If you’re approaching age 65, you may be looking into Medicare coverage and researching which plan is right for you.
If you’re debating between Original Medicare or a Medicare Advantage plan, you should compare premiums, copayments, and deductibles.
If you have a certain medication that you must take that is expensive, you should also compare how much toward that medication each policy pays so you can find the plan that saves you the most money.
In this guide, we will answer the most common question we hear about Medicare in Kentucky to help you make an informed decision about your Medicare coverage.
Medicare is a federal program and you become eligible for benefits at 65 in Kentucky just like every other state.
You should apply for Medicare three months prior to your 65th birthday if you do not already receive retirement or disability benefits from the Social Security Administration.
You do not have to be on Social Security in order to receive Medicare, but you will have to apply for it – you won't automatically receive it.
Some individuals can qualify for Medicare early with certain disabilities. You also have to have been on disability for 24 months before you can become eligible for Medicare. However, if you have ALS or end-stage renal disease, you can apply and qualify for Medicare as soon as you receive your diagnosis.
Medicare has several parts and costs vary based on the type of plan.
Part A Premiums
Medicare Part A is premium-free for most people. However, if you have not worked enough quarters, you have to pay for Part A premiums. At 40 quarters, Part A is free. If you worked 30 to 39 quarters, the Part A premium is $274 in 2022. If you worked less than 30 quarters, the premium is $499 in 2022.
The deductible for Part A is $1,556 in 2022 – for each benefit period. A benefit period is the time you sequentially use Part A. For the first 60 days, you do not have to pay a copayment. For days 61 through 90, the copayment is $389 per day in 2022.
For days 61 through 90, the copayment is $389 per day in 2022. If you use benefits for 91 or more days, the copayment is $778 for each lifetime reserve day in 2022. You will receive 60 lifetime reserve days to use with your Part A plan.
Once you use up all of your lifetime reserve days, you must pay the full amount of your hospital care.
Part B Premiums
You will receive Part B automatically. If you do not want Part B, you must send the form back to Social Security stating that you do not want Part B. The premiums for Part B are $170.10 for 2022. The deductible is $233 in 2022. You also pay – in most cases – 20 percent of anything Medicare Part B approves for doctors, medical equipment, and outpatient therapy.
Part C Premiums
Part C is for Medicare Advantage plans. The premiums and deductions depend on the plan and insurance company you choose.
Part D Premiums
Part D also has separate plans. The premium and deductible vary based on the plan you choose. You can obtain Medicare Part D through an Advantage Plan, buy it as a stand-alone plan, or through an employer-sponsored plan.
You can change your plan yearly during Medicare's annual enrollment period (AEP) from October 15 through December 7. When you choose a new plan, it does not go into effect until January 1.
Modified Adjust Gross Income
In addition to the regular costs of Medicare, if you earn a higher income, you must pay a higher premium for Part B. The increased payments are on a sliding scale, which you can find here.
There is no income limit to receive Medicare in Kentucky. However, you can apply for help paying for Medicare premiums for Parts A and B through a Medicare Savings Program. If you are a qualified Medicare beneficiary (QMB), the Medicare Savings Program will help pay for copayments and premiums. If you make less than $1,063 per month and are single, or less than $1,437 per month, and are married, the Medicare Savings Program will help pay for Medicare copayments and premiums.
If you need help paying Part B premiums, you need to qualify for the Specified Low-Income Medicare Beneficiary (SMLB) program. You can make up to $1,276 per month if you are single and $1,724 per month if you are married.
Qualified Individuals (QI) is a program that also pays for Part B premiums. You must make less than $1,436 per month if you are single and $1,940 per month if you are married.
Finally, if you qualify as a Qualified Disabled Working Individual (QDWI), the program pays Part A premiums for some disabled people who return to work. The income limit under this program is 200 percent of the federal poverty level, which is $2,126 if you are living by yourself and $2,873 per month if you are living with someone else. It is difficult to meet the criteria as a Qualified Disabled Working Individual, so many people apply for Medicaid.
The program also has asset limits based on federal laws. For QMB, QI, and SLMB, you cannot have more than $7,860 in assets if you are single and $11,800 if you are married. The QDWI program's asset limit is $4,000 if you are living by yourself and $6,000 if you are living with someone else.
If you receive disability or retirement benefits from the Social Security Administration, you are already enrolled in Medicare because your application for Social Security serves as your application for Medicare.
If you are not receiving benefits, either because you did not work enough quarters or you elected to continue working, you have to apply for Medicare.
If you want to apply for just Medicare – not Social Security – you can do so through the Social Security Administration's website.
Yes, Medicare Advantage is available in Kentucky. There are more than four million people with a Medicare Advantage plan in Kentucky.
Medicare Advantage plans are offered through private insurers, so it’s important to compare the plans available to you and the coverage they offer. Once you find a plan that you believe fits your needs, including your financial needs, compare it to Original Medicare, including Parts A, B, D, and Medigap.
If you are ready to apply for Medicare or Medicare Advantage, you can compare plans near you. Once you choose the plan that works best for you, you can then compare the cost against Original Medicare. However, keep in mind that a Medicare Advantage plan might include vision and dental while Original Medicare does not provide this coverage.