Thanks to expanded benefits and plan offerings, Medicare Advantage (MA) continues to grow more popular each year. In 2023, nearly 31 million people had an Advantage plan, accounting for more than one-half of Medicare beneficiaries. This page explains Medicare Advantage plans in Kentucky to help you get the best plan for your unique needs.
What is Medicare Advantage in Kentucky?
Medicare Advantage, also known as Medicare Part C, provides the same coverage you get with Original Medicare. This includes:
- Medicare Part A, hospital insurance
- Medicare Part B, medical insurance
Prescription drug coverage is through Medicare Part D. If you do not have creditable prescription drug coverage (meaning a plan that's as good as or better than Medicare), you face lifelong penalties.
Medicare Advantage plans with prescription drug coverage in Kentucky
Medicare Advantage Prescription Drug plans (MA-PD) are all-in-one policies that combine your Medicare Parts A, B, and D benefits.
Most Advantage plans also offer additional coverage. Benefits vary but may include:
- Fitness programs
- Hearing aids
- Routine dental care
- Routine vision care
Private insurance companies provide Medicare Advantage plans.
Who is eligible for Medicare Advantage in Kentucky?
If you have Medicare Parts A and B, you qualify for Medicare Advantage in Kentucky.
You are eligible for Medicare if you're an American citizen or permanent legal resident aged 65 or older. Enrollment in Parts A and B is automatic if you began collecting Social Security benefits at least 4 months before your 65th birthday.
You may qualify for Medicare before turning 65 if you collect Railroad Retirement Board (RRB) or Social Security disability benefits for 24 months. Enrollment is automatic in month 25.
When can you sign up for a Medicare Advantage plan in Kentucky?
You may join a Medicare Advantage plan in Kentucky during specific enrollment periods.
Your Initial Enrollment Period (IEP) begins 3 months before you qualify for Medicare lasts for 7 months. For example, if your 65th birthday or 25th month of collecting disability occurs in April, your IEP starts on January 1 and ends on July 31.
If you missed your IEP, you may sign up for Part A and/or Part B during the General Enrollment Period (January 1 through March 31). You then have from April 1 until June 30 to join a Medicare Advantage plan.
Medicare's Annual Enrollment Period (AEP) allows current beneficiaries to make any changes needed to their Medicare coverage from October 15 through December 7. This includes joining an Advantage plan.
The Medicare Advantage Open Enrollment Period runs from January 1 through March 31 and is for people currently enrolled in Part C. You may either join a new MA plan or return to Original Medicare. If you lose your prescription drug coverage after making that change, you may also enroll in a standalone Part D plan.
Special Enrollment Periods let you join a Part C plan if you experience special circumstances. There are dozens of ways to qualify. The full list is on Medicare.gov.
Types of Medicare Advantage plans in Kentucky
There are four main types of Medicare Advantage plans in Kentucky.
- Health maintenance organizations: HMO plans use a provider network that may include any entity that offers healthcare services. Plan members must choose a primary care doctor and get a referral to see a specialist. Non-emergency services from an out-of-network are rarely covered by an HMO plan.
- Preferred provider organizations: PPO plans also have provider networks but allow members to see an out-of-network provider for a higher copay. PPO plan members also don't need to choose a primary doctor or get a referral to see a specialist.
- Private fee-for service: PFFS plans establish cost guidelines for covered service. Most also have a provider network but members can use an out-of-network provider for a higher cost.
- Special needs plans: SNPs limit enrollment to people who meet certain criteria, with each plan setting its own guidelines. This means one of the following: qualifying for both Medicare and Medicaid (dual eligible), having a chronic condition (e.g. diabetes, HIV/AIDS, ESRD), or living in an institution.
How to choose a Medicare Advantage plan in Kentucky
To ensure you get the best Medicare Advantage plan for your unique needs and budget, consider these four metrics:
- Costs: May include an annual deductible, monthly premiums, and copays or coinsurance.
- Coverage: Benefit vary widely. Compare your options carefully and don't forget the drug formulary for MA-PD plans.
- Network: May include doctors, hospitals, labs, durable medical equipment providers (DME), and more.
- Ratings: Medicare publishes plan ratings every fall to help members compare their options during AEP.
With our Find a Plan tool, it's easy to compare Medicare Advantage plans in Kentucky. Just enter your location information and coverage start date to review the Medicare plan options in your area.
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