If you’re a resident of Kentucky and don’t have insurance coverage through your employer, there are many different healthcare options to consider. Whether you’re self-employed or low-income, multiple plans exist that can fit within your budget.
Health insurance options in Kentucky
In Kentucky, 97% of the state’s population has health insurance; just 6% of the state’s population — 276,000 — goes without coverage.1 n Kentucky, the average premium payment for health insurance is $605 per month or $7,260 per year.2
The launch of the Affordable Care Act (ACA) had a significant impact on the state. While the majority of Kentuckians get coverage through their employers, approximately 78,000 Kentucky residents purchased a health insurance plan through the Marketplace in 2021.3
Medicare and Medicaid provide coverage to 42% of the state’s population.4 Under the ACA or Obamacare, the state expanded Medicaid coverage to include individuals and families with incomes up to 138% of the federal poverty guideline.5
|Family Size||138% of the Poverty Guideline|
If you live in the state of Kentucky and need insurance, your health coverage options are dependent on your age, income, and employment status.
If you don’t get coverage through an employer, you can purchase an individual policy through the state’s Health Insurance Marketplace, the Kentucky Health Benefit Exchange. There are four insurance providers who offer ACA-qualifying plans in Kentucky:
- CareSource Kentucky
- Anthem Health Plans of KY.
- Molina Healthcare of Kentucky
- WellCare Health Plans of Kentucky 6
Going through the ACA can be a good idea if you have a pre-existing health condition since ACA insurers aren’t allowed to deny you coverage.
In Kentucky, 78,000 people enrolled in a healthcare plan through the Healthcare.gov platform during the 2021 open enrollment period.7
For 2022, Kentucky residents will buy plans from the Kentucky Health Benefit Exchange.
There are five different tiers of coverage:
- Bronze: Bronze plans offer the lowest monthly premium but pay the least for covered care (60%). These plans make sense if you’re young, relatively healthy, and want a safety net in case of a medical emergency.
- Silver: If you want to spend less money out of pocket for medical expenses, consider this tier. They have higher premiums than bronze plans but pay more for covered costs (70%).
- Gold: Gold plans have more expensive monthly premiums, but pay more for covered costs (80%) when you undergo medical procedures or treatments. If you have an ongoing health condition, signing up for a gold plan may make financial sense.
- Platinum: Platinum plans have the highest monthly premiums but have low deductibles. They also pay the most for covered care (90%). If you require much ongoing care, platinum plans may be more cost-effective for you.
- Catastrophic: People under 30 or those who qualify for a hardship exemption can apply for a catastrophic plan. The premiums on catastrophic policies are quite low but they have very high deductibles. If you have a health emergency, you’ll have to spend more money out of your pocket to cover the cost. As of 2020, the deductible for all catastrophic health plans is $8,150.8
The only way to sign up after the OEP expires is if you’re for special enrollment due to a qualifying life event. You qualify if you lost your health coverage, got married, had a baby, moved, or adopted a child.10
In terms of premiums, it’s important to look at the benchmark cost — the second-lowest silver plan. In Kentucky in 2021, a 40-year-old would pay $476 for the benchmark plan, a $5 increase over the premium for the benchmark plan in 2020.11
How much you’ll pay for your insurance plan is dependent on what tier of coverage you choose. The average marketplace premium by metal tier for 2019-2021 are shown below:12
|Average Lowest-Cost Bronze Premium||Average Lowest-Cost Silver Premium||Average Lowest-Cost Gold Premium|
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Average Rate Changes
Depending on your income, you may qualify for subsidies, or advance premium tax credits, to reduce your monthly premiums.13
For example, the average premium for health insurance in Kentucky is $605 per month. However, the average premium after the advanced premium tax credit — one of the health insurance subsidies available — is just $199 per month. Within the state, 62,000 people qualified for the advanced premium tax credit when enrolling in a health plan in 2020.14
Some applicants will also qualify for cost-sharing reductions, which lower what you have to pay for deductibles, copayments, and coinsurance. In Kentucky, 31,000 enrollees qualified for cost-sharing reductions in 2020.15
Children under the age of 19, pregnant women, parents and caretaker relatives, low-income adults between the ages of 19 and 64, and foster children between the ages of 18 and 26 who are not receiving Medicaid in another category are eligible for Medicaid coverage.16
Low-income adults can qualify for Medicaid benefits and receive preventative care, pharmacy services, and even transportation assistance. Income restrictions apply.17 For instance, the maximum income for a family of four is $35,245.18 Eligible residents can apply for coverage online.19
As of February 2021, nearly 1.5 million people are enrolled in Medicaid.20
Kentucky expanded Medicaid to cover more low-income adults. The impact on the state has been significant. Preexpansion, the percentage of uninsured individuals was at a staggering 13%. But as of 2020, that number has dropped to 7%.21
Kentucky Children’s Health Insurance Program (KCHIP)
Children under the age of 19 who don’t have health insurance can qualify for free coverage through KCHIP. To qualify, families need to have incomes less than 213% of the federal poverty level. For example, the maximum income for a family of three is $47,880.22 KCHIP covers doctor visits, dental care, hospitalizations, mental health services, laboratory tests, and vision exams. Children can also get glasses, vaccinations, and speech therapy through KCHIP.23
As of February 2021, 106,000 individuals are enrolled in KCHIP.24
If you are over the age of 65, you can qualify for coverage through Medicare, regardless of your income. In some cases, you can qualify for financial assistance with your Medicare premiums.
- If you have a disability or are in the end stages of renal disease, you may be eligible for Medicare. If you are receiving Social Security payments or Railroad. retirement — benefits for retired railroad employees and their families — the government automatically enrolls you in Medicare.25
Medicare beneficiaries who do not qualify for full Medicaid benefits can get help with the monthly premiums, deductibles, and coinsurance costs through Kentucky’s Medicare Savings Program. To be eligible, you must meet the following criteria:
- You have Medicare Part A coverage.
- Your monthly income is less than $1,425 for individuals and $1,922 for couples.
- You have resources under $7,730 for individuals or $11,600 for couples.26
Short-Term Health Insurance
If you miss the OEP window for the Health Insurance Marketplace and can’t get coverage through your employer, consider an alternative insurance plan. You can sign up for a short-term health insurance plan at any time. Short-term coverage — also known as temporary health insurance — can cover doctor visits, prescriptions, hospitalizations, and some lab tests.
Short-term plans don’t meet the ACA requirements. They don’t have to cover essential health benefits, and short-term insurers can’t exclude people with pre-existing health conditions. However, they tend to cost less than plans offered through the Health Insurance Marketplace.
Kentucky follows the federal standard on short-term health insurance. The maximum term for such plans is less than 12 months, and can be renewed up to a maximum duration of 36 months.27
If you are in between jobs
If you’re starting a new job and need coverage until your new health insurance plan goes into effect, consider these options:
The Consolidated Omnibus Budget Reconciliation Act (COBRA) allows you to retain your insurance coverage for up to 18 months when you lose or quit your job. You typically have to pay the entire premium — which can be quite expensive — but it can bridge the gap until your new employer’s insurance policy is active. When you leave your job, your previous employer will send you information about how to elect COBRA coverage.28
Getting health insurance
If you’re one of Kentucky’s 4.5 million residents, you should know that there are a number of options available for you if you need a health insurance policy.29 Whether you’re self-employed, low-income, or qualify for Medicare, you can get both preventative and major medical healthcare coverage.
Insurance and Department of Health Information
Kentucky Department of Insurance
500 Mero St., 2 SE 11
Frankfort, KY 40601