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Medicare in Kentucky

Healthcare can be a bumpy ride, but GoHealth straightens the learning curve for Medicare in Kentucky

Reviewed by: Ed McClane, Licensed Insurance Agent. Written by: Bryan Strickland.

Key Takeaways

  • Original MedicareOriginal Medicare (Parts A and B) is fee-for-service health insurance available to all Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). in Kentucky is an option at age 65. It features hospital and medical coverage with the option of adding drug and supplemental coverage (called Medigap).

  • Medicare AdvantageMedicare Advantage is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). in Kentucky (Part C) replaces Original Medicare (Part A and B) but offers the same Part A and B benefits and coverages as Original Medicare. Along with Part A and B benefits, Medicare Part C often bundles additional services like dental, hearing, vision and prescription drug coverage.

  • While 20% of Medigap plans available to Original Medicare beneficiaries offer the protection of an out-of-pocket maximum, all Medicare Advantage plans feature an out-of-pocket maximum.

 

The Kentucky Derby, the crown jewel of horse racing and a crowning achievement for the state of Kentucky, evokes images of patrons in playful attire sipping mint juleps on a sparkling spring day.

But conditions aren’t always idyllic, and down on the track, the horses that can adapt to the changing climate have a leg up.

It’s much the same with health insurance. No one has any concerns about their plan when the sun is shining on them, but are you prepared for the rainy days? GoHealth is here to get you on track with Medicare in Kentucky.

Who Qualifies for Medicare in KY?

If you’re a U.S. citizen and are age 65 or older, you qualify for Medicare in Kentucky. It’s as simple as that.

Medicare is a federal program that provides affordable healthcare for older Americans nearing retirement.

You’re also eligible regardless of your age if:

You can enroll in Part A (also known as “hospital insurance”), Part B (“medical insurance”) or both. Once enrolled in Part A and B (known collectively as Original Medicare), you have the option to add Part D to cover a portion of your prescription expenses. You may also choose to add Medigap, which is supplemental coverage that helps fill in the gaps in out-of-pocket costs like copays and coinsurance.

Medicare Advantage in Kentucky offers an alternative. Medicare Advantage (also known as Part C) replaces Original Medicare while offering the same coverages as Part A and B and bundling Part D and supplemental coverage along with benefits like dental and vision coverage.

How do I Apply for Medicare in KY?

Your choices for applying for Medicare in KY include:

  • Enrolling online with the Social Security Administration. [1]
  • Enrolling over the phone at 1-800-772-1213 (TTY: 1-800-325-0778).
  • Visiting a local Social Security office. [2]

If you are receiving Social Security benefits before you turn 65, you may be automatically enrolled in Original Medicare. If not, you have to apply. Your first chance to sign up is during your Initial Enrollment Period, which starts three months before the month of your 65th birthday.

What is the Income Limit for Medicaid in KY?

It depends on who you are.

Each state has its plan for administering Medicaid, a federal/state program founded alongside Medicare in 1965 that helps those facing a financial need and/or disability regardless of age. Kentucky offers coverage for the youngest of children to the oldest of adults. Those aged 19-up are eligible if their income is 138% or less than the Federal Poverty Level, [3] but some programs for children expand coverage up to 218% of the Federal Poverty Level. [4]

Who is Eligible for Medicaid in Kentucky?

In addition to Medicaid programs for adults, children, pregnant women, and the disabled, Kentucky offers a Presumptive Eligibility program during the Covid-19 State of Emergency. This Medicaid program provides temporary managed care to Kentucky residents under age 65 who don’t have medical insurance. [5]

What is the Most Common Medicare Supplement Plan?

Medicare supplement plans, also known as Medigap plans, are available to people enrolled in both Parts A and B of Original Medicare and help fill in coverage gaps. All 10 of the standard Medigap plans offered by private insurance companies are available in Kentucky. However, different insurers may charge different rates for the same plans based on a variety of factors. Medigap should be added in the six months after your Original Medicare coverage begins to ensure eligibility without medical questions.

All 10 plans, lettered from Plan A to Plan N, cover 100% of Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits run out. All 10 also pay at least 50% of Part B coinsurance and copayments.

Each plan offers a specific mix of benefits, but just two of them (Plans K and L) protect you with an out-of-pocket maximum. Medicare Advantage plans, by contrast, are required to include the benefit of an out-of-pocket maximum.

Which Company has the Best Medicare Advantage Plan?

When it comes to Medicare plans in Kentucky, Original Medicare can be used nationwide, while Medicare Advantage is usually aligned with a network of providers in your area. Since there are numerous Medicare Advantage plans, it is common for one or more to include your preferred doctor, and the network concept is among the reasons Medicare Advantage in Kentucky often offers affordable rates.

One way to measure Medicare Advantage plans is by their Medicare Star Rating. The Centers for Medicare & Medicaid Services assigns a rating of one to five stars (five being the best) to individual Medicare Advantage plans. If you’re already on a Medicare Advantage plan and it’s not five-star plan, you are offered the opportunity to switch to a five-star plan each year. [6]

While the rating system can shed light on Medicare Advantage plans’ performance, it’s not as easy as just picking the highest-rated plan. A GoHealth licensed insurance agent, without obligation, can help you compare plans and find the one that’s the right fit for you.

Medicare in Kentucky by the Numbers

Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 870,965 people are enrolled in Medicare in Kentucky. The total number of beneficiaries enrolled in Medicare Advantage in Kentucky is 295,046. The previous year, 271,750 enrolled in Medicare Advantage. Medicare Advantage participation in Kentucky went from 31.70% to 33.88% year over year. If you’d like to dive deeper into how Medicare in Kentucky breaks down across the state, we provide a glance at who is using Medicare, and how.

Outline of Kentucky
870,965
Beneficiaries with Part A & Part B
295,046
Medicare Advantage Beneficiaries
33.88%
Medicare Advantage Participation Rate
53.49%
% Female
46.51%
% Male
1.01
Average HCC Score
$9,801.7
Actual Per Capita Costs
24.71%
% Eligible for Medicaid
34.63%
% of Beneficiaries with an Emergency Department Visit
18.95%
Hospital Readmission Rate
92.54%
% Non-Hispanic White
5.02%
% African American
0.62%
% Hispanic
1.82%
% Other/Unknown

Table reflects the latest Beneficiary Demographics data: 2018, All Beneficiaries by State, Centers of Medicare & Medicaid Services (CMS)

Average HCC Score: The Hierarchical Condition Category score gauges a population’s overall health. The score is based on a value of 1.0. Populations with an HCC score of less than 1.0 are considered relatively healthy. The score can be used to estimate health costs.

Kentucky Medicare Resources & Contacts

Beneficiaries spend an average of $9,801.70 each year on Medicare in Kentucky. To be certain you are not leaving anything on the table, let us help. A GoHealth licensed insurance agent can assess your coverage or explain which Kentucky-based resources, like these, may be able to help:

KY SHIP - Medicare counseling

1-877-293-7447

https://chfs.ky.gov/agencies/dail/Pages/ship.aspx

What should I know about KY SHIP?

Residents can get free, unbiased Medicare advice through the State Health Insurance Assistance Program.

Senior Medicare Patrol

1-877-603-6558

https://louisvilleky.gov/government/health-wellness/senior-medicare-patrol

What should I know about the Senior Medicare Patrol?

This program protects Kentucky residents already on Medicare against fraud.

Public Health Kentucky Prescription Assistance Program (KPAP)

1-800-633-8100
Phone lines open M-F, 8:30 a.m. to 6 p.m.

https://chfs.ky.gov/agencies/dph/dpqi/hcab/Pages/kpap.aspx

What should I know about KPAP?

This state program offers assistance with prescription costs for Medicare beneficiaries in the “donut hole” among others.

kynect (Kentucky Medicaid)

1-855-306-8959

https://kynect.ky.gov/s/?language=en_US

What should I know about the kynect?

The program, headed by the Kentucky Cabinet for Health and Family Services, helps guide residents through their Medicaid journey.

Nationwide Resources

Speak with an insurance agent that is licensed in Kentucky about your Medicare questions.

1-855-792-0088 TTY: 711

Monday - Friday, 8 AM - 9 PM CT

Medicare & Medicaid

If you have general questions about Medicare in KY, or need help with current Medicare benefits.

1-800-MEDICARE (1-800-633-4227)

Social Security Administration

You can reach the SSA by phone for general questions. Not all questions can be answered over the phone.

Also, SSA.gov provides online resources for the following: Review information, apply for benefits, or manage your account online

Speak to SSA Representative, Monday - Friday, 8 AM - 7 PM ET

Medicare Learning Guides

Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.

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New to Medicare Guide

Helpful information to get you started with enrolling in Medicare.

Medicare Beneficiary Guide

For those currently enrolled in Medicare.

Medicare Plans Guide

Costs, coverage and enrollment details for each Medicare plan.

Low Income & Medicare Guide

For individuals with a qualifying income status.

A Caregiver’s Guide

For those helping a loved one with Medicare.