At a glance: Medicare health insurance in Kentucky
- Nearly 21 percent of Kentucky’s population is enrolled in Medicare.
- 29 percent of Kentucky Medicare beneficiaries select Medicare Advantage plans.
- Residents in Kentucky can select from between 10 and 35 Medicare Advantage plans in 2020, depending on where they live.
- In Kentucky, 57 insurers offer Medigap plans, but there are no guaranteed-issue rights for enrollees under age 65.
- Nearly half of Kentucky Medicare beneficiaries have stand-alone Part D prescription coverage.
- Per-enrollee Medicare spending in Kentucky is roughly the same as the national average.
Medicare enrollment in Kentucky
As of May 2020, there were 938,178 Kentucky residents enrolled in Medicare. That’s nearly 21 percent of the state’s total population, compared with under 19 percent of the United States population enrolled in Medicare. 78 percent of Medicare beneficiaries in Kentucky are eligible due to age (ie, being at least 65), while the other 22 percent are eligible due to a disability. Kentucky is tied with Alabama, Mississippi, and Puerto Rico for having the highest percentage of its Medicare population eligible as a result of disability (the national average is 15 percent).
Medicare Advantage in Kentucky
29 percent of Kentucky Medicare beneficiaries selected private Medicare Advantage plans in 2018. That’s comparable to the national average, but a little lower: 34 percent of Medicare beneficiaries nationwide were enrolled in Medicare Advantage plans in 2018. The rest of the state’s Medicare beneficiaries had opted instead for coverage under Original Medicare.
Residents in Kentucky can choose from among up to 35 different Medicare Advantage plans in 2020, although some counties only have 10 or 12 Medicare Advantage plans available.
The annual enrollment period in the fall (October 15 to December 7) allows beneficiaries to switch from one Medicare Advantage plan to another, or from Medicare Advantage to Original Medicare or vice versa. There is also a Medicare Advantage open enrollment period (January 1 to March 31) during which people who are already enrolled in Medicare Advantage plans can switch to a different Medicare Advantage plan or drop their Medicare Advantage plan and enroll in Original Medicare instead.
Medigap in Kentucky
Medigap plans are used to supplement Original Medicare, covering some or all of the out-of-pocket costs (for coinsurance and deductibles) that people would otherwise incur if they only had Original Medicare on its own. Original Medicare does not have an upper cap on out-of-pocket costs, which makes supplemental coverage particularly important. More than half of Medicare beneficiaries nationwide have supplemental coverage through Medicaid or an employer-sponsored plan, but Medigap provides important protections for those who must purchase their own supplemental coverage.
In Kentucky in 2020, there are 57 insurers offering Medigap plans.
Medigap plans are standardized under federal rules, and people are granted a six-month window, when they turn 65 and enroll in Original Medicare, during which coverage is guaranteed issue for Medigap plans. But federal rules do not guarantee access to a Medigap plan if you’re under 65 and eligible for Medicare as a result of a disability. Two-thirds of the states have adopted rules to ensure at least some access to Medigap plans for disabled enrollees, but Kentucky is not among them. It’s possible that some of the 57 insurers that offer Medigap plans in Kentucky will consider an applicant who is disabled and under 65, but there is no guarantee. Enrollees can call the insurers directly, or reach out to the Kentucky State Health Insurance Assistance Program for assistance.
There are several states (Alaska, Iowa, Nebraska, North Dakota, South Carolina, Washington, and Wyoming) that don’t require private Medigap insurers to offer plans to people under 65, but that have maintained their pre-ACA high-risk pools in order to offer supplemental coverage to Medicare enrollees who are unable to obtain Medigap coverage. But Kentucky’s high-risk pool ceased operations in 2013.
Most disabled Medicare beneficiaries under age 65 have the option to enroll in Medicare Advantage plans, which do cap out-of-pocket costs and cannot discriminate based on an enrollee’s age or health status. There’s one exception however: Medicare Advantage plans do not have to accept new enrollees with end-stage renal disease.
Part D coverage in Kentucky
Original Medicare does not cover outpatient prescription drugs. But Medicare beneficiaries can get prescription coverage via a Medicare Advantage plan, an employer-sponsored plan (offered by a current or former employer), or a stand-alone Part D plan.
As of May 2020, 434,599 Medicare beneficiaries in Kentucky were enrolled in stand-alone Part D prescription drug plans. Another 295,379 had Medicare Part D incorporated with their Medicare Advantage coverage.
For 2020 coverage, there are 28 stand-alone Part D plans available in Kentucky, with premiums ranging from $13 to $75 per month.
Medicare spending in Kentucky
In 2018, Original Medicare spent an average of $10,136 per beneficiary in Kentucky (the analysis standardized the data to eliminate differences in payment rates from one area to another, but it was only based on Original Medicare spending, so it did not include costs for Medicare Advantage enrollees). The national average that year was $10,096 per enrollee, so Medicare spending in Kentucky was very much in line with the national average.
You can contact the Kentucky State Health Insurance Assistance Program for questions related to Medicare coverage in Kentucky.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.