Kentucky Medicare Advantage Plans | Care in the Bluegrass State

What Are Medicare Advantage Plans in Kentucky?

Medicare Advantage plans are an alternative to Original Medicare, offered by Medicare-approved private insurance companies. These plans include Part A (hospital) and Part B (medical), and most also include Part D (prescription drug coverage). Many plans provide added benefits like routine dental, vision, hearing, telehealth, and fitness programs.

Medicare Eligibility

To enroll in a Medicare Advantage plan, you must first sign up for Original Medicare (Parts A and B). Most individuals become eligible for Medicare enrollment at age 65, but some qualify earlier due to disability, ALS, or ESRD. It’s important to understand Initial, General, and Special Enrollment Periods to avoid late penalties or coverage gaps.

What Types of Medicare Advantage Plans Are Available in Kentucky?

Kentucky offers the following MA plan types:

• Health Maintenance Organizations (HMOs): Require in-network care and referrals for specialists.
• Preferred Provider Organizations (PPOs): Offer flexibility for out-of-network care (at a higher cost); typically do not require referrals.
• Private Fee-for-Service (PFFS) Plans: Allow care from any provider who agrees to the plan’s terms; some plans include a network.
• Special Needs Plans (SNPs):
  • C-SNPs: For chronic conditions such as cancer or diabetes.
  • I-SNPs: For individuals receiving care in institutions or needing nursing care.
  • Dual Eligible Special Needs Plans (D-SNPs): For people who qualify for both Medicare and Medicaid, often offering additional benefits like dental, prescription coverage, and care coordination at little to no cost.
• Medical Savings Accounts (MSAs): Combine a high-deductible plan with a medical savings account funded by the insurer.

What Are Your Prescription Drug Options with Medicare Advantage?

Most MA plans include Part D drug coverage. However, MSAs and some PFFS plans do not. If your plan lacks drug coverage, you may:

• Enroll in a standalone Part D plan (if eligible).
• Face a late enrollment penalty if you delay without having other creditable drug coverage.

How Do You Choose a Medicare Advantage Plan?

Before selecting a plan, it’s essential to understand Medicare Advantage costs:

• Premiums: Many plans have $0 premiums; others require monthly payments.
• Deductibles, Coinsurance & Copays: Out-of-pocket costs for medical services vary by plan.
• Out-of-Pocket Maximums: Limits your annual costs for covered services.
• Extra Benefits: Look for added coverage such as dental, vision, hearing, telehealth, fitness, or over-the-counter allowances.

When and How Do You Enroll in a Medicare Advantage Plan?

You can enroll in Medicare during specific enrollment periods:

• Initial Enrollment: 3 months before to 3 months after your 65th birthday month.
• Annual Open Enrollment (Oct 15–Dec 7): Join, switch, or drop MA plans.
• General Enrollment (Jan 1–Mar 31): For those enrolling in Part B.
• Medicare Advantage Open Enrollment (Jan 1–Mar 31): Change or return to Original Medicare.
• Special Enrollment Periods: Triggered by:
  • Moving outside your plan’s service area
  • Losing employer or union coverage
  • Plan termination
  • Qualifying health conditions

What If You Want to Change Your Medicare Advantage Plan?

You may switch or drop your MA plan during:

• Open Enrollment (Oct 15–Dec 7)
• Medicare Advantage Open Enrollment (Jan 1–Mar 31)

What Are Medicare Resources in Kentucky?

• Kentucky SHIP Program: Offers free Medicare counseling. Learn more by contacting SHIP at (877) 293-7447 (option 2) or (502) 564-6930.
• Kentucky SMP Program: Educates beneficiaries on preventing Medicare fraud.
• Kentucky Department of Insurance: Handles Medicare-related complaints.
• For low-income residents, Kentucky Medicaid may help with healthcare costs. Visit Kentucky Medicaid or call (855) 459-6328. Learn more about the differences between Medicare and Medicaid.

Understanding Medicare Advantage Star Ratings

The CMS star ratings system is how the Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (MA) plans using a 5-star quality scale. These ratings help consumers compare the performance of different plans based on a standardized set of measures.

CMS Star Ratings Overview

• 1 star: Poor performance
• 2 stars: Below average
• 3 stars: Average
• 4 stars: Above average
• 5 stars: Excellent

These ratings are updated annually and reflect data collected from Medicare Advantage (Part C) and Medicare Advantage Prescription Drug Plans (Part D).

Other Medicare Plan Options to Help with Out-of-Pocket Costs

Medicare Supplement Plans, also known as Medigap, help pay costs not covered by Original Medicare—such as deductibles, copays, and coinsurance.

To buy a Medigap plan, you must be enrolled in Parts A and B. The best time to enroll is during your six-month Medigap Open Enrollment Period when you’re guaranteed coverage without medical underwriting.

Medigap doesn’t include drug coverage, so you may also need a standalone Part D plan. There are 10 standardized plan options. Medicare Supplement Plan G is currently the most popular and fastest-growing plan, alongside Plan N. Plan F is no longer available to new Medicare enrollees after 2020.

Learn more about Medicare Supplement Plans in Kentucky.

Next Steps

If a Medicare Advantage plan in Kentucky fits your health and budget needs, compare plans in your area. Review networks, out-of-pocket costs, and added benefits—and be ready to enroll when eligible.