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Insurance and Healthcare Consultant

Tammy Burns is an experienced health insurance advisor. She is ACA-certified for health insurance and other ancillary, life, and annuity product.

As a resident of Kentucky, you have several options for health insurance. You can enroll in a plan through your employer, or receive coverage through Medicare or Medicaid. You can also purchase coverage directly from health insurance companies. This guide provides more details about your health insurance options and eligibility for assistance programs in the state.

What to know about insurance in Kentucky

  • Marketplace Plans: Kentuckians can enroll for coverage using the federal Health Insurance Marketplace. You must enroll through the exchange if you’re interested in receiving the Advanced Premium Tax Credit.
  • Advanced Premium Tax Credit: You don’t need to use the exchange if you’re not interested in the Advanced Premium Tax Credit or don’t qualify for it.
  • Open Enrollment: Open enrollment begins on November 1st and ends on December 15th every year. If you miss this enrollment period, you’ll need to wait until the following year to sign up, unless you’re eligible for a special enrollment period.
  • Special Enrollment: You may qualify for a special enrollment period to sign up or change plans due to certain life events, such as if you’ve moved, changed jobs, been recently married, or had a child.
  • Direct insurance: As a Kentucky resident, you can purchase health insurance directly from an insurance company if you wish. You can also have multiple policies if your employer-sponsored health plan doesn’t provide the coverage you need.
  • Types of plans: About 47% of Kentuckians receive health coverage from their employers, while just under 3.9% have non-group private coverage. Another 25.5% of residents are enrolled in Medicare, and 15.8% receive coverage through Medicaid. Approximately 6.4% of Kentucky residents are uninsured.

How do I enroll in Kentucky’s health insurance marketplace?

Because Kentucky doesn’t have its own exchange, you can visit HealthCare.gov to enroll through the federal Health Insurance Marketplace. You need to create an account before you can browse available health plans, which is a simple and straightforward process. Provide your name and contact information, select a password and then choose your security questions. Make sure to remember your password and security information.

You’ll need to provide the following information for everyone you’re including on your policy:

  • Each household member’s Social Security number
  • How many people are claimed as dependents on your federal income taxes
  • Marital status
  • Whether you need financial assistance
  • Your household income

Healthcare.gov automatically checks your eligibility for financial assistance and Kentucky Medicaid. You’ll also be shown whether you qualify for the Advanced Premium Tax Credit. Once you’ve entered all this information, you’ll be shown a list of available plans. You can also compare plans side-by-side using the tool provided on the Healthcare.gov website. Then, you select a plan and complete the enrollment process.

You can purchase health insurance plans from two companies in Kentucky:

  • Anthem Blue Cross Blue Shield
  • CareSource

How do I enroll in Kentucky individual and family insurance?

Applying for individual and family coverage involves a similar enrollment process. You should consider your health care needs and those of each person who’ll be covered before you decide on a plan. Consider the type of plan, the monthly premiums, and the expected out-of-pocket costs.

Insurance for individuals in Kentucky 

In Kentucky, there are three types of insurance policies you can choose from, each with its own benefits and disadvantages:

  • Health Maintenance Organization (HMO) plans: HMOs can save you money but they place restrictions on where you can receive medical treatment. You can only see providers within the insurer’s network and you’ll need a referral to see a specialist.
  • Preferred Provider Organization (PPO) plans: PPOs also have a network of providers, but you have the flexibility to seek care outside the network at a higher cost. Referrals aren’t required to see specialists.
  • Point-of-Service (POS) plans: POS policies combine features of HMOs and PPO plans. Although these plans have a network of approved providers, you can receive out-of-network medical services. You’ll pay more to do so, though, and you also need to get referrals to see specialists.

Individuals have more options when seeking coverage. As long as you’re healthy, you can choose a plan that has a higher deductible and coinsurance requirement to save money on your monthly premiums.

Insurance for families in Kentucky 

When you’re considering family coverage, you need to consider your total out-of-pocket expenses including premiums, copayments, and deductibles. If someone in your family has a chronic illness, it may cost you less overall to enroll in a policy with higher premiums and a lower deductible.

Also consider the type of plan that best meets your needs. If you’re considering an HMO, research each plan’s provider network to determine if you’ll have access to the providers you’re most likely to visit. Otherwise, a PPO or POS plan may be a better choice.

How much does health insurance cost in Kentucky?

Plans offered on the Health Insurance Marketplace are divided into four tiers: bronze, silver, gold, and platinum. These tiers break down plans based on their annual deductibles, coinsurance requirements, and monthly premiums. The plan with the lowest monthly premiums may not have the lowest overall costs, so it’s important to consider the health care needs of each family member when comparing your options.

Average premiums in Kentucky 2018 2019 2020 2021
Most affordable bronze Plan $313 $327 $335 $342
Most affordable silver Plan $410 $430 $453 $455
Most affordable gold Plan $527 $564 $582 $579

  • Bronze plans have the lowest premiums, but require copayments of 40% of the cost of services received. These plans also have the highest deductibles. Bronze plans are ideal for young, healthy people who want coverage just in case the unexpected occurs. They aren’t effective for those who have known medical conditions or who are at high risk of needing medical care due to a family history of disease. The least expensive bronze plan in Kentucky costs $342 per month in 2021.
  • Silver plans are a step up from bronze plans because they have lower deductibles and coinsurance. Low-income families may also be able to apply to receive a silver plan for less than the cost of a bronze plan. Your copayments with a silver plan will be 30% of the cost of care once you’ve met your deductible. In 2021, the most affordable silver plan in Kentucky costs $410 per month.
  • Gold and platinum plans have the highest monthly premiums, but they also provide the most comprehensive coverage. The higher premium is justified by the increased coverage and low annual deductible. A gold plan requires a 20% copayment for your medical expenses, while a platinum plan only requires 10%. Because of the high monthly premiums, these plans are best suited to families with one or more members who need ongoing care for a chronic medical condition. The least expensive gold plan in Kentucky costs $527 per month in 2021.

What kind of low-income health insurance is available in Kentucky?

The Kentucky Medicaid and KCHIP programs offer health insurance coverage for eligible low-income residents. Medicaid provides coverage for several categories of adults, while the KCHIP program covers children and expectant mothers.

Medicaid in Kentucky 

To qualify for Kentucky Medicaid, you need to be caring for a minor child, be blind or have a disability, or be over the age of 65 and unable to afford the cost of medical care. Medicaid covers the cost of hospital stays, doctor visits, medical testing, and any care that’s considered medically necessary for qualified individuals.

Medicaid is only available to residents with low or very low incomes. For example, an individual applying for Medicaid in Kentucky can have a maximum annual income of $17,131, while a couple is allowed a maximum of $23,169. The threshold increases if you have more members in your household: a family of three can have a combined yearly income of $29,207, while for a family of five the maximum is $41,284.

For help applying for Kentucky Medicaid, you can call 800-635-2570 or enroll using the Member Portal.

Kentucky KCHIP 

Children whose families are unable to afford health insurance can receive coverage through the KCHIP program. This program covers children up to age 19 and pregnant women who can’t afford health insurance. It has low premiums and copayment requirements and covers preventive and emergency care, rehabilitative therapy, and dental and vision care. It also covers prenatal care for expectant mothers, including doctor’s examinations and required diagnostic testing. Eligibility is based on family income, and those with incomes up to 213% of the federal poverty level are eligible. For assistance applying, you can call 855-459-6328.

What are Kentucky’s Medicare options for seniors and people With disabilities?

Kentuckians have numerous options for Medicare enrollment and plans that can help offset their costs.

  • Original Medicare comprises Parts A and B. Part A covers inpatient care in hospitals and skilled nursing facilities, home health care services, and hospice care. Part B provides coverage including outpatient procedures, routine doctor’s visits, diagnostic testing, medical transportation, and medical supplies and devices. Prescription medications aren’t covered under Original Medicare, but you can enroll in Medicare Part D for this benefit.
  • Medicare Advantage allows private insurance companies in Kentucky to offer plans subsidized by the federal government to keep premiums low. These plans must cover all the services provided through Original Medicare, and many offer additional benefits, such as prescription drug coverage and dental and vision care, among others.

Original Medicare and Medicare Advantage plans have monthly premiums, annual deductibles and copayment requirements. This means that you may still have significant out-of-pocket expenses. Medicare Supplement (Medigap) policies can help you cover these expenses. As long as you enroll in a Medigap plan within six months of turning age 65 or starting Medicare under 65, you can’t be denied coverage or have your rates increased due to your medical history.

Eligibility

You must meet the eligibility requirements to qualify for Medicare. The program is only available for United States citizens and permanent residents who are over the age of 65, or who have been receiving Social Security Disability Insurance benefits for at least 24 months. If you have end-stage renal disease, you may also qualify for Medicare.

Enrollment

Depending on your circumstances, you may be enrolled in Medicare automatically. If not, you have a seven-month-long initial enrollment period that begins three months before your 65th birthday and ends three months after your birthday month. During this time, you can check to see if you’re eligible, sign up for Original Medicare, enroll in Part D coverage or a Medicare Advantage plan. If you miss your initial enrollment period, you can sign up during the Medicare General Enrollment Period (January 1–March 31), and your coverage will start July 1. You may also qualify for a special enrollment period if you meet certain criteria.

Medicare Resources

The Kentucky State Health Insurance Assistance Program (SHIP) offers free counseling to help you understand your coverage options and enroll in Medicare or Medicaid. For more information and assistance, you can call the SHIP hotline at 877-293-7447.

Are there short-term health insurance plan options in Kentucky?

There are no state restrictions on short-term health insurance plans in Kentucky, which means that insurers must abide by the federal guidelines instead. The purpose of a temporary health insurance policy is to cover you for a short time when you have a gap in your coverage. A short-term plan can cover your medical expenses so you don’t have to pay out of pocket while you’re waiting for coverage to begin under an employer’s health plan, are temporarily unemployed, or are waiting to enroll in Medicare.

Short-term policies sold in Kentucky can have a maximum term of one year. If needed, you can renew a policy for a total of three years. Insurers offering these policies don’t need to abide by ACA rules. This means you can be denied coverage for preexisting conditions and your premiums can be increased if you’ve been sick or injured in the past.

Kentucky Insurance FAQs

Does Kentucky require health insurance?

The state of Kentucky doesn’t require residents to have health insurance coverage, but the Affordable Care Act does mandate health insurance coverage on the federal level. While you won’t suffer any tax penalties for not having coverage, not being insured will disqualify you for the Advanced Premium Tax Credit.

Do I have to use the Health Insurance Marketplace in Kentucky?

While the federal Health Insurance Marketplace is a good place to enroll in a health insurance plan if you want to qualify for a tax credit, it’s not the only place you can enroll in coverage. If you’re not interested in the Advanced Premium Tax Credit or you don’t qualify for it, you’re free to sign up for any health insurance plan offered by insurers in the state.

What types of alternative health insurance plans (like cost-sharing plans) are available in Kentucky?

Cost-sharing health plans place contributions from all members into a pool that’s used to pay individual members’ medical expenses. These plans are an alternative to traditional insurance and typically don’t cover pre-existing conditions or preventive care.

Do I need health insurance if I have an HSA/FSA?

A health savings account or flexible savings account is designed to help you prepare for large or unexpected expenses due to an illness or disease that requires costly treatment. HSA/FSA accounts work best when paired with health coverage and aren’t replacements for insurance.

Do I need short-term disability coverage in Kentucky if I have health insurance?

Health insurance is meant to cover your medical care costs, while a short-term disability policy is designed to cover household expenses if you’re unable to work temporarily. On its own, a short-term disability policy won’t be sufficient to cover your health care expenses if you’re injured or get sick, but it can be a good supplement to a health insurance plan.

Do I need long-term disability coverage in Kentucky if I have health insurance?

Long-term disability coverage works in the same way as short-term disability plans. If you’re injured and suffer a permanent disability that keeps you out of work, long-term disability plans will pay your day-to-day expenses while your health insurance will cover the cost of medical care.

What does KCHIP cover?

Children enrolled in the KCHIP program receive coverage for preventive care, eye care, dental procedures, mental health services, physical therapy, immunizations, hospital stays, prescription drugs, and counseling or treatment for learning disabilities.

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