Overview of Kentucky’s Health Insurance Exchange
When the Affordable Care Act was passed in 2010, states gained the opportunity to build health insurance marketplaces called exchanges. Kentucky’s exchange is called Kynect. The program offers plans through the following key providers: Anthem, Humana, Bluegrass Family Health, UnitedHealthcare, and the Kentucky Health Cooperative.
Kynect operates as an online marketplace where you can comparison shop for health plans in much the same way you shop online for airline tickets or hotel accommodations.
Beginning October 1, 2013, Kentucky residents are able to shop for insurance online at kynect.ky.gov, in person with a navigational assistant, or through the Kynect call center (1-855-4KYNECT).
Click here for answers to frequently asked questions about the Kentucky Health Exchange and Kynect.
Open enrollment lasts until March 1, 2014. Your plan will be effective on January 1, 2014.
Per the Affordable Care Act, all plans must offer the following essential services:
- Ambulatory patient services (doctor visits)
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices (Habilitative services are for people with disabilities who need speech, occupational, or physical therapy.)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
In addition to operating a state-based exchange, Kentucky will also participate in the expansion of Medicaid. Kentucky has 640,000 uninsured citizens, of which almost half qualify for Medicaid. The remaining portion of the uninsured population will be able to purchase insurance through the exchange.
There are four basic plans available with varying levels of coverage: Bronze (60 percent of expenses paid by plan), Silver (70 percent), Gold (80 percent), and Platinum (90 percent). Lower plans have lower premiums, but higher out-of-pocket costs. A catastrophic plan is available for folks under the age of 30. This plan has a high deductible.
Adults living at or below 133 percent of the federal poverty level (also known as the FPL, which is $11,490 a year in wages for one person and $23,550 a year in wages for a family of four), or pregnant women living at or below 195 percent of the FPL, can qualify for Medicaid in Kentucky, based on eligibility standards that take effect January 1, 2014.
Additional federal financial protections will start in 2015 that include a maximum annual out-of-pocket cost of $6,350 for individuals and $12,700 for families. Capping out-of-pocket costs will help consumers pay medical bills that aren’t covered by insurance, reducing the chance of bankruptcy.
Tax credits are based on the Silver Plan, so you can easily determine what your additional out-of-pocket costs will be if you elect a higher or lower plan compared to Silver. The Affordable Care Act (ACA) was designed so the Silver Plan would be affordable to people who had to buy their own insurance, regardless of how expensive the healthcare rates may be where they live.
Individuals and families with incomes less than 400 percent of the federal poverty level (and who are covered by an exchange plan) are eligible for healthcare tax credits. The payment of credits will begin in 2014.
People want to how much their subsidies are, but the real question is how much will you pay? Once you figure out what the maximum healthcare percentage is for your income, then you know that's the most you'll have to pay for a Silver Plan (you may pay less). For example, if your income is $32,500 a year (283 percent of the poverty level), the most you’ll have to pay for health insurance is nine percent of your wages, which amounts to $2,926 a year, or $244 a month. The challenge is to look at the costs of Bronze, Silver, Gold, and Platinum and decide which plan offers the best value for you. A helpful calculator offered by the Kaiser Family Foundation provides an estimate of your subsidy eligibility and how much you should expect to spend on health insurance.
Information on Subsidies
Kynect uses a quick and anonymous pre-screening process that informs consumers if they are eligible for Medicaid, the Kentucky Children’s Health Insurance Program, or healthcare payment assistance. The pre-screening process also includes an Individual Health Plan Savings Calculator for estimating all possible financial assistance for health insurance.
To learn more about the Kentucky Healthcare Connection, please visit http://kynect.ky.gov/ or call 1-855-4KYNECT (1-855-459-6328). You can also email customer service using this Web form or get help via online chat with a live representative.
QUESTION(s): I live in Kentucky and have a seasonal job. Who can I call for help?
People living in Kentucky can use the Kynect web site (https://kyenroll.ky.gov/) to find individuals and companies who can help you apply for health insurance. You can search by zip code or by county name to find the nearest Department for Community-Based Services office.
For people living outside Kentucky, you can use the Local Help portion (https://localhelp.healthcare.gov/) of Healthcare.gov to find organizations in your area that can help you apply for insurance and answer any questions you may have.
QUESTION(s): I have been told the insurance offered on the KY Exchange will not cover out of state doctor visits. Is this correct?
This depends on the health insurance plan you purchase. Some plans may cover doctor’s visits outside state lines. Some may not. They may also cover them at two different rates: in-network and out-of-network. In-network doctors and facilities have negotiated a rate with your health insurance company for their services. Out-of-network doctors and facilities have not. In almost all cases, it will be more affordable for you to see a doctor or facility that is in-network for you insurance plan, even if you are out of state.
However, if your only option is out-of-network, your plan might still cover a portion of your insurance expense. For more details, reach out to Kynect (https://kyenroll.ky.gov/).