The Open Enrollment period for Kentucky runs from Nov 1, 2022, to Jan 15, 2023. For Kentucky, a specific portal, Kynect, will be used to browse and select an Affordable Care Act (ACA) plan. The plans available to you are specific to you and your background. When choosing a health insurance plan, compare plans based on your monthly premium and deductibles, plus any financial help you might be eligible for is best.
What are the Best Plans for the Kentucky Health Benefit Exchange?
For this specific article, we are looking at the most affordable plans for a single 30-year-old female who does not smoke and is not on disability. She makes an annual average income of $50,000 and lives in Jefferson County, Kentucky. There are specific ObamaCare Subsidies offered based on your income level. To qualify for a premium tax credit, individuals or families must have a net income above 138% of the federal poverty line (FPL). For this profile, her income is 388.2% of the FPL, qualifying her for some help, an estimated $27 premium tax credit.
The Kentucky Health Benefit Exchange (KHBE) oversees the commonwealthʻs implementation of the Affordable Care Act. Kynect is used through the KHBE to search and enroll in a plan. The table below lists all insurance plans available in 2023 for the above profile. It outlines the plan name and carrier, the monthly premium, and the deductible amount.
The table includes bronze, silver, gold, and platinum-qualified health plans (QHPs). The table does not have catastrophic plans. There are four primary insurers in the state. These include:
- Passport by Molina Healthcare.
- CareSource by Kentucky Co.
- Wellcare Plans of Kentucky Inc.
- Anthem Health Plans of KY.
For this profile and financial help estimate, remember that the $27 tax subsidy is being applied to the listed monthly premium. However, it is essential to remember that this is an estimate of your financial help. Your advanced premium tax credit will be determined when you apply for coverage.
Kentucky Health Benefit Exchange Qualified Health Plans (QHPs)
Constant Care Silver 1 250
CareSource Marketplace Bronze
Constant Care Silver 11 250
Confident Care Gold 1
Clear Bronze + Vision + Adult Dental
Everyday Gold + Vision + Adult Dental
Anthem Bronze Pathway X HMO 6700 for HSA ( + Incentives)
CareSource Marketplace Standard Silver Dental, Vision, & Fitness
Anthem Silver Pathway X Transition HMO 6500 ($0 Virtual PCP + $0 Select Drugs + Incentives)
Anthem Bronze Pathway X HMO 9100 ($0 Virtual PCP + $0 Select Drugs + Incentives)
Choice Bronze HSA + Vision + Adult Dental
Focused Silver + Vision + Adult Dental
CareSource Marketplace Bronze Dental, Vision, & Fitness
Anthem Bronze Pathway X Transition HMO 7700 ($0 Virtual PCP + $0 Select Drugs + Incentives)
CareSource Marketplace Gold Dental, Vision, & Fitness
Anthem Gold Pathway X HMO 2450 ($0 Virtual PCP + $0 Select Drugs + Incentives)
Anthem Bronze Pathway X Transition HMO 9100 ($0 Virtual PCP + $0 Select Drugs + Incentives)
Anthem Bronze Pathway X Transition HMO 6800 for HSA ( + Incentives)
Everyday Bronze + Vision + Adult Dental
Anthem Bronze Pathway X HMO 7700 ($0 Virtual PCP + $0 Select Drugs + Incentives)
Complete Silver + Vision + Adult Dental
CareSource Marketplace Low Premium Silver Dental, Vision, & Fitness
CareSource Marketplace Low Premium Silver
Confident Care Gold 1 + Vision
Complete Gold + Vision + Adult Dental
Anthem Silver Pathway X HMO 6000 ($0 Virtual PCP + $0 Select Drugs + Incentives)
CareSource Marketplace HSA Eligible Bronze
Anthem Gold Pathway X Transition HMO 2450 ($0 Virtual PCP + $0 Select Drugs + Incentives)
CareSource Marketplace Bronze First
CareSource Marketplace Bronze First Dental, Vision, & Fitness
Anthem Silver Pathway X HMO 0 ($0 Virtual PCP + $0 Select Drugs + Incentives)
Constant Care Silver 1 250 + Vision
Anthem Bronze Pathway X Transition HMO 7300 ($0 Virtual PCP + $0 Select Drugs + Incentives)
CareSource Marketplace Gold
Clear Silver + Vision + Adult Dental
Anthem Silver Pathway X HMO 3450 for HSA ( + Incentives)
Anthem Silver Pathway X Transition HMO 4200 for HSA ( + Incentives)
CareSource Marketplace Standard Silver
Anthem Bronze Pathway X HMO 6700 ($0 Virtual PCP + $0 Select Drugs + Incentives)
Anthem Silver Pathway X HMO 3500 ($0 Virtual PCP + $0 Select Drugs + Incentives)
Choice Bronze HSA
What should I consider when picking a health plan?
When selecting an ACA health plan for Kentucky, there are many things to consider. Some significant factors to consider are your current and future health needs, your financial situation, how much you can afford, and if you frequently travel.
Your Health Needs
When browsing plans, you'll want to evaluate your current health needs and any preferences for providers, facilities, and pharmacies you might have. Do the healthcare providers, hospitals, and pharmacies that you prefer fall within the prospective plan's network?
Additionally, if you require prescription medications, you'll want to ensure that these will be covered under your new plan. Each insurer has a list of medicines covered by their plan, usually found on their website. You should list your current medication and compare it to the plan's list to ensure your prescriptions are covered and understand all potential out-of-pocket costs.
Your Financial Situation
Your financial situation depends on how much you can pay out of pocket. The following are the basic categories of plans by metal tier that you can select within the health exchange. These plans vary based on monthly premiums and are suited to various living situations.
ACA Plan Breakdown & Cost Sharing
A good option for young
and healthy individuals.
A good option for healthy,
Best for people who will need comprehensive coverage
Best for people with
frequent medical needs
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How Much You Can Afford
You have your health needs and budget figured out. Now you can select the health plan that will best meet your needs. You’ll likely choose those plans that cover your health needs by their premium or deductible. The average premium expenses for ACA plans in Kentucky are as follows:
Average Marketplace Premium for Kentucky by Metal Tier, 2018-2023
2023 Average Lowest-Cost Bronze Premium
2023 Average Lowest-Cost Silver Premium
2023 Average Lowest-Cost Gold Premium
Consider offsetting a high deductible health plan (HDHP) with a service like Mira. HDHPs have a higher deductible than the average insurance plan, where monthly premiums are much lower. An HDHP, in 2023, is any plan with a deductible of at least $1,500 for an individual or $3,000 for a family. HDHPs are recommended for healthy people with infrequent medical needs and those experiencing illness. Consider pairing it with a Mira membership. Mira offers an affordable alternative to health insurance, and there is no deductible to be met.
If You Frequently Travel
If you travel a lot and need coverage during this time, you may want to purchase an additional add-on in the health exchange, such as a preferred provider organization (PPO). PPOs give you access to out-of-network coverage and allow you to see specialists without a referral. These plans do often come with a high premium and vary per state.
What happens if you can’t afford any plan on the exchange?
Only four states and DC will impose a tax penalty on those who do not have health insurance, and Kentucky is not one of the four. There is no penalty for not enrolling in a health insurance plan for Kentucky. However, having health coverage is extremely important, and you may qualify for assistance with paying for your health insurance.
How to enroll in an ACA plan?
Signing up for an ACA health plan in Kentuckyʻs Health Care exchange can be confusing. When entering the site, you must create an account by providing an email address and basic information about yourself. You can take three simple steps to browse, decide upon, and enroll in a health plan. These general steps are as follows:
- Have All Relevant Information Ready
- Know What You Should Consider When Browsing Plans
- Select the Best Option for Your Needs
ACA Health Plans in Kentucky Frequently Asked Questions (FAQs)
Below are some frequently asked questions about health insurance in Kentucky we gathered for you.
Virtual care for only $25 per visit
Virtual primary care, urgent care, and behavioral health visits are only $25 with a Mira membership.
What health insurance terms should I understand during this enrollment period?
There are many health insurance terms to know and understand during this enrollment period. Mira compiled a list of 10+ insurance terms, including Health Savings Accounts, deductibles, Benefit Periods, premiums, and many more. Donʻt forget that the open enrollment period for Kentucky spans Nov. 1, 2022, through Jan. 15, 2023.
What requirements do I need to meet to be eligible in Kentucky?
Yes, to be eligible to sign up for a plan in the NY-State Health Exchange, you:
- Must live in Kentucky
- Must be a U.S. citizen, national or lawfully present, immigrant
- Cannot be currently incarcerated
What are the benefits that my plan is required to provide?
Affordable Care Act health insurance plans are required to provide ten essential benefits, known as minimum essential coverage. Any plan on the ACA exchange must include benefits about:
- Outpatient care
- Emergency care
- Inpatient care/hospitalization
- Pregnancy, maternity, and newborn care
- Mental health and substance use services
- Prescription drugs
- Rehabilitation services and devices
- Laboratory services
- Preventive care and chronic disease services
- Pediatric care
When is the special enrollment period?
The Special Enrollment Period (SEP) refers to the “time outside the yearly Open Enrollment Period when you can sign up for health insurance.” You must qualify for SEP by having experienced a qualifying event(s). These include events such as:
- losing health coverage
- getting married
- having a baby, or adopting a child,
- your household income is below a certain amount (150% of FPL)
There are many ACA plans on the Kentucky Health Benefit Exchange. These vary by metal tier, coverage types, and premium and deductible amounts. Choosing the best plan for you is a process that takes time, but it can be simple. Considering your financial situation, healthcare needs, and other factors will help you choose the most affordable yet comprehensive health plan.
An alternative to individual health insurance plans is health memberships such as Mira. Consider Mira if you struggle to find affordable yet high-quality health coverage in Kentucky. For as little as $45 a month, Mira members get access to low-cost virtual and urgent care, up to 80 percent off select medications, and same-day lab testing. Additionally, a Mira care team member will work with you to find an affordable provider in your area. Sign up for Mira today and get covered today!
Kendra Bean is from Maui, Hawaiʻi. She is currently enrolled at the University of Hawaiʻi at Mānoa, specializing in Epidemiology. She is passionate about improving health literacy and access to care, specifically in rural areas.