Medicare in Kentucky: Key takeaways
- There were 912,417 Kentucky residents enrolled in Medicare as of November 2018.
- 77 percent of Medicare beneficiaries in Kentucky are eligible due to age.
- As of 2016, Medicare paid about $9,449 annually per enrollee in Kentucky.
- In 2017 in Kentucky, 28 percent of all Medicare recipients chose a Medicare Advantage plan.
- There were 62 insurers offering Medigap plans in 2018 in Kentucky.
- 465,879 Medicare beneficiaries in Kentucky were enrolled in stand-alone Part D prescription drug plans as of November 2018.
Total Medicare enrollment in Kentucky
There were 912,417 Kentucky residents enrolled in Medicare as of November 2018 — more than 20 percent of the state’s total population, compared with a little more than 18 percent of the United States population enrolled in Medicare.
Breakdown of the aged vs. disabled
77 percent of Medicare beneficiaries in Kentucky are eligible due to age (ie, being at least 65), while the other 23 percent are eligible due to a disability. That’s the highest percentage of disabled Medicare beneficiaries in the country, although 23 percent of Medicare beneficiaries in Alabama, Mississippi, and Puerto Rico are also eligible for Medicare due to a disability.
Nationwide, 16 percent of all Medicare beneficaries are eligible due to a disability. At 9 percent, Hawaii has the smallest percentage of disability-eligible Medicare beneficiaries.
Medicare spending per recipient
As of 2016, Medicare paid about $9,449 annually per enrollee in Kentucky. That’s according to a standardized spending report from CMS, which eliminates spending differences that stem from strictly geographic differences in costs (eg, higher labor costs or overhead expenses in higher cost-of-living areas). The report only considers Original Medicare spending, as opposed to Medicare Advantage.
The national average per-enrollee spending was $9,533 in 2016, so Medicare spending in Kentucky was a little below the national average. Louisiana had the highest per-capita Medicare spending, at $11,399, while Hawaii had the lowest, at $6,441.
Medicare Advantage in Kentucky
Medicare Advantage offers health benefits for Medicare beneficiaries through private plans instead of through Original — or traditional — Medicare (the federal government’s fee-for-service program).
Some Medicare Advantage plans are available with no premium other than the cost of Part B, but they also have provider networks that are more limited than Original Medicare, and total out-of-pocket costs can be considerably higher than enrollees would pay if they had Original Medicare plus a Part D plan plus Medigap. In short, there are pros and cons to either option, and enrollees need to carefully consider what coverage will best fit their needs.
Residents in Kentucky can choose from between four and 26 different Medicare Advantage plans for 2019, depending on where they live (plan availability varies by county). And as of 2019, there’s 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.
In 2017 in Kentucky, 28 percent of all Medicare recipients chose a Medicare Advantage plan. Nationwide, 31 percent of Medicare beneficiaries are enrolled in a Medicare Advantage program.
Minnesota is the only state where more than half (56 percent) of Medicare eligibles enrolled in a Medicare Advantage plan. On the other end of the spectrum, just 1 percent of Medicare beneficiaries in Alaska are enrolled in Medicare Advantage plans.
Medigap in Kentucky
Because Original Medicare doesn’t cover everything, enrollees generally opt for supplemental coverage as well. Medigap plans cover 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.
There were 62 insurers offering Medigap plans in 2018 in Kentucky, although some only offer coverage in certain areas of the state.
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 there’s no federal requirement that Medigap plans be guaranteed-issue for enrollees under age 65 who are eligible for Medicare as a result of a disability. More than half of the states have adopted rules to ensure at least some access to Medigap plans for disabled enrollees, but Kentucky is not among them.
Stand-alone Medicare Prescription Drug plans
465,879 Medicare beneficiaries in Kentucky were enrolled in stand-alone Part D prescription drug plans as of November 2018. That’s about 51 percent of the state’s total Medicare beneficiaries, as opposed to less than 43 percent of all Medicare beneficiaries nationwide enrolled in stand-alone Part D plans.
There are 26 stand-alone Part D plans available in Kentucky in 2019, with premiums ranging from $16 to $92 per month.
Medicare prescription drug coverage — called Medicare Part D — was the result of legislation passed in 2003 and signed into law by President George W. Bush in 2006. By the end of its first decade, Medicare Part D was providing coverage for almost three quarters of all eligible Medicare beneficiaries, including those who have Part D coverage as part of their Medicare Advantage plan).
Coverage for those under 65 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.