Understanding The Differences Between Medicare Supplement Plans and Medicare Advantage Plans in the State of Kentucky

Understanding The Differences Between Medicare Supplement Plans and Medicare Advantage Plans in the State of Kentucky

Last updated on: November 08, 2022

Why do I need to know about Medicare Supplement plans and Medicare Advantage plans in Kentucky?

Most people are automatically enrolled in Original Medicare when they turn 65 (with some exceptions) in KY. Because many retirees have low income, they look forward to Medicare paying for their rising health care costs. However, Original Medicare doesn’t cover everything, a fact that comes as a surprise to many seniors. Part A of Original Medicare is hospital insurance. It covers inpatient hospital stays, skilled nursing facilities, home health care, hospice care, etc. Part B is medical insurance. It covers doctor visits, ambulance rides, preventative screening tests, etc. Part A and B do not cover copayments, coinsurance, or deductibles, and they also do not cover certain benefits such as dental care, vision care, prescription drugs, or overseas emergency care in KY. Seniors who only have Original Medicare can find themselves paying thousands of dollars every year out of pocket.

That’s why it is important to have some sort of additional insurance in KY. The two options available are Medicare Supplement insurance (also known as Medigap insurance) and Medicare Advantage (MA/Part C) insurance. One type is supplemental coverage, filling in the gaps that Original Medicare doesn’t cover through a private insurer; the other type is alternative coverage, a way to get the same benefits through a private insurer. You need to have either a Medigap plan or an MA plan in order to keep your healthcare costs manageable, but you can’t have both in Kentucky. Learn about the differences so you can make an informed choice and get peace of mind about your healthcare coverage!

What is a Kentucky Medicare Supplement Plan?

Medicare Supplement plans, or Medigap plans, do exactly what they sound like they do – fill in the gaps left by your Original Medicare. You pay a monthly premium for the Medicare Supplement plan in addition to the monthly Part B premium that you continue to pay. When you have a covered medical expense in Kentucky, Medicare will pay the approved amount, and then your Medigap policy will pay its share to supplement the remaining cost. You don’t pay for anything except for your plan premium.

There are 10 Medigap plan types, but only 8 are available to new enrollees (Plans C and F began to be phased out as of January 1, 2020.) These plans are standarized in most states including Kentucky, meaning that the product is the same – the only difference is the price. All standardized Medicare Supplement policies are guaranteed renewable, meaning that insurance carriers can’t cancel your policy so long as you pay your premium on time. Medicare Supplement plans only cover one person in KY, not spouses or families. These plans do not cover prescription drug coverage, long-term care, vision care, dental care, hearing care, or private-duty nursing.

What is a Kentucky Medicare Advantage Plan?

Medicare Advantage plans in KY are ways to get your Original Medicare benefits and additional benefits through a private insurance carrier instead of the federally administered program. These plans (also known as Part C) replace Part A and Part B coverage; the plan you choose will bundle all of your coverage (Part A, Part B, and Part D, which is prescription drug coverage) into one plan in Kentucky. Some MA plans offer vision care, hearing care, and dental care as well. Each month, Medicare pays a fixed amount for your care to carriers offering Medicare Advantage plans. You continue to pay your Part B premium as well as the premium for your Medicare Advantage plan (which may be as low as $0).

There are several different types of Medicare Advantage plans in Kentucky, including Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPO), Private Fee for Service Plans (PFFSs), Special Needs Plans (SNPs), HMO Point of Service Plans (HMOPOSs), and Medical Savings Accounts (MSAs). Medicare Advantage plans do require your providers to be in-network, but it caps your annual out-of-pocket spending (unlike with Original Medicare).

What are the key differences?

The two products are fundamentally different, but here are the key differences between Medicare Supplement plans and Medicare Advantage plans to help you decide which is the best fit for your health needs and budget:

  • With Medigap insurance, the only difference between carriers is price, because all of the plans are standardized in KY. With Medicare Advantage, there are more differences between plans, so you’ll need to compare plans more carefully.
  • Medicare Advantage premiums will usually be lower than Medicare Supplement premiums.
  • Medicare Supplement plans require you to pay your Part B deductible; MA plans may not (both plans require you to pay the Part B premium).
  • Medicare Advantage plans generally cover prescription drugs, and hearing/dental/vision; Medigap does not.
  • Medigap coverage allows you to choose any doctor/provider. Medicare Advantage plans restrict your choices to their network in Kentucky.
  • Medicare Supplement plans usually cover all copayments and coinsurance. Medicare Advantage plans may require you to pay these costs out-of-pocket.

There are a number of factors that you should consider before choosing either a Medigap plan or a Medicare Advantage plan in Kentucky, including local convenience, frequency of travel, provider preference, and more.

You can compare Medicare Supplement plans in Kentucky at this link, or speak to an agent about what type of supplemental/alternative insurance will be best for your situation and lifestyle!

Categories: Medicare Articles, Medicare Part C, Medicare Advantage Plan Types
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