Medicare in Kentucky: Plans and Coverage (2026)

Medicare in Kentucky runs on federal rules, with free SHIP counseling through CHFS/DAIL and a Medicaid-administered savings program that can cut your premiums to zero. This guide covers what Medicare costs in Kentucky for 2026, how each part works, and how to get help paying.1,2

In This Guide

• Key Facts for 2026
• Original Medicare in Kentucky: Parts A and B
• Medicare Advantage in Kentucky (Part C)
• Medicare Part D: Prescription Drugs
• Medigap in Kentucky
• Help Paying for Medicare in Kentucky
• Medicare Enrollment Periods
• Free Medicare Help: Kentucky SHIP
• Frequently Asked Questions

About these numbers: Premiums and deductibles below come from CMS for calendar year 2026, effective January 1. Medicare costs change every year, and CMS publishes each year's figures at medicare.gov.3 To reach a person about your own coverage, call 1-800-MEDICARE (1-800-633-4227), staffed 24 hours a day, 7 days a week except some federal holidays; TTY users call 1-877-486-2048.6 A Kentucky SHIP counselor can also work through the numbers with you at no charge.1

Original Medicare in Kentucky: Parts A and B

Original Medicare is administered directly by the federal government. The mechanics and costs are the same in Kentucky as in every other state.

Part A (Hospital Insurance)

Part A covers inpatient hospital stays, limited skilled nursing facility care, hospice, and some home health care.3

The hospital deductible rose $60 from 2025, to $1,736 per benefit period.3 A benefit period starts when you're admitted and ends once you've gone 60 days in a row without inpatient hospital care or skilled care in a nursing facility. Get readmitted after that and the deductible resets.

Part B (Medical Insurance)

Part B covers doctor visits, outpatient care, preventive services, durable medical equipment, and mental health care. Part B does not cover routine dental, vision, or hearing.7 Most Medicare Advantage plans offer routine dental, vision, and hearing benefits instead, so check what a specific plan actually covers before you count on it.8

• Monthly premium: $202.90 (higher if your 2024 income exceeded $109,000 single or $218,000 married, under IRMAA)3
• Annual deductible: $2833
• After the deductible: you pay 20% of the Medicare-approved amount for most services3

Delay Part B past your enrollment window without qualifying for a Special Enrollment Period or a Medicare Savings Program and you owe a permanent late penalty of 10% for every 12 months you could have had it.9

Medicare Advantage in Kentucky (Part C)

Medicare Advantage plans are sold by private insurers as an alternative to Original Medicare. They cover everything Parts A and B do, except hospice, which Original Medicare keeps covering. Most bundle in Part D drug coverage along with extras like dental, vision, and hearing.8

Plan availability varies significantly across Kentucky. Louisville and Lexington metro areas generally offer a wider choice of plans. Rural Kentucky, particularly in the Appalachian counties of Eastern Kentucky, tends to have fewer options. Plan networks, premiums, and drug formularies differ by county and change annually.

How These Plans Work

• You continue paying your Part B premium ($202.90) on top of any plan premium, though CMS says some plans may help pay all or part of it. The CMS estimate for the average Medicare Advantage premium in 2026 is about $14 a month, and many plans charge $0 extra.3,8
• Most plans run on networks (HMO or PPO). Confirm your providers are in-network before enrolling. Emergency care, out-of-area urgent care, and temporary out-of-area dialysis are covered whether you get them in the plan's network or outside it.8
• Plans typically require prior authorization for certain services, which Original Medicare generally does not.8
• Every plan caps annual in-network out-of-pocket spending (federally limited to $9,250 in 2026; many plans set a lower cap). Original Medicare has no such cap. CMS puts it this way: there is no yearly limit on what you pay out of pocket unless you have supplemental coverage like Medigap, Medicaid, employer, retiree, or union coverage. With none of those, your exposure is open-ended.8

Use the Medicare Plan Finder at medicare.gov to compare plans by ZIP code. Enter your doctors and prescriptions to see what each plan covers and your estimated annual cost. Kentucky SHIP counselors can walk through those results with you at no charge.

Medicare Part D: Prescription Drugs

Part D covers outpatient prescription drugs. You can get it as a standalone plan paired with Original Medicare, or bundled into a Medicare Advantage plan.

The Inflation Reduction Act eliminated the old coverage gap, so the donut hole no longer exists.4 Part D now moves through three phases:

1. Deductible: you pay full price until you meet your plan's deductible (up to $615 in 2026).10
2. Initial coverage: you pay copays or coinsurance while your plan and drug manufacturers cover the rest.
3. Catastrophic: once your out-of-pocket spending reaches $2,100, you pay $0 for covered drugs for the rest of the year.4

The $2,100 cap is the most important number in Part D for 2026. It was $2,000 in 2025 and adjusts annually. The average standalone Part D premium is about $34.50 a month, though plan premiums vary widely.3 Every plan also offers the Medicare Prescription Payment Plan, which lets you spread out-of-pocket drug costs into capped monthly payments across the year instead of paying in full at the pharmacy.4 People who qualify for Extra Help often pay far less, sometimes $0.

Medigap in Kentucky

Medigap policies are sold by private insurers and fill the cost-sharing gaps in Original Medicare, including deductibles, coinsurance, and copays. They work with Original Medicare, and a Medigap policy can't pay a Medicare Advantage plan's copays, coinsurance, deductibles, or premiums.8

Kentucky offers the full set of federally standardized plans, labeled A-D, F, G, and K-N, regulated by the Kentucky Department of Insurance.11 Plans C and F are closed to anyone who became Medicare-eligible on or after January 1, 2020. Plan G is the plan a Kentuckian newly eligible today can buy in Plan F's place: it covers the Part A deductible, Part A and Part B coinsurance, and skilled nursing facility coinsurance, leaving only the $283 Part B deductible as your responsibility.12,11,3

Your strongest entry point is the federal Medigap Open Enrollment Period, the six months beginning when you turn 65 and enroll in Part B. During that window, an insurer must sell you any plan at the standard rate regardless of your health history.11 Outside that window, Kentucky insurers may use medical underwriting, meaning they can review your health, charge more, or decline you.

Kentucky also has a Medigap birthday rule (KRS 304.14-525, effective January 1, 2024): once a year, within 60 days after your birthday, a current policyholder can move the same plan letter to a different insurer with no medical underwriting. It is a plan-for-plan replacement (for example, Plan G to Plan G), not a way to change benefit levels.5 The same law also created a new six-month open enrollment period for people under age 65 who are newly eligible for Medicare.5

Medigap or Medicare Advantage?

You cannot run both at once: a Medigap policy can't pay your Medicare Advantage copays, coinsurance, deductibles, or premiums, and while you're in an Advantage plan it's illegal for anyone to sell you one unless you're switching back to Original Medicare. Choose Medigap and you stay on Original Medicare with the freedom to see any provider who accepts Medicare nationwide, at a higher monthly premium. Choose Medicare Advantage and you trade some of that flexibility for a plan network and potentially lower upfront cost. That first choice isn't permanent, though. If this is your first Medicare Advantage plan and it doesn't suit you, federal law gives you a trial right to buy a Medigap policy and a separate drug plan as long as you return to Original Medicare within 12 months of joining; if you dropped a Medigap policy to join, you may be able to get that same policy back if the company still sells it, or another policy sold by a Kentucky insurer if it doesn't. Wait past that window and in most cases you can't get the old policy back, and you may not be able to get any Medigap policy at all.8 For a comparison, see our guide to Original Medicare vs. Medicare Advantage.

Help Paying for Medicare in Kentucky

Two programs can substantially reduce Medicare costs for people with limited income and resources.

Medicare Savings Programs

Kentucky administers the Medicare Savings Programs through Kentucky CHFS Medicaid, using the standard federal income tiers and resource limits.2

Those are the figures a Kentucky applicant is actually measured against, and they run $20 above the ones printed on Kentucky's own MAP-16 fact sheet, which lists $1,330 / $1,804 for QMB, $1,596 / $2,164 for SLMB and $1,796 / $2,435 for QI-1. The $20 is the general income disregard, and Kentucky's screening page applies it the other way, as a deduction: "When figuring out your income, do not include $20. The first $20 does not count against you." Use the higher numbers.2 QMB is the most valuable: it pays Medicare Part A and Part B premiums, deductibles and coinsurance, and bars providers from balance-billing you; SLMB and QI-1 pay the Part B premium only. For all three the 2026 resource limit is $9,950 for one person and $14,910 for a couple.2

Both tests are on what Kentucky counts, not on your gross income or everything you own. Countable resources include, but are not limited to, checking accounts, savings accounts, stocks, bonds, certificates of deposit, annuities, trusts and life insurance policies, and some resources may be excluded under Medicaid's exemption criteria, including the home you live in, the vehicle you drive, or up to $1,500 for burial expenses or life insurance. Kentucky's Medicaid agency makes the determination, and Social Security instructs its own staff that "Even if the individual's income or resources appear somewhat higher than the state limits, encourage them to apply for the MSPs." If you are anywhere near a line, apply. The income limits update annually with the Federal Poverty Level.2

To apply, call your local Department for Community Based Services (DCBS) office, or fill out the Kentucky Medicare Savings Program application and send it to that office. If you are eligible for Medicare Part A but do not have it because you cannot afford the premium, contact Social Security to file for actual or conditional Part A first, since that is what opens QMB to you.2 Enrolling in QMB, SLMB, or QI automatically qualifies you for Extra Help with Part D.2 QDWI, the fourth Medicare Savings Program, is the exception: it pays the Part A premium for certain working people with disabilities who lost premium-free Part A, and it does not confer Extra Help, so a QDWI enrollee who wants Extra Help has to apply through Social Security.2,13

Extra Help for Part D

Extra Help, also called the Low-Income Subsidy, pays Part D premiums, deductibles, and copays for people with limited income and resources.13 Since 2024, the partial-subsidy tier was eliminated, so everyone who qualifies now receives the full subsidy.

• Income limit (2026): up to about $1,995 a month for an individual, $2,705 for a couple (the limits for the 48 contiguous states and DC, Kentucky included; Alaska and Hawaii are higher)13
• Resource limits: $16,590 for an individual, $33,100 for a married couple, or $18,090 and $36,100 if you tell Social Security you expect to use some of your resources for burial expenses13
• If you qualify for QMB, SLMB, or QI, you're enrolled in Extra Help automatically2

Apply through Social Security or call 1-800-772-1213.13

Medicare Enrollment Periods

These deadlines are federal and apply the same way in Kentucky as everywhere else.14

The General Enrollment Period and the working-past-65 Special Enrollment Period in the table above are set by federal rule and run the same way in Kentucky as everywhere else. COBRA and retiree coverage do not count as coverage based on current employment for that window, and if you're self-employed or your plan isn't available to everyone at the company, ask your insurer whether it qualifies before you delay; if it doesn't, sign up at 65. That Special Enrollment Period does not apply if you're eligible for Medicare based on End-Stage Renal Disease (ESRD).15,14 Changes made during Annual Open Enrollment take effect January 1. If you're already receiving Social Security before 65, you're enrolled in Parts A and B automatically. Otherwise you sign up through the Social Security Administration.14

If you missed your Initial Enrollment Period and don't qualify for a Special Enrollment Period, use the General Enrollment Period (January 1 through March 31). Coverage starts the first day of the month after you sign up. A late-enrollment penalty may still apply.15,9

Free Medicare Help: Kentucky SHIP

You don't have to sort through these options alone. Kentucky runs a State Health Insurance Assistance Program (SHIP), administered by the Kentucky Cabinet for Health and Family Services (CHFS) through the Department for Aging and Independent Living (DAIL). SHIP counseling comes from local, well-trained counselors, costs nothing, and covers all 120 Kentucky counties; SHIP does not sell any health insurance products.1

A Kentucky SHIP counselor can help you:

• Understand what Parts A, B, C, and D cover and what each costs
• Compare Medicare Advantage and Medigap plan options
• Apply for the Medicare Savings Programs and Extra Help
• Work through billing problems, claim denials, and appeals

To reach a counselor, call the statewide SHIP Hotline at 1-877-293-7447 and choose option 2, or call DAIL at 1-502-564-6930 and ask for a SHIP counselor. The program page is at chfs.ky.gov/agencies/dail/pages/ship.aspx.1

Key Kentucky Medicare Contacts

Learn More

Find personalized help comparing your Medicare plan options in Kentucky at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.