In Kentucky, the federal Medicare program provides affordable healthcare for almost 950,000 people who are 65 or older. In addition to a monthly premium, Kentucky Medicare beneficiaries receive free yearly eye exams, preventive dental care, and limited coverage for prescription drugs. Some Kentucky Medicare beneficiaries have additional needs and qualify for Medicaid, which offers four Medicare Savings Programs to help with costs not covered by Medicare.
Kentucky residents can choose from Original Medicare, a private Medicare Advantage plan, or a Medigap policy. Medigap policies are designed to fill in the gaps that original Medicare doesn’t cover, such as copays and coinsurance. Medicare Advantage plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations, and Private Fee-for-Service Plans. They can also offer drug coverage through Medicare Part D prescription drug plans. Some Medicare Advantage Plans may also include special needs services. Kentucky residents are eligible for a Medicare Savings Program if they meet certain income and asset limits.
Kentucky Medicare Eligibility
Each state runs its Medicaid program differently, but all states must follow federal requirements when it comes to eligibility. Kentucky limits nursing home and HCBS enrollees’ home equity to a minimum of $688,000, and it requires nursing home applicants to spend most of their income toward care expenses before receiving benefits. In addition, it allows seniors to deposit their income into a Qualified Income Trust (also known as a Miller Trust) and not count it when determining Medicaid eligibility.
Those who are above the limit for regular Medicaid ABD but not for SSI can use their medical bills to reduce their countable assets and become eligible. This is called the “spend down” program and covers three months of expenses at a time. Countable assets include bank accounts, investment and retirement accounts, and personal property. However, a homeowner’s home does not count, and some irrevocable trusts are non-countable as well.
How to Enroll in Kentucky Medicare?
Signing up for Kentucky Medicare is a big decision. There are many factors to consider, including whether you should sign up during a special enrollment period or wait until you’re eligible for coverage. A licensed Kentucky Medicare advisor can help you understand your options and choose the plan that’s best for you.
After you’ve signed up for Medicare Part A and Medicare Part B, you can add extra coverage, such as prescription drug coverage or dental and vision insurance. These plans are offered by private regional and national health insurers, which are approved by Medicare. You can also purchase a Medigap policy to help pay for expenses not covered by Medicare.
To enroll in Medicare, you’ll need to provide documents that prove your age, citizenship, work history, and military service (if applicable). You may be asked for original copies of these documents, so keeping them in a safe place is a good idea.
Unlike most other health insurance, Medicaid beneficiaries are required to enroll in a managed care plan when they qualify for the program. During the first 90 days after their enrollment, mandatory enrollees can change their plan for any reason. Before choosing a plan, it is important to consider your coverage area, doctors you see regularly, and your specific health needs.
What is the Difference Between Medicaid and Medicare in Kentucky?
Here is a table to show the differences between Kentucky Medicare and Medicaid:
| Feature | Medicare | Medicaid |
|---|---|---|
| Eligibility | Age 65+, disability | Low-income, pregnant women, children, some disabled adults |
| Funded by | Payroll taxes, beneficiary premiums | Federal & state governments |
| Covered services | Hospital stays, doctor visits, optional parts (Advantage & prescription drugs) | Varies, often broader than Medicare |
| Cost-sharing | Deductibles, copayments, coinsurance | Low or no cost-sharing |