- Nearly 21 percent of residents are enrolled in Medicare in Kentucky.
- 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. The state does not require Medigap plans to be guaranteed-issue for Medicare beneficiaries under the age of 65, so insurers can use medical underwriting for this population.
- Nearly half of the beneficiaries of Medicare in Kentucky have stand-alone Part D prescription coverage.
- Per-enrollee spending for Medicare in Kentucky is roughly the same as the national average.
Medicare enrollment in Kentucky
As of September 2020, there were 943,466 people enrolled in Medicare in Kentucky. That’s about 21 percent of the state’s total population, compared with about 19 percent of the United States population covered by Medicare.
Medicare eligibility depends mostly on age, but some beneficiaries are eligible because of a disability. 78 percent of Kentucky’s Medicare population is is eligible due to age (ie, being at least 65), while the other 22 percent are eligible due to a disability (including ALS or ends-stage renal disease). Kentucky is tied with Alabama, Arkansas, 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 was 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, which is Medicare Part A and Part B, administered directly by the United States government.
By the fall of 2020, about 39 percent of Kentucky’s Medicare beneficiaries had private coverage (Advantage plans), which was very much in line with the 40 percent national average by that point (the national numbers for private Medicare plans include a small number of people who have Medicare cost plans, but these are not available in Kentucky).
Medicare Advantage plans provide all of the benefits of Original Medicare, including hospital and outpatient/physician care (but the out-of-pocket costs can vary considerably from what they’d be under Original Medicare). Most Advantage plans also include Medicare Part D coverage for prescription drugs, and many include extra programs like gym memberships, nurse hotlines, and coverage for dental and vision services. But provider networks tend to be more limited with Advantage plans, and out-of-pocket costs vary from one plan to another. There are pros and cons to either option, and different solutions that work for different people.
Medicare Advantage plans offered by private health insurers that have varying service areas, so plan availability varies from one part of the state to another. In some counties, there are more than 40 plans available for 2021 (and as many as 45 in Jefferson County) although some counties only have 14 or 15 Medicare Advantage plans available.
The annual open enrollment period in the fall (October 15 to December 7) allows beneficiaries to switch their Medicare Advantage enrollment from one plan to another, or to change 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 enrollment and receive coverage through Original Medicare instead.
Medigap in Kentucky
Medigap plans are used to supplement Original Medicare, covering some or all of the out-of-pocket medical 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 healthcare 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 healthcare coverage.
In Kentucky as of 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; the state’s Medicare supplement guide notes that insurers can use medical underwriting when an applicant is under age 65, even if they apply during the first six months after enrolling in Medicare.
The Medicare plan finder tool shows numerous Medigap plans available to a person under age 65 in Kentucky (in other states where the state doesn’t have rules to require this, availability of Medigap plans for people under age 65 tends to be very limited, with perhaps only one or two insurers voluntarily offering plans). But the Kentucky Department of Insurance confirmed that the state’s Medigap insurers are allowed to use medical underwriting when a person is applying outside of their Medigap initial enrollment period, and that applies to everyone under the age of 65 (since the Medigap initial enrollment period doesn’t begin until a person is at least 65).
The Department of Insurance noted that although KY Rev. Stat. § 304.17-311 has, for many years, required insurers to “make available upon request Medicare supplement insurance for persons not eligible for Medicare by reason of age,” this does not mean that the plans are guaranteed issue. “Make available” in this case just means that the insurer has to allow people to submit an application. But the application can be rejected if the person does not meet the insurer’s underwriting guidelines.
And if an applicant is approved for Medigap coverage under the age of 65, the prices are higher for those plans than they would be for a 65-year-old applicant. 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.
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. All Medicare beneficiaries are eligible for Medicare Advantage plans if the plans are available in their area. As of 2021, this includes people with end-stage renal disease (ESRD; kidney failure). This population’s access to coverage was helped by the 21st Century Cures Act, which makes Medicare Advantage plans guaranteed-issue for beneficiaries with kidney failure as of 2021 (prior to 2021, people with kidney failure could not join an Advantage plan unless there was an ESRD special needs plan available in their area).
Kentucky Medicare Part D
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 Medicare Part D plan.
As of September 2020, 433,240 beneficiaries of Medicare in Kentucky were enrolled in stand-alone Medicare Part D plans. Another 304,582 had Medicare Part D incorporated with their Medicare Advantage coverage, with the Advantage plan providing coverage for their prescription drugs.
For 2021 coverage, there are 30 stand-alone Medicare Part D plans available in Kentucky, with premiums ranging from $7 to $82 per month.
Medicare’s annual open enrollment period in the fall (October 15 to December 7) is an opportunity for people to change their Part D coverage for the coming year. Medicare Part D enrollment selections made during this window take effect on January 1.
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 spending on Medicare in Kentucky was very much in line with the national average.
How does Medicaid provide financial assistance to Medicare beneficiaries in Kentucky?
Many Medicare beneficiaries receive assistance through Medicaid with the cost of Medicare premiums, prescription drug expenses, and services not covered by Medicare – such as long-term care.
Our guide to financial assistance for Medicare enrollees in Kentucky includes overviews of these benefits, including long-term care coverage, Medicare Savings Programs, and eligibility guidelines for assistance.
Medicare in Kentucky: Resources for beneficiaries and their caregivers
You can contact the Kentucky State Health Insurance Assistance Program for questions and information related to Medicare coverage in Kentucky, Medicare eligibility in Kentucky, or for help understanding your benefits or the process of filing for Medicare benefits.
The Kentucky Department of Insurance regulates and licenses the state’s health insurance companies and the brokers/agents who sell policies in Kentucky. They can answer questions, provide consumers with information and assistance, and address complaints about the entities they oversee.
This overview of how Kentucky Medicaid can help Medicare beneficiaries with low income and low asset levels is a useful resource for beneficiaries and their caregivers.
The Medicare Rights Center is a nationwide service, with a website and call center, that can provide assistance and information related to a variety of Medicare questions and scenarios.
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.