October 6, 2016
Kentucky residents with Original Medicare may have options for receiving their Medicare benefits. Medicare beneficiaries can get their coverage through Original Medicare or from a private insurance company that offers Medicare plans in Kentucky. Availability and costs of Medicare plans offered by private insurance companies can vary depending on where you live.
Original Medicare for Kentucky beneficiaries
Original Medicare is the federal government program that provides health insurance for seniors and people under the age of 65 with certain disabilities. Original Medicare includes standardized benefits, which are available to beneficiaries in Kentucky and throughout the United States.
Original Medicare comes in two parts, Part A (hospital insurance) and Part B (medical insurance). Part A covers inpatient services, including hospital and skilled nursing facility stays, limited home health care, and hospice care. Part B covers outpatient services, including doctor exams, preventive screenings, durable medical equipment, and other medically necessary services and supplies.
If you have Original Medicare in Kentucky, you can visit any doctor or provider in the country that accepts Medicare. Coverage outside of the United States is limited, and you generally won’t be covered except in emergencies.
You are eligible for Medicare if:
- You are 65 or older and
- You are a United States citizen or permanent legal resident.
- You receive disability benefits, have end-stage renal disease (ESRD), or have amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease). Disabled individuals can get Medicare regardless of age, if they’re collecting disability benefits from the Social Security Administration or the Railroad Retirement Board.
Medicare-eligible individuals can apply for the program through the Social Security Administration (SSA). If you are applying for retirement benefits, you can enroll in Medicare at the same time:
- Online at the Social Security website. Individuals applying for Medicare only (as opposed to applying for SSA benefits as well) can use this application.
- By calling Social Security at 1-800-772-1213. If you are a TTY user, you can call 1-800-325-0778. SSA representatives can be reached Monday through Friday, from 7AM to 7PM.
- In person at a local Social Security office. To look up office locations in Kentucky, click here.
Medicare beneficiaries in Kentucky, as in the rest of the country, can apply for Original Medicare, Parts A and B during the following enrollment periods:
- Initial Enrollment Period: This is the seven-month period when most individuals are first eligible to enroll in Part A and/or Part B. It begins three months before you turn 65, includes the month of your 65th birthday, and ends three months later.
- General Enrollment Period: This enrollment period occurs annually from January 1 to March 31, and the effective date for your coverage would be July 1. If you didn’t sign up when you were first eligible and don’t qualify for a Special Enrollment Period, you may have to pay a late enrollment penalty for Part A and/or Part B for as long as you are enrolled.
- Special Enrollment Period: If you delayed Part A and/or B because you had coverage through an employer-sponsored health plan, you can sign up for Medicare under a Special Enrollment Period when that coverage or employment ends. You don’t have to pay a penalty for Part B as long as you sign up during the eight-month Special Enrollment Period.
Medicare coverage options in Kentucky
Original Medicare Part A and Part B doesn’t provide coverage for every health service. It doesn’t cover long-term care, vision, dental, or prescription medications, for example. Furthermore, the deductibles and coinsurance amounts that apply to benefits under Original Medicare may result in high out-of-pocket expenses for individuals enrolled in Part A and/or Part B.
However, you may be able to obtain some of these additional benefits to your Medicare coverage through alternative means. In Kentucky, a variety of Medicare plans, offered by private insurance companies contracted with Medicare, are available. Your options as a Medicare beneficiary in Kentucky will depend on where you live, since not all plans may be available in every location within the state.
- Medicare Advantage (Part C): Medicare Advantage plans are offered by private insurance companies that contract with the Centers for Medicare & Medicaid Services (CMS) to provide Medicare Part A and Part B coverage (except for hospice care which remains covered under Medicare Part A). Medicare Advantage plans are required to include a maximum out-of-pocket spending limit, which can vary from plan to plan. Once your out-of-pocket expenses have reached this amount (including the deductible), the Medicare Advantage plan pays 100% of covered health-care costs for the rest of the year. Medicare Advantage plans may also cover extra benefits such as routine dental, vision care, hearing care. Some plans, known as Medicare Advantage Prescription Drug plans, also include prescription drug coverage. To be eligible for Medicare Part C, you must be entitled to or enrolled in Medicare Part and Medicare Part B, and live in the Medicare Advantage plan’s service area. You’ll need to keep paying your Medicare Part B premium in addition to any premium required by your Medicare Advantage plan.
- Medicare Part D (prescription drug coverage):Because Original Medicare does not include prescription drug coverage, many Medicare beneficiaries chose to purchase prescription drug coverage from a Medicare Advantage Prescription Drug plan or from a stand-alone Part D Prescription Drug Plan in order to receive Medicare Part D benefits. Whether you get your Medicare prescription drug coverage by enrolling in a Medicare Advantage Prescription Drug plan or by signing up for a stand-alone Medicare Part D Prescription Drug Plan, the insurer will have a formulary, which is a list of prescription medications covered by that plan. Formularies vary by plan, so it’s a good idea to check to see if your medication is on the plan’s formulary. Also, the formulary can change at any time. You will receive notice from your plan when necessary. You may have to pay a premium for your prescription drug coverage (unless you qualify for “Extra Help”) and if you have Medicare Part B, you must continue paying your Part B premium as well.
- Medicare Supplement (Medigap): Medicare Supplement Insurance plans are available to Medicare beneficiaries in Kentucky. If you decide to stay with Original Medicare (Part A and Part B), you may have the option to sign up for a Medicare Supplement (Medigap) plan to help pay for Original Medicare’s out-of-pocket costs. You can only use Medicare Supplement plans to pay for Medicare Part A and Part B costs; these plans don’t work with Medicare Advantage. Different Medicare Supplement plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles. Medicare Supplement plans in Kentucky offer a number of standardized benefits, identified by letter. Standardized benefits means that benefit plans of the same letter offer the same benefits no matter which insurance carrier offers the plan, although some companies may offer additional innovative benefits. Premiums can differ widely between insurance companies offering the same benefit plan so it is a good idea to shop for the best value in terms of coverage and cost.
Kentucky resources for Medicare beneficiaries
For more information on Medicare and state resources, Medicare.gov refers Kentucky residents to the following links:
- Kentucky Department of Insurance: Medicare beneficiaries can look up consumer information on health insurance companies, including ratings and complaints. Contact the department at 1-502-564-3630; TTY users can call 1-800-648-6056 Monday through Friday, 8AM-4:30PM.
Learn more about how Medicare plans work in Kentucky, including:
Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program.