With most of the Affordable Care Act’s major provisions now in effect, the nation’s health insurance marketplace has undergone a significant transformation. Obamacare impacts individuals, families and small business owners alike. Most Americans are required to have minimum essential coverage unless they qualify for an exemption; however, the law is designed to make health insurance more accessible and affordable with income-based financial assistance and one-stop shopping via state-based and federally facilitated exchanges. Meanwhile, the private marketplace remains a place to shop for quality, affordable health insurance plans that meet ACA requirements.
The following guide offers a glimpse at the various types of ACA-compliant health insurance in Kentucky, including individual and family health plans, small group health plans, coverage for high-risk applicants, mini-COBRA continuation coverage, Medicaid, and CHIP.
Health and healthcare in Kentucky
Kentucky ranked 47th in United Health Foundation’s 2014 America’s Health Rankings.4 The state’s strengths included a low prevalence of binge drinking, a low violent crime rate, and a low incidence of infectious diseases. Challenges include a high prevalence of smoking, a high rate of preventable hospitalizations, and a high rate of cancer deaths.
Kentucky individual and family health insurance
When Obamacare’s first open-enrollment period began, Oct. 1, 2013, Kentucky launched kynect [sic], a state-based health insurance exchange where individuals, families and small businesses can shop for affordable coverage.
Those who buy health insurance through Kentucky’s exchange may be eligible for income-based subsidies, including premium tax credits that may be applied to any metal plan and cost-sharing subsidies that apply to silver plans. Individuals who go without health insurance may face a tax penalty known as the shared responsibility payment.
Kentucky residents may also shop for ACA-compliant health insurance plans in the private marketplace on websites such as HealthCare.com. Check out HealthCare.com’s tax subsidy calculator to see if you qualify for a premium tax credit. If you do, visit Kentucky’s health insurance exchange to apply for health insurance coverage.
The U.S. Department of Health and Human Services reported that 82,747 individuals in Kentucky selected a marketplace plan through the exchange from Oct. 1, 2013, through April 19, 2014.2 In 2015, the number of individuals in Kentucky enrolled in a marketplace plan increased to 106,330 during the open enrollment period.3
|Kentucky’s health insurance exchange:||kynect.ky.gov|
|Kentucky department of insurance:||insurance.ky.gov|
Kentucky small group health insurance plans
In Kentucky, small businesses with 50 or fewer employees may purchase small group health insurance plans through the kynect exchange and in the private marketplace through websites such as such as HealthCare.com. Small businesses that use kynect and have 25 or fewer employees may qualify for a Small Business Healthcare Tax Credit.
Self-employed individuals with no employees must apply for an individual health insurance plan on or away from the state’s exchange.
Kentucky state COBRA variations for small groups
The Consolidated Omnibus Reconciliation Act (COBRA) allows those employed by businesses with 20 or more employees to continue their group health insurance plan for a limited time should they lose coverage due to qualifying events such as termination of employment due to reasons other than gross misconduct, a reduction in work hours, divorce or legal separation, and loss of dependency status. To learn more about the federal COBRA program, visit dol.gov/ebsa/cobra.html.
In some states, those who work for a small business and lose health insurance coverage due to a qualifying event may be eligible for health insurance continuation through mini-COBRA or a similar state continuation program. In a few states, these programs may also be extended to those who work for larger companies and exhaust their federal COBRA continuation coverage limit. Mini-COBRA generally works like the federal COBRA continuation coverage, but its terms may vary.
Kentucky’s small group COBRA continuation variations are as follows4:
|Eligible group sizes||Employer groups of fewer than 20 employees; must have a fully insured plan|
|Maximum continuation period – standard||18 months|
|Maximum premium Increase||100 percent|
|State legislation reference||State Continuation of Coverage Under Kentucky Law|
|More information||800-587-7222 or 502-564-6034 – Kentucky Health Insurance Advocate’s Office|
|Additional notes||Employees and their dependents must have been covered by the group policy or any group policy it replaced for at least three months.
Employees must notify the insurer and pay the full group premium rate within 31 days after receiving notice of their right to continue coverage.
Kentucky high-risk pools
It used to be that health insurance companies could deny applicants or charge them more based on health history and preexisting conditions. When the Affordable Care Act was passed in 2010, many states created federally funded preexisting condition insurance programs or accepted federal funding to assist with similar high-risk pool programs they already operated.5
The Affordable Care Act prohibits this practice for health insurance plans considered minimum essential coverage with effective dates beginning Jan. 1, 2014, and later. As such, the PCIPs and state high-risk pools created to provide health insurance for those once considered uninsurable are being phased out.
Medicaid is a state health insurance program for low-income individuals under age 65, pregnant women, children, disabled individuals, and seniors over age 65; it is partially funded by the federal government. In 2014, states were given the option to accept additional federal funding and expand their Medicaid program eligibility to those who make up to 133 percent of the federal poverty level (effectively 138 percent due to how it is calculated, according to HealthCare.gov). 6
Kentucky expanded its Medicaid program in 2014.7 Medicaid/CHIP open enrollment takes place year-round.
The information below is specific to Kentucky’s Medicaid program:
|Governing agency||Centers for Medicare & Medicaid|
|Administrator||Kentucky Cabinet for Health and Family Services|
|How to apply online||kynect.ky.gov|
|Additional application options||chfs.ky.gov/dms/Eligibility.htm.|
|Phone number||855-459-6328 or TTY 855-326-4654|
|Open-enrollment period||Year-round in all states|
The Children’s Health Insurance Program is a partnership between the states and federal government. CHIP provides health insurance to uninsured children who meet certain eligibility guidelines.
The information below is specific to Kids’ Health, Kentucky’s health insurance program for low-income children:
|Program name||Kentucky Children’s Health Insurance Program|
|How to apply||kynect.ky.gov|
|For additional options, visit||kidshealth.ky.gov/en/kchip/apply.htm.|
|Phone number||877-KCHIP-18 (877-524-4718) / 877-KCHIP-19 (877-524-4719) – deaf and hard of hearing|
|Eligibility8||Children younger than 19 years old who live in families at or less than 213 percent of the federal poverty level|
1 United Health Foundation. 2014 America’s Health Rankings Annual Edition. “Annual State Health Rankings.” http://www.americashealthrankings.org
2 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2014/.
3 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2015/.
4 Kentucky Department of Insurance. “State Continuation of Coverage Under Kentucky Law.” January 2012. http://insurance.ky.gov/Documents/statecontinuationcoverage012612.pdf.
5 National Conference of State Legislators. Coverage of Uninsurable Pre-Existing Conditions: State and Federal High-Risk Pools. Updated April 2014. Retrieved from http://www.ncsl.org/research/health/high-risk-pools-for-health-coverage.aspx.
6 Centers for Medicare & Medicaid Services. “Medicaid Expansion & What It Means for You.” HealthCare.gov. N.D. https://www.healthcare.gov/what-if-my-state-is-not-expanding-medicaid/.
7 Centers for Medicare & Medicaid Services. “Kentucky.” Medicaid.gov. N.D. http://medicaid.gov/Medicaid-CHIP-Program-Information/By-State/kentucky.html.
8 Kentucky: Kids Health. “Am I Eligible?” http://kidshealth.ky.gov/en/kchip/eligibility.htm.