Kentucky Health Insurance

Health insurance in Kentucky

● Kentucky originally ran its own health insurance marketplace, Kynect, but HealthCare.gov in the fall of 2016. Kentucky plans to return to Kynect in the fall of 2021.

● Open enrollment for 2021 coverage in Kentucky will run out from November 1 to December 15, 2020. Residents with eligible events can sign up or change plans outside of open enrollment.

● Short-term health plans can be sold in Kentucky with initial plan terms of up to 364 days.

● Two insurers offer 2021 coverage in kentucky's individual marketplace; the average increase in the approved rate is less than 5%.

● The Kentucky Health Care Cooperative is one of 19 ACA CO-OP's that have failed.

● After Kentucky adopted the ACA's Medicaid expansion, the state experienced the largest percentage increase in Medicaid enrollment in any state.

● Kentucky planned to implement a labor requirement in April 2019 that would have reduced Medicaid enrollment by nearly 100,000 people. But a federal judge blocked him before it could take effect, and Governor Bevin withdrew everything together as soon as he became insosamo.

● Kentucky is unable to improve new federal rules on short-term health insurance.

● More than 942,000 Kentucky residents are enrolled in Medicare.

This page is designed to be a resource for Kentucky residents with questions about health insurance coverage. It includes an overview of kentucky's health insurance marketplace that serves individuals and families who purchase their own coverage, and the next open enrollment period for individual marketplace coverage. We also included a summary of Medicaid expansion in Kentucky and an explanation of the state's short-term health insurance rules. Medicare coverage for elderly and disabled residents is included in our overview, along with a summary of health insurance resources for Kentucky residents.

Kentucky's health insurance marketplace

Kentucky initially ran its own exchange and registration website, Kynect, and the state-run exchange was widely considered one of the most successful state exchanges in the country. But former Governor Matt Bevin, who was in office from late 2015 to late 2019, followed the campaign's promise to switch kentucky's exchange to the HealthCare.gov.

Kentucky technically has still maintained a state-run exchange all this time, however, and is one of several states that have state-run exchanges but use the HealthCare.gov website for registration. And because of the 2022 plan year, Kentucky will once again have a fully state-run exchange. Governor Andy Beshear notified CMS that Kentucky will return to Kynect starting in November 2021.

The marketplace in Kentucky - Kynect or HealthCare.gov, depending on the year - serves individuals and families who purchase their own health insurance, including people employed in a small business that doesn't offer health benefits, people who retired before Medicare eligibility, and people who are self-employed and therefore don't have an option for employer-sponsored health coverage.

The Kentucky marketplace also serves as a registration platform for people eligible for income-based Medicaid and CHIP. And for people who buy their own health insurance, it's the only place these claimants can benefit from subsidies to help offset the monthly cost of their coverage and their out-of-pocket costs.

Kentucky opens enrollment period and dates

Open enrollment for 2021 coverage in Kentucky will run out from November 1, 2020 to December 15, 2020. Outside of that window, residents can only sign up (in return or out of exchange) if they experience a qualifying event.

By 2021, the state exchange will continue to offer individual plans from two health insurance companies (Anthem and CareSource). The average rate changes approved for 2021 are a 5.7% increase for Anthem and a 4% decrease for CareSource, equal to a weighted average rate increase of 4.95%.

CareSource has expanded its service area for 2020, so there are 56 counties where residents can choose between Anthem and CareSource. In the rest of the state, plans are available from one or other insurer, but not both. For 2021, CareSource's storage note indicates that it plans to further expand its coverage area.

83,139 people enrolled in private individual marketplace plans through the Kentucky exchange during the open enrollment period for 2020 coverage.

Kentucky’s failed CO-OP

The ACA has established a federal loan program to encourage the creation of consumer-oriented plans (CO-POs), which are consumer-run nonprofit health insurance companies. Through the program, 23 CO-PO's were established in January 2014, including the Kentucky Health Care Cooperative. However, 19 of them, including Kentucky's, failed.

Kentucky Health CO-OP had a solid registration in 2014 and planned to expand into neighboring West Virginia for 2016. But co-op closed at the end of 2015, along with many others that closed at the same time, largely due to significant shortcomings in the financing of risk corridors that year.

Medicaid eligibility and expansion in Kentucky

In addition to implementing a state-run health insurance exchange, Kentucky expanded Medicaid under the Affordable Care Act. As part of the medicaid eligibility expansion, Kentucky residents with a family income of up to 138% of the federal poverty level are eligible for Medicaid.

Kentucky Medicaid enrollment more than doubled between 2013 and mid-2020, growing by 127%, by far the largest percentage increase of any state and more than four times higher than the national average increase of 28%. Kentucky has long led the country in terms of Medicaid enrollment growth as a result of the ACA, but enrollment increased during the COVID pandemic, growing faster in Kentucky than in the rest of the country, in part because Kentucky took an active role in helping people understand their eligibility and enroll.

But under the Bevin administration, Kentucky was less eager to increase Medicaid enrollment. After the Trump Administration made it clear that they would be open to the possibility of work requirements for Medicaid, Kentucky was the first state to receive federal approval to implement a Medicaid work requirement, which was supposed to take effect in July 2018. But the month before it would take effect, a federal judge blocked the Kentucky HEALTH implementation.

The waiver was re-approved by HHS in November 2018, with an effective date of April 2019. but the work requirement was again blocked, a few days before it would take effect. And in December 2019, A few days after taking office, Governor Andy Beshear ended kentucky's HEALTH waiver, officially lifting the state's Medicaid work requirement.

Visit the Kentucky Department for Medicaid Services website for information about the state's Medicaid program and the Kentucky Children's Health Insurance Program (KCHIP).

Availability of short-term health insurance in Kentucky

Kentucky is unable to be part of federal short-term health insurance rules. This means that plans sold in the state can have initial terms of up to 364 days and a total duration of up to three years, although many of the sales plans are limited to six months.

Kentucky health ratings

When it comes to public health, Kentucky faces some challenges. The state has received low rankings from various ratings in recent years.

Kentucky ranked 43rd in the 2019 edition of America's Health Rankings and 40th in the Commonwealth Fund's 2019 Scorecard on State Health System Performance.

How did Obamacare help Kentucky?

In 2013, Kentucky's uninsured rate was 14.3%, slightly below the national average at that point. But by 2016, the state's uninsured rate had fallen to 5.1%, which at that point was well below the national average of 8.6%. This reduction was largely due to the state's successfully state exchange (Kynect) and medicaid expansion under the ACA.

But when the 2017 open enrollment period began on November 1, 2016, Kentucky residents switched to using HealthCare.gov for enrollment. Former Governor Matt Bevin, who took office in 2015, has switched the state to the federal registration platform in an effort to reduce costs and take advantage of HealthCare.gov.

Kentucky still has a state-based exchange, but it no longer has the autonomy it faces to have a state-run registration platform (which will change in the fall of 2021, when Kentucky will once again use Kynect and have full autonomy over its exchange). For example, when the open enrollment period for 2018 coverage was dimeo, 10 of the 12 states with state-run registration platforms opted for longer enrollment periods and most continued to do so for enrollment in the 2019 and 2020 plans (for the 2021 plan year, there are 15 fully state-run exchanges). But because Kentucky has used HealthCare.gov years, they haven't had that level of flexibility. This is part of the state's motivation for the transition from HealthCare.gov in the fall of 2021 and the reactivation of the Kynect registration platform and website.

The Affordable Care Act in the bluegrass state

In the 2010 vote on the Affordable Care Act (aka Obamacare), kentucky's two Republican senators voted "no." Current Kentucky senators - Mitch McConnell and Rand Paul - remain staunchly opposed to the ACA.

Kentucky's representatives in the House divided their votes on the ACA along party lines, with two votes in favor and four not. Kentucky's current representatives include five Republicans and only one Democrat. One of the Republicans, Thomas Massie, was among the 20 Republicans in the House of Representatives who voted no to the American Health Care Act in 2017, which would have repealed several important parts of the ACA. That bill passed the House, but it did not pass the Senate and was never enacted.

At the state level, former Governor Steve Beshear's support for the ACA has repeatedly attracted national attention, with even President Obama noting this during his 2014 State of the Union address. Beshear used an executive order to establish kentucky's state health insurance marketplace, Kynect.

Kynect has been seen as a model for state marketplaces. Beshear also fully supported medicaid expansion, calling it the "most important decision" to improve the health of Kentucky residents.

Kentucky elected Republican Matt Bevin governor in the 2015 election. Bevin campaigned on an anti-Obamacare platform and shut down the state-run exchange platform less than a year after taking office. Steve Beshear's son, Andy Beshear, defeated Bevin in the 2019 election and is planning to return the state to the Kynect platform in the fall of 2021.

Does Kentucky have a high-risk pool?

Before the ACA reformed the individual health insurance marketplace, pre-existing conditions were an obstacle to getting coverage in nearly every state, including Kentucky. Medical histories were examined during the application process, and people who did not meet health eligibility guidelines were unable to purchase private coverage. Kentucky Access was founded in 2001 to offer coverage to people who were unable to obtain policies in the individual marketplace due to pre-existing conditions.

Under the ACA, all new health insurance policies have become a guaranteed issue as of January 1, 2014. This aspect of the reform has largely eliminated the need for high-risk pools, and Kentucky Access notified its members that the plan would cease operations at the end of 2013. Policyholders were able to switch to private coverage through Kynect instead.

Medicare coverage and enrollment in Kentucky

Medicare is a health insurance program run by the federal government to provide coverage to elderly and disabled Americans. There were 942,146 Kentucky residents enrolled in Medicare as of August 2020. Most are eligible due to age, but 22% are under the age of 65 and are eligible due to a disability, including LAS or end-stage kidney disease. Kentucky is tied to a handful of other states for the highest percentage of Medicare beneficiaries under the age of 65 (the national average is only 15 percent).