policy to an HMO or PPO Plan, so if you want this coverage, it’s important to verify your plan’s benefits before signing up.
Medicare Advantage Resources in Kentucky
Before you begin your search for the best Medicare Advantage Plan for your needs and budget, it’s helpful to talk to an expert who can guide you in comparing available plans and benefits. Kentucky has several agencies that can point you in the right direction, helping you understand out-of-pocket costs, claims processes, and how to protect yourself from Medicare fraud.
Kentucky Department of Insurance
Kentucky’s Department of Insurance regulates Medicare Advantage Plans sold in the state, monitors insurance companies’ financial viability, and provides consumers with the information they need to make educated decisions regarding their health coverage. It provides comprehensive information on what to know before signing up for a Medicare Advantage policy and upcoming industry changes. It also fields and investigates consumer complaints regarding problems with settling a claim.
Contact Information: Website | 502-564-3630
State Health Insurance Assistance Program
The State Health Insurance Assistance Program is a volunteer-driven program that provides free, impartial health insurance counseling for those who qualify for Medicare. Trained volunteers speak at community events and provide one-on-one guidance and advice regarding Medicare benefits, Medicaid, and long-term care insurance. They can help you determine the plans available in your region, compare benefits and out-of-pocket costs, and sign up for the plan that meets your needs. They can also help you read and understand medical bills and dispute denied claims.
Contact Information: Website | 877-293-7447, option #2
Area Agencies on Aging and Independent Living
Kentucky has a network of 15 local Area Agencies on Aging, each of which serves seniors in a designated region of the state. These agencies serve as a point of contact for SHIP, which provides unbiased health insurance options counseling to help you make educated decisions regarding health care. AAAs can also provide screenings to help you determine whether you qualify for Medicare Savings Programs or prescription drug assistance. Information and referral services are available at no cost to seniors.
Contact Information: Website | 502-564-6930
Learn More From Our Sources
- Medicare | Health Maintenance Organization (HMO) | Last accessed June 2021
- Medicare | Preferred Provider Organization (PPO) | Last accessed June 2021
- Medicare | How Medicare Special Needs Plans (SNPs) work | Last accessed June 2021
- HHS | Who is eligible for Medicare? | Last accessed June 2021
- Medicare | Part B late enrollment penalty | Last accessed June 2021
- Medicare | Special circumstances (Special Enrollment Periods) | Last accessed June 2021
- Medicare | How to get prescription drug coverage | Last accessed June 2021
- Medicare | Part D late enrollment penalty | Last accessed June 2021
- TEAM KENTUCKY | DEPARTMENT OF INSURANCE | Last accessed June 2021
- Kentucky Cabinet for Health and Family Services | State Health Insurance Assistance Program | Last accessed June 2021
- Kentucky Cabinet for Health and Family Services | Area Agencies on Aging and Independent Living | Last accessed June 2021