Starting next month, Kentuckians will be able to shop for health care plans through the state’s marketplace as open enrollment begins Nov. 1 and runs through Jan. 15, 2023.
Because of the recently passed Inflation Reduction Act, the payment assistance, tax credits and low premiums enacted through the previous American Rescue Act of 2021 have been extended into 2025.
We’ve compiled this guide to help walk you through the enrollment process once it opens and decide if health care coverage under the Affordable Care Act is right for you and your family.
What is the marketplace called in Kentucky?
Most Kentuckians are eligible to sign up for coverage on the state’s exchange kynect.ky.gov, Kentucky’s official marketplace for health insurance. Requirements include being a resident of the commonwealth and a US citizen or qualified immigrant.
Outside of the open enrollment period beginning Nov. 1, and whether you’re insured or not, you need to experience a qualifying life event to sign up for coverage. That includes a change in your situation, like getting married, having a baby or losing your health coverage, according to Healthcare.gov.
Low-income Kentuckians and their families might also be eligible for coverage under a low-cost Medicaid plan, and they can verify their eligibility with a free prescreening tool.
“That will give you an idea about what benefits you could potentially qualify for,” Carrie Banahan, deputy secretary for Kentucky’s Cabinet for Health and Family Services, said in an interview.
Kentucky’s Children’s Health Insurance Program also offers health insurance to children and teens in households with incomes too high to qualify for Medicaid that still need affordable health insurance, according to this guide from the AARP. Kynect outlines these benefits on its website.
What do the plans cover?
All plans offered on the marketplace cover 10 essential health benefits, including:
Ambulatory patient services (outpatient care you get without being admitted to a hospital)
Hospitalization (like surgery and overnight stays)
Pregnancy, maternity and newborn care (before and after birth)
Mental health and substance use disorder services, including behavioral health treatment (such as counseling and psychotherapy)
Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities or chronic conditions gain or recover mental and physical skills)
Preventive and wellness services and chronic disease management
Pediatric services, including oral and vision care for children
Marketplace plans must also include birth control coverage and breastfeeding coverage.
Adult dental and vision coverage aren’t considered “essential,” but other plans may offer these benefits, according to Healthcare.gov.
Those shopping for coverage on the marketplace can get a qualified health plan, with or without payment assistance.
How to sign up for health coverage
Start by using Kynect’s plan comparison tool.
It will run a check of any tax credits you qualify for to help pay for your premium and available qualified health plans. It will ask you questions about your health, to estimate your annual income and other questions before allowing you to compare plans.
A checklist to walk you through what documents you need is available online.
You can also just contact a “kynector” to explain your coverage options. That can be done online or by calling 855-459-6328 once open enrollment begins Nov. 1.
What types of KY ACA plans are there?
Generally, Kynect plans fall into one of three categories: bronze, silver and gold plans, according to AARP.
Bronze plans have the lowest monthly premiums, but the highest deductibles and copays and cover only about 60% of your health care.
Silver plans have more moderate monthly premiums, deductibles and copays. They cover about 70% of your costs. These are also the only plans available for cost-sharing subsidies from the government.
Finally, gold plans have high monthly premiums and lower deductibles and copays, with coverage for roughly 80% of your care costs.
Kentuckians younger than 30 can also apply for a “catastrophic plan” with low monthly premiums, but high deductibles.
What’s new with the ACA in 2022?
According to Healthcare.gov, you might qualify for more savings and lower costs on the marketplace because of the American Rescue Act of 2021.
Under that law:
More people than ever before qualify for help paying for health coverage, even those who weren’t eligible in the past.
Most people currently enrolled in a marketplace plan may qualify for more tax credits.
Health insurance premiums after these new savings will go down.
Because of the federal Inflation Reduction Act, passed in August, lower costs will continue through to 2025. If you qualify for savings on 2023 coverage, you’ll see the lower costs when you shop for plans, starting Nov. 1.
Do you have a question about health care in Kentucky for our service journalism team? We’d like to hear from you. Fill out our Know Your Kentucky form or email email@example.com.