In 2010, the federal healthcare law — the Affordable Care Act (ACA) — was passed. Ultimately, this law gave states the opportunity to build health insurance marketplaces called exchanges. Kynect is Kentucky’s exchange. This system allows individuals and employers to buy health insurance.
Kynect operates as an online marketplace where you can comparison shop for health plans. Learn about your healthcare options and how to sign up for a plan that best meets your needs.
Kynect has five insurance companies offering plans:
- Bluegrass Family Health
- Kentucky Health Cooperative
- United Health
All plans must offer the following essential services:
- preventive and wellness care
- sick visits
- emergency services
- hospital stays
- maternity care
- newborn care
- pediatric services
- mental healthcare
- substance abuse rehab services
- behavioral health treatment
- prescription drugs
- rehabilitative and habilitative services and devices (speech, occupational, or physical therapy)
- lab work
There are four basic plans through the exchange. These have varying coverage levels:
- bronze (60 percent of expenses paid)
- silver (70 percent)
- gold (80 percent)
- platinum (90 percent)
Lower percentage plans have lower premiums. The downside is higher out-of-pocket costs. A catastrophic plan is also available for those under the age of 30. This plan has a high deductible.
In addition to operating a state-based exchange, Kentucky participates in Medicaid expansion. Some families may also qualify for the Kentucky Children’s Health Insurance Program (KCHIP). This offers free or low-cost plans to qualifying children without insurance.
Kynect uses a quick and anonymous prescreening process that informs consumers if they’re eligible for Medicaid, the KCHIP, or payment assistance. The prescreening process also includes an individual health plan savings calculator for estimating all possible financial assistance for health insurance.
Your ultimate decision should be based on your income versus how often you might need to use the coverage. Platinum offers the best coverage, but costs the most. The silver plan is the most popular because it offers decent coverage without the cost of a gold or platinum plan. Additionally, some plans cover out-of-state doctor visits, while others may not.
Once you figure out the maximum healthcare percentage for your income, then you know that's the most you'll have to pay for a silver plan. 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 9 percent of your wages, or $2,926 annually. This averages out to about $244 a month.
The challenge is to compare the costs of each plan and decide which offers the best value. 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.
Depending on your income, you may qualify for financial aid to help offset the costs of coverage. This may come in the form of:
- tax credits
Adults living at or below 133 percent of the federal poverty level (FPL) may qualify for state Medicaid. Pregnant women living at or below 195 percent FPL may qualify, too. The FPL for 2015, according to the health insurance marketplace, is:
- $11,770 in individual annual wages
- $11,770 for individuals
- $15,930 for a family of two
- $20,090 for a family of three
- $24,250 for a family of four
As of 2015, the annual maximum out-of-pocket cost is $6,350 for individuals. It’s $12,700 for families. Maxing out-of-pocket costs can help you pay medical bills that aren’t covered by insurance, easing your financial load. This may also help decrease the risk for bankruptcy over an unexpected medical expense.
Tax credits are based on the silver plan. This helps you determine any extra out-of-pocket costs if you choose a higher or lower plan. The ACA was designed so the silver plan is more affordable for individuals buying their own insurance. This is regardless of how expensive the healthcare rates are where you live.
Individuals and families with incomes less than 400 percent of the FPL (and who are covered by an exchange plan) are eligible for healthcare tax credits. Credit payments began in 2014.
The next open enrollment period for Kynect starts November 1, 2015, and ends January 31, 2016. Your coverage can begin as early as January 1, 2016.
To learn more about Kynect, please visit kyenroll.ky.gov or call 1-855-4kynect (459-6328). You can also email customer service using this form or get help via online chat with a live representative. People living in Kentucky can use the Kynect website to find application help. If you live out of state, you can use the Local Help portion of Healthcare.gov.
Start researching and find the plan that’s best for you. The earlier you get coverage, the better you can take care of your healthcare needs.