Kentucky Health Insurance: Find Affordable Plans

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 cheap health insurance options and eligibility for assistance programs in the state.

• 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 October 15 to December 7 , 2022. 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.

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 affordable health insurance plans from four companies in Kentucky:

• Anthem Blue Cross Blue Shield
• CareSource
• WellCare

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.

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.

• 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 $333 per month in 2023.
• 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 2023, the most affordable Silver plan in Kentucky costs $417 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 $472 per month in 2023.

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 $18,075, while a couple is allowed a maximum of $24,353. The threshold increases if you have more members in your household: a family of three can have a combined yearly income of $30,630, while for a family of five the maximum is $43,186.

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 find affordable 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.

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. The Medicare Part A deductible for inpatient hospital stays is $1,600 in 2023. Medicare Part B enrollees pay a standard monthly premium of $226 for 2023.
• 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. As of 203, there are 102 Medicare Advantage Plans available in the state, however, you can only select a plan that’s available in your county.

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

If you start receiving your Social Security or Railroad Retirement Board benefits at least four months before you turn 65, you’ll be automatically enrolled in Medicare. Otherwise, you must fill out an application online or contact your local Social Security office. You can enroll in Medicare during the following periods:

• Initial enrollment: Your initial enrollment period starts three months before your 65th birthday and ends three months after your 65th birthday. If you’ve never had Medicare, you can enroll during this period. If you started receiving Medicare when you were younger, you can also make changes to your plan.
• General enrollment: Choose this enrollment period if you missed your initial enrollment period. The Medicare general enrollment period is January 1 to March 31. You can choose Original Medicare, Medicare Advantage, Medigap, or Part D.
• Medicare Advantage open enrollment: You can make changes to your Medicare Part C, also known as Medicare Advantage, from January 1 to March 31.
• Open enrollment: You can join, switch plans, or drop your coverage from October 15 to December 7 each year.
• Special enrollment periods: You may qualify for a special enrollment period if you lose your coverage or have changes to your eligibility outside the regular enrollment periods.

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.

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 Affordable Care Act 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.

• CMS.gov | Medicare Open Enrollment | Last accessed December 21, 2022
• Healthcare.gov | Special Enrollment Period (SEP) | Last accessed December 21, 2022
• HealthCare.gov | The Marketplace in your state | Last accessed December 21, 2022
• HealthCare.gov | 4 steps to getting covered in the Health Insurance Marketplace | Last accessed December 21, 2022
• HealthCare.gov | Deductible | Last accessed December 21, 2022
• HealthCare.gov | Health Maintenance Organization (HMO) | Last accessed December 21, 2022
• HealthCare.gov | Preferred Provider Organization (PPO) | Last accessed December 21, 2022
• HealthCare.gov | Point of Service (POS) Plans | Last accessed December 21, 2022
• HealthCare.gov | SHOP Premiums in Kentucky | Last accessed December 21, 2022
• HealthCare.gov | The ‘metal’ categories: Bronze, Silver, Gold & Platinum | Last accessed December 21, 2022
• HHS.gov | Who is eligible for Medicare? | Last accessed December 21, 2022
• Kentucky Cabinet for Health and Family Services | Department for Medicaid Services | Last accessed December 21, 2022