En español | Most Kentucky residents can buy health insurance through kynect, the state’s Affordable Care Act (ACA) marketplace, during open enrollment, which runs from Nov. 1, 2022, through Jan. 15, 2023.
Residents who experience a qualifying life event, such as a marriage, a divorce, the birth of a child, a move or the loss of health insurance, may be eligible to buy or change coverage outside the open-enrollment period.
Most people already enrolled in ACA marketplace plans have seen their premiums go down because the 2021 American Rescue Plan Act (ARPA) increased tax credits for insurance premiums and expanded the number of households that qualify for them. Every household that pays more than 8.5 percent of its income for a marketplace plan now qualifies for federal tax credits to help with coverage. These enhanced subsidies are now available through 2025.
Prior to the 2021 law, such tax credits were only available to people earning less than a certain salary ($54,360 for one person).
Most Americans with a marketplace plan can save an average of about $800 per year, according to the federal government.
Who is eligible?
- Most Kentucky residents can buy health insurance through kynect during open enrollment or if they experience a qualifying life event, regardless of whether they’re currently insured. Some non-U.S. citizens, including green card holders, may also be eligible for coverage.
- Low-income individuals and families may also qualify for free or low-cost health insurance through Medicaid. Use kynect’s prescreening tool
to see if you’re eligible, or sign up on this kynect benefits page to apply for benefits.
- The Kentucky Children’s Health Insurance Program offers health insurance for children and teens in families with incomes too high to qualify for Medicaid but who still may struggle to find affordable coverage. To enroll or to see if you’re eligible, visit the kynect page outlining these benefits.
When can I enroll?
- From Nov. 1, 2022, to Jan. 15, 2023.
- You can enroll outside of open enrollment if you experience a qualifying life event but you have only 60 days from that event to enroll.
- You can enroll anytime if you qualify for Medicaid or if your children qualify for the Children’s Health Insurance Program (CHIP).
How do I sign up?
First, use kynect’s plan comparison tool to estimate costs and see what sorts of plans and benefits you may qualify for — or enter personal information like your name and zip code to set up time to speak with an assister, which could be a “kynector” or an insurance agent, who can explain the options available to you. Or speak with a kynect call center representative by calling 855-459-6328.
Once you’re approved for a plan, you’ll need to pay your first monthly premium for your coverage to begin.
To apply and enroll:
- Online: Create an account or sign up on the kynect website. New customers will need to provide personal information like name, date of birth and email address.
- By phone: Call 855-459-6328 toll-free to speak with a representative.
- By mail: Print either a one-person or a family coverage application and mail, fax or hand deliver it to your local Department for Community Based Services office.
- In person: Visit your local Department for Community Based Services office.
- Through an authorized representative, a kynector or an insurance agent: Visit the kynect website to learn more about who can help you and how to find this sort of assistance.
What is covered, and how much will it cost?
Coverage and cost depend on where you live, the type of plan you choose, your household income, your age and the ages of those in your family.
If you qualify for Medicaid, you’ll be able to get free or low-cost coverage and may not need to worry about premiums or copays, depending on your level of income.
All kynect qualified health plans cover 10 “essential” benefits, including:
- Emergency services and hospitalization
- Maternity and newborn care
- Mental health services (including counseling)
- Chronic disease management and preventative care
- Prescription drugs
Insurance companies cannot deny coverage because of preexisting conditions. When you apply, you can identify your medical needs and choose a plan that makes financial sense for you and your family.
For individuals up to age 21 dental and vision services are included in marketplace plans. Dental plans for adults 21 and older are not currently available through the state-based marketplace, but separate vision plans can be purchased through kynect.
What about federal assistance for premiums?
Every eligible household that pays insurance premiums that exceed 8.5 percent of annual income now qualifies for federal tax credits for insurance premiums through 2025.
According to Megan O’Reilly, AARP vice president of government affairs for health and family, subsidy recipients ages 50 to 64 have already seen average annual savings of over $950.
Is there any other financial assistance available?
Yes. If you qualify for a premium tax credit, you may also qualify for a cost-sharing reduction, an ACA provision offering extra savings, that would help you pay for such out-of-pocket expenses as deductibles and copays. You must enroll in a Silver-level plan to get this assistance.
What plans are available?
Kynect plans are organized into three categories:
- Bronze plans have the lowest monthly premiums and the highest deductibles and copays, and cover roughly 60 percent of care costs. They’re designed to help you in case of serious illness or injury.
- Silver plans have moderate monthly premiums, deductibles and copays. They cover roughly 70 percent of costs. They’re the only plans eligible for cost-sharing subsidies; however, if you are an American Indian or Alaskan native, all plans have a cost-sharing subsidy.
- Gold plans have higher monthly premiums and lower deductibles and copays, and cover roughly 80 percent of care costs.
Kentucky residents younger than 30 can also apply for a catastrophic plan offering low premiums but with high deductibles.
What if I already have health insurance?
If you already have coverage through your employer or directly through an insurance provider but are eligible for lower premiums, you can switch to a qualified health plan. But you may not qualify for tax credits if you opt out of your employer’s plan — unless those premiums exceed a certain portion of your household income. The premiums would need to be more than 9.12 percent of your household income for individual coverage to qualify for the tax credits.
If you lose your COBRA coverage, you may be able to sign up for a kynect plan during a 60-day special enrollment window. Try to apply and select your plan through kynect before your COBRA coverage ends to make sure there’s no gap in coverage.
If you already have a marketplace plan and want to adjust your coverage, you’ll need to wait until the next open enrollment period opens this fall, unless you experience a qualifying life event.
Will I need to get a new doctor?
That depends. Because not all doctors accept all plans, you should check with your physician’s office to see whether he or she accepts a particular marketplace plan. Widely accepted insurance providers, including Anthem and CareSource, offer plans in 100 counties. Two new providers, Ambetter from WellCare of Kentucky and Passport Health Plan by Molina, are available in select counties.
Will my family members qualify for the same health plan that I do?
It depends. You can enroll as a family. But in some cases, some family members may also be eligible for subsidies or other programs such as Medicare, Medicaid or the state’s CHIP, depending on age, income, and disability or caregiver status. Such families may choose to enroll separately. They may still be able to see the same doctor or go to the same medical practice, depending on the types of insurance plans accepted.
This guide was updated on Aug. 25 with new information about the extension of enhanced subsidies.
Also of interest:
- ACA Subsidies Extended
- How Medicare Rx Price Negotiations Will Work
- Big Changes Coming to Medicare Part D
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