Turning 65 soon — or already on Medicare and unsure if you have the right plan? This free local guide covers every Medicare option available to Boone, Kenton, Campbell, and Hamilton County residents, with county-specific resources and free SHIP counselor contacts.
Medicare has four main parts plus supplemental coverage. Understanding what each covers — and what it doesn't — is the foundation of making a smart choice for your situation.
Part A covers inpatient hospital care, skilled nursing facility care after a qualifying hospital stay, hospice, and some home health. Most people pay $0 premium if they (or a spouse) worked 40+ quarters.
Part B covers medically necessary services and preventive care — doctor visits, outpatient care, lab tests, durable medical equipment, and most outpatient procedures. Everyone pays a monthly premium.
Medicare Advantage plans are offered by private insurers approved by Medicare. They bundle Parts A and B (and usually Part D) into one plan — often with extras like dental, vision, hearing, and fitness benefits. Network restrictions apply.
Medigap plans pay the cost-sharing (deductibles, coinsurance, copays) that Original Medicare leaves behind. You keep any doctor that accepts Medicare — no networks. Plans are standardized A–N in both Kentucky and Ohio.
Part D is standalone prescription drug coverage added to Original Medicare + Medigap. Medicare Advantage usually includes drug coverage already. Choose a Part D plan based on your specific medications — formularies differ significantly.
If you qualify for both Medicare and Kentucky Medicaid, you're "dual eligible" — and you may qualify for D-SNP plans that coordinate both benefits, potentially reducing your costs to near zero. Kentucky's Medicaid expansion program is called Kentucky Medicaid.
This is the single most important decision most Medicare beneficiaries make. Neither option is universally better — the right choice depends on your health, finances, and how you use healthcare.
| Factor | 🔵 Medicare Advantage (Part C) | 🛡️ Medicare Supplement + Part D |
|---|---|---|
| Monthly premium | Often $0–$50 (plus Part B premium) | $120–$185 (Medigap) + $10–$55 (Part D) + Part B |
| Annual out-of-pocket max | Capped by law ($9,350 in-network 2025) | Effectively $0 with Plan G (only Part B deductible) |
| Provider network | In-network required (HMO) or preferred (PPO) | Any provider that accepts Medicare — nationwide |
| Referrals needed | Usually yes for HMO; no for PPO | Never — see any specialist directly |
| Extra benefits | Often includes dental, vision, hearing, OTC allowance, gym | None — just Medicare coverage |
| Prescription drugs | Usually included (MAPD plans) | Separate Part D plan required |
| Predictability | Variable — costs depend on care used | Very predictable — fixed premiums, minimal surprise bills |
| Travel / snowbirds | Emergency only outside service area | ✅ Full coverage anywhere Medicare is accepted |
| Changing plans | Annually during Open Enrollment | Can switch, but may face underwriting after initial enrollment |
| Best for… | Healthy, budget-conscious, staying in NKY/Cincinnati area | Frequent healthcare users, travelers, want predictable costs |
| Local NKY availability | Humana, Aetna, Anthem, UHC, Devoted, Wellcare | 20+ Medigap carriers in KY; 20+ in OH — rates vary widely |
NKY sits on a state line. Whether you're a Kentucky resident using Cincinnati providers — or an Ohio resident moving to NKY — these differences matter.
SHIP counselors are free, unbiased, and do not sell insurance. They are federally funded to help Medicare beneficiaries understand their options and make the right choice. Always consult a SHIP counselor before enrolling in any plan.
Find out exactly when your enrollment windows open and close — and whether you may face a late penalty.
Gather these documents and complete these steps before enrolling in any Medicare plan. Having everything ready prevents costly enrollment mistakes.
Print or save this checklist before your SHIP counselor appointment:
Apply at SSA.gov online or visit the Fort Thomas SSA office (1714 Alexandria Pike, 800-772-1213). If you're already receiving Social Security benefits, you'll be enrolled automatically and your Medicare card will arrive in the mail. If not, you must actively apply — do it 3 months before your birthday to have coverage start on the first of your birthday month.
Apply at SSA.gov →Before talking to any insurance company, call 859-491-0522 and speak with a free SHIP counselor at LINK of NKY. They will walk you through all your options without trying to sell you anything. Bring your list of doctors and prescriptions. This single step prevents most costly enrollment mistakes.
Based on your health, finances, and whether you use Ohio-side providers (UC Health, TriHealth, Christ Hospital), decide between Medicare Advantage or Medigap + Part D. Your SHIP counselor will help you run this comparison with your actual situation — not a generic scenario.
For Medicare Advantage: compare at Medicare.gov/plan-compare using your zip code and drug list. For Medigap: get quotes from 3+ carriers — the same Plan G from different companies can vary by $50–$80/month in NKY. For Part D: use the Medicare.gov drug plan finder with your exact medication list.
Compare Plans at Medicare.gov →Plans change every year — premiums, formularies, and networks all get updated. Even if you're happy with your plan, compare it to alternatives during Open Enrollment. Changes take effect January 1. If you're in Ohio, also check your Medigap options within 30 days of your birthday each year under the Ohio birthday rule.
Medicare Advantage (Part C) replaces Original Medicare through a private insurance company. You get all your care through the plan's network and pay copays at time of service. Many plans have $0 premiums and include dental, vision, and hearing. The trade-off: you're limited to in-network providers and may face higher costs if you use care heavily.
Medicare Supplement (Medigap) works alongside Original Medicare — you keep the government coverage and the Medigap plan pays the gaps (deductibles, coinsurance). You can see any doctor who accepts Medicare, anywhere in the US, with little or no cost-sharing. The trade-off: monthly premiums are higher ($120–$185+ for Plan G in NKY).
For NKY residents specifically: if you regularly use Cincinnati-based health systems (UC Health, TriHealth, Christ Hospital), verify any Advantage plan covers those Ohio providers before enrolling.
Yes — Ohio has a Medicare Supplement birthday rule: within 30 days of your birthday each year, Ohio Medigap enrollees can switch to a plan with equal or lesser benefits without health underwriting. This is a significant benefit that lets you shop for lower rates annually without risking denial.
Kentucky does NOT have this rule. Kentucky residents can only switch Medigap plans without underwriting during their initial 6-month open enrollment window at age 65. After that, insurers in Kentucky can use medical underwriting — meaning they can charge more or deny coverage based on health history.
This is one of the key differences for NKY residents on the Kentucky side of the line: enroll in Medigap at 65 while you have guaranteed issue rights. Don't wait.
Medicare Part B premium: $185/month in 2025 (standard; higher for higher incomes).
Medicare Advantage: Many plans in the Cincinnati/NKY market have $0 additional premium. You still pay Part B. Your out-of-pocket costs depend on how much care you use, up to the plan's annual maximum (capped at $9,350 in-network in 2025).
Medigap Plan G in NKY (age 65): Approximately $120–$185/month depending on the carrier. Plus the Part B premium. Plus a separate Part D premium ($10–$55/month). So total monthly cost with Medigap: roughly $315–$425/month — but your annual out-of-pocket risk is very low (just the Part B deductible of $257 in 2025).
It depends on the specific plan. Many Kentucky-based Medicare Advantage plans include Cincinnati-area (Ohio) providers in their networks — but not all do, and coverage varies by system. UC Health, TriHealth, and Christ Hospital are major Cincinnati health systems; check each plan's provider directory before enrolling.
PPO-type Advantage plans generally give you more flexibility to use out-of-network providers (at higher cost-sharing). HMO plans typically require in-network care except for emergencies.
Medicare Supplement (Medigap) has no networks — it covers any provider that accepts Original Medicare, in any state. If you regularly use Ohio providers, Medigap may be the safer choice for you.
If you have active coverage through your own employer (or a spouse's employer) and the employer has 20+ employees, you generally do NOT need to enroll in Medicare Part B at 65 — your employer plan is primary. You can delay Part B without penalty and enroll later during a Special Enrollment Period (within 8 months of your coverage ending).
However: enroll in Part A at 65 even if you have employer coverage — it's free for most people and coordinates with your employer plan.
If your employer has fewer than 20 employees, Medicare becomes primary at 65 and you should enroll. Not enrolling in Part B in this case can result in claim denials.
Always verify with your HR department and a SHIP counselor before making this decision — the rules depend on your specific situation.
Extra Help (also called Low Income Subsidy or LIS) is a federal program that helps people with limited income and resources pay for Medicare Part D drug costs. In 2025, you may qualify if your annual income is below about $22,590 (single) or $30,660 (married).
If you qualify, Extra Help covers most of your Part D premium, deductible, and copays — potentially saving $5,000+ per year. You also get a Special Enrollment Period to change Part D plans at any time.
Apply through Social Security at SSA.gov/extrahelp or by calling 1-800-772-1213. In NKY, LINK of NKY can also help you determine eligibility and apply. If you qualify for Kentucky Medicaid, you automatically qualify for Extra Help.
In Boone County (zip codes 41005, 41011, 41042, 41048, 41091, 41094, 41095, 41099), Medicare Advantage plans are typically offered by Humana, Aetna, Anthem Blue Cross Blue Shield, UnitedHealthcare (AARP), Devoted Health, and WellCare. The exact plans and premiums change each year during Open Enrollment.
Use Medicare.gov/plan-compare and enter a Boone County zip code to see current-year plans, star ratings, premiums, and drug formularies. Filter by plan type (HMO vs. PPO) and enter your specific medications and preferred doctors for the most accurate comparison.
See our Boone County Medicare guide for the most detailed county-specific information.
Medicare Part A is free for most people (if you or a spouse worked 40+ quarters / 10 years and paid Medicare taxes). Part B has a monthly premium — $185/month in 2025 for most enrollees.
Medicare Advantage plans often have $0 additional premium (beyond Part B), which can make total monthly Medicare costs just $185/month for basic coverage — but you pay copays when you use care.
Medicare Supplement (Medigap) adds $120–$185/month for Plan G in Kentucky, plus a separate Part D plan for drugs.
If your income is low, you may qualify for Kentucky Medicaid, Extra Help for drugs, and Medicare Savings Programs (MSPs) that can pay your Part B premium entirely. Contact LINK of NKY at 859-491-0522 to check your eligibility.
