What You Need to Know
The average cost for a Medicare Advantage plan in Kentucky in 2021 is $17.07,
Some Kentucky plans have a zero-dollar premium.
What Are Medicare Advantage Plans in Kentucky?
Considering Medicare coverage in Kentucky? In addition to Original Medicare, you may also want to consider a Medicare Advantage Plan. Medicare Advantage plans include Original Medicare Part A and Part B. Most plans (though not all) include prescription drug coverage. And unlike Original Medicare, there is a limit to your out-of-pocket costs. In addition, many Medicare Advantage plans include extra benefits not covered by Original Medicare.
Original Medicare is run by the federal government. Medicare Advantage plans, also known as Part C, are available through private health insurance companies.
What Types of Medicare Advantage Plans Are Available?
There are 53 Medicare Advantage plans in Kentucky.1 These plans include:
- Health maintenance organization (HMO): Compared to other plans, premiums for HMO plans are low. Some plans have a zero-dollar premium. But you’ll have to see providers within your HMO’s network, except for in emergency situations. You will also need a referral from your primary care provider (PCP) to see a specialist.
- Preferred provider organization (PPO): PPO plans have higher premiums than HMOs. The advantage is that you can see providers that are outside of the network. However, you’ll pay more when you do so. With these plans, you don’t need to choose a PCP or get a referral to see specialists.
- Special needs plan (SNP): SNPs are designed to help cover the costs of specialized care. SNP plans limit membership to people with certain diseases or characteristics. They tailor benefits to meet the specific needs of these groups. You must receive care from your SNP network, except for in emergencies. You also need a PCP or care coordinator for specialist referrals. 2 The three types of SNPs are:
- Chronic condition special need plan (C-SNP): These plans are designed for people who have arthritis, cancer, or another ongoing medical condition.
- Dual eligible special need plan (D-SNP): You must be eligible for both Medicare and Medicaid to enroll.
- Institutional special need plan (I-SNP): If you need nursing home care or nursing care at home, an I-SNP can be an option.
- Private fee-for-service (PFFS): A PFFS will determine your care cost as well as how much to pay doctors and medical facilities. With a PFFS, a PCP or specialist referrals aren’t required. 3
- Medicare savings account (MSA): An MSA combines medical savings account with a high-deductible insurance plan. 4
Medicare Advantage offers hearing and vision benefits and possibly additional perks.
What Are Prescription Drug Options with Medicare Advantage?
Many Kentucky residents who choose Original Medicare buy a standalone Medicare Part D plan. Medicare Part D is included in most Medicare Advantage plans.
However, if your Medicare Advantage HMO or PPO plan doesn’t include prescription drug coverage, you can’t buy a standalone Part D plan. You can buy Part D coverage with a PFFS plan.
How Do You Choose Medicare Advantage Plans?
When you compare Medicare Advantage Plans, think about costs and the coverage you need. Note the following:
- Premiums: Your monthly cost is known as a premium. If you get a zero-premium plan, you’ll still be responsible for the Medicare Part B premium, which is $148.50 in 2021.5
- Other Costs: You’ll have to pay these costs in addition to your premium:
- Coinsurance: The percentage you pay out-of-pocket for services once you meet your deductible.
- Copays: The amount you pay for certain medical services.
- Deductibles: The annual cost you pay before your coverage begins.
The yearly, out-of-pocket maximum you can pay In 2021 is $7,550 for in-network services. 6
- Plan Benefits
- Vision: Covers eye exams, glasses, and contact fittings.
- Dental: Pays for dental exams and cleanings.
- Telehealth: Includes remote health services like virtual doctor visits and psychotherapy.
- Other Perks: Many Medicare Advantage plans pay for extras like fitness programs, hearing aids, or transportation services.
Costs are Capped
Medicare Advantage limits your out-of-pocket costs while there is no limit with Original Medicare.
When and How to Enroll in Medicare Advantage?
If you’d like a Medicare Advantage Plan, you have to sign up for Medicare Part A and B. After you do, you can shop around for plans in your area and complete an application. You may get Medicare Advantage during certain enrollment periods. 7
- Initial Enrollment Period (IEP): The IEP is a seven-month period that begins before the month you turn 65 and ends three months after. You can enroll in a Medicare Advantage plan during this time.
- Annual Election Period (AEP): The AEP is from October 15 through December 7 each year. You can sign up for a Medicare Advantage plan for the first time or switch to a different plan.
- Medicare Advantage Open Enrollment Period: The Medicare Advantage Open Enrollment Period is from January 1 to March 31. You can switch or drop your Medicare Advantage plan. It will take a month for your changes to take effect.
- General Enrollment Period: If you begin Medicare Part B between January 1 and March 31, you can join a Medicare Advantage plan during the General Enrollment Period.
- Special Enrollment Period: There are situations in which you can make changes to your Medicare Advantage plan outside of regular enrollment periods. 8 These include:
Who Has Signed up For Medicare Advantage in Kentucky?
In Kentucky, about 360,000 residents have signed up for Medicare Advantage. That number is a penetration rate of approximately 19% among all people who qualify for Medicare in the state.
How Much Do Medicare Advantage Plans Cost in Kentucky?
In 2021, the average cost for a Medicare Advantage plan in Kentucky is $17.07, which is a bit lower than the national average of $21.9 Remember that you also pay the premium for Medicare Part B.
What If You Want to Change Your Medicare Advantage Plan?
If you want to change your Medicare Advantage plan in Kentucky, you have two options. You may switch or drop your plan during the open enrollment period of October 15 to December 7. You may also enroll in a different plan or get rid of your current one from
January 1 to March 31.10
What Are Alternatives to Medicare Advantage?
One alternative to Medicare Advantage include:
- Original Medicare: You can stay with Original Medicare with Part A and Part B. If you do, you may want to consider a private Medicare supplement (Medigap) policy. Sold by health insurance companies, these plans pay out-of-pocket expenses that Original Medicare doesn’t cover. Many people also get a Medicare Part D standalone prescription drug plan.
What Are Medicare Resources in Kentucky?
- Kentucky Department of Insurance: Know Before You Enroll discusses everything you need to know about the federal Medicare program before you enroll in a Medicare Advantage plan in Kentucky. 11
- Kentucky State Health Insurance Assistance Program (SHIP): Educates people about Medicare. You can call the SHIP Hotline at (877) 293-7447 (option #2) or call DAIL at (502) 564-6930 and ask for a SHIP counselor.12
If you’re interested in Medicare Advantage, visit the Medicare Plan Finder or contact insurance providers. Explore all the options at your disposal and choose the right one for your financial and health situation.