Looking ahead to 2016
The Kentucky Department of Insurance has finalized rates for 2016, and all five of the individual market Kynect carriers had their rate changes approved without modifications (all changes are averages, rate changes for a particular plan will vary):
- Kentucky Health Cooperative (an ACA-created CO-OP) = 25.1 percent increase
- Anthem BCBS = 12.2 percent increase
- CareSource Kentucky = 11.83 percent increase (network will expand and plans will be available in additional counties).
- Humana = 5.2 percent increase
- Wellcare Health Plans = 10.98 percent decrease
- A full list of rates that have been filed and approved with the Kentucky Department of Insurance is available here, including small group plans and off-exchange carriers.
In addition to the five carriers that were already offering individual plans through Kynect, the exchange is adding three more carriers for 2016:
- UnitedHealthcare will offer plans statewide
- Aetna will have plans available in 10 counties
- Bluegrass Family Health will have plans available in 79 counties (out of 120 counties in Kentucky).
UnitedHealthcare and Bluegrass Family Health previously offered only small group plans through the exchange, and Aetna had not previously participated in Kynect.
With the addition of the new carriers, everyone in Kentucky will have at least three private carriers from which to choose when open enrollment begins in November.
Kentucky Health Cooperative garnered significant market share in 2014, enrolling 75 percent of Kynect’s private plan customers (the other 25 percent was split evenly between Humana and Anthem, which were the only other participating carriers in 2014). But the CO-OP ended up raising premiums by 20 percent for 2015 because the initial low rates had not been sufficient to cover claims costs.
The average current Kentucky Health Cooperative premium per member is $310 per month, and will rise to $388 per month in 2016. Wellcare’s current average per member premium is $318 per month. Anthem’s current average premium is $313 per month. CareSource has a current average premium of $249 per month. Humana’s current average premium is $321 per month. Given the approved rate increases (or decrease, in the case of Wellcare) and the introduction of three new carriers, it’s likely that there could be considerable shifting in the market share of Kynect’s carriers in 2016. Premium subsidies will offset price hikes for most consumers, but it will be particularly important for current enrollees to shop around during open enrollment (as opposed to relying on automatic renewal of their existing coverage).
Five carriers currently provide Medicaid managed care plans in Kentucky, and their contracted were renewed in July 2015: Anthem, Coventry Cares, Passport, Humana, and Wellcare.
Gubernatorial race and the future of Kynect
In November – just two days after open enrollment begins – Kentucky residents will elect a new governor. Current Gov Beshear is term limited, so he’s not in the running. The Democratic nominee, Jack Conway (currently the Attorney General) supports Kynect. But the Republican nominee, Matt Bevin, would rather terminate Kynect and switch to Healthcare.gov (a move that he could accomplish via executive order in Kentucky, as the exchange was created with an executive order from Beshear). Bevin has also confirmed that he would roll back Medicaid expansion in the state if he’s elected.
2015 enrollment data
106,330 people had selected a private plan through Kynect by February 21. That total did not include the people who enrolled during Kynect’s special enrollment period (SEP) for people who realized – after open enrollment ended – that they owed a tax penalty for not having insurance. Kentucky’s SEP ran from March 2 through April 30, and the exchange enrolled another 3,047 people in private plans during that time. The individual mandate, which requires most people to have health insurance, went into effect Jan. 1, 2014. However, many people weren’t aware of the mandate and only learned of it when they filed their 2014 taxes. Consumers couldn’t do anything about the 2014 penalty at that point, but the special open enrollment period allowed them to minimize the 2015 penalty that will be assessed when tax returns are filed next spring.
Open enrollment ended on February 15, but the exchange granted an extension to February 28 to anyone who made a “good faith” effort to enroll by that date, but was unable to finish due to trouble with the website or getting through to the call center.
But not everyone who enrolled ended up paying the initial premium (which meant the coverage was never actually in-force). And some people cancelled their coverage soon after it began. By the end of March, 92,372 people in Kentucky had in-force private plan coverage through Kynect. 69.3 percent of them are receiving premium subsidies, and 37.4 percent have silver plans that include cost-sharing subsidies (only available to enrollees with incomes up to 250 percent of the poverty level). The 3,047 tax-season SEP enrollees mentioned above will likely add to that total, since many of them did not yet have in-force coverage as of March 31.
An additional 152,529 people had enrolled in Medicaid through Kynect between November 15 and February 21. Medicaid enrollment continues year-round.
In terms of retaining 2014 enrollees, Kynect re-enrolled 94.4 percent of their first-year insureds. That’s far higher than the nationwide averages (69 percent retention among state-based exchanges, and 78 percent for Healthcare.gov exchanges)
Enhancement for 2015
Even though Kentucky’s state-run marketplace was already one of the nation’s most successful exchanges in 2014, officials worked hard to make improvements and updates for 2015 open enrollment.
Kynect met with brokers, insurance carriers, and Kynectors (navigators) to get feedback and learn what areas need improvement. Enhancements include:
- The call center increased the number of customer service representatives from 185 at the start of the first open enrollment period to 400 for the start of the 2015 open enrollment period. The call center also expanded operating hours and underwent a systems upgrade to reduce wait times and enable more efficient operations.
- More agents, brokers, and Kynectors are participating in the 2015 open enrollment.
- Kynect debuted a mobile app to enhance outreach and customer service, especially for the under-35, “young invincible” population. The app allows users to check plan options and see rates, and then complete their application on the Kynect website. As of Feb. 19, more than 8,500 people had downloaded the app.
- Kynect launched a full-service enrollment center at the Fayette Mall in Lexington. Through Feb. 19, nearly 7,600 people visited the center and nearly 6,000 people applied for new coverage.
2015 options on Kynect
Five insurers are participating in Kentucky’s individual marketplace during 2015 open enrollment: Anthem Blue Cross and Blue Shield, CareSource, Humana, Kentucky Health Cooperative, and Wellcare of Kentucky. WellCare and CareSource offer Medicaid managed care plans in Kentucky, but did not previously participate in the private individual market.
In addition, two carriers – Bluegrass Family Health and UnitedHealthcare – are offering only small group plans through the exchange (with the exception of Humana, the carriers offering individual plans are also offering small group plans).
Six dental carriers are offering plans through Kynect for 2015.
Penalties will rise
Those who are uninsured three or more months of the year may have to pay a penalty, and the penalties are increasing for 2015.
Those who don’t qualify for an exemption will have to pay the greater of:
- 2% of annual household income. The maximum penalty under this calculation method is the national average premium for a bronze plan, which is about $3,100 according to .
- $325 per adult or $162.50 per child under 18. The maximum penalty per family using this method is $975.
Use the healthinsurance.org penalty calculator to see how much you may owe.
Grandmothered plans allowed in Kentucky
Transitional, or grandmothered, health plans are allowed to renew in Kentucky until October 1, 2016, which means they can remain in force as late as September 30, 2017. Renewal is at carrier discretion however, and transitional plans are not required to renew – carriers can choose instead to replace them with ACA-compliant plans. About 14,000 people in Kentucky were on plans – mostly from Humana – that were terminated at the end of 2014 because the carrier opted to switch to only ACA-compliant plans.
Impressive coverage gains in 2014
Kentucky realized a 10.6 point decline in its uninsured rate following the launch of its health insurance marketplace and expansion of its Medicaid program. The percentage of people without health insurance dropped from 20.4 percent in 2013 to 9.8 percent in 2014, according to the Gallup-Healthways Well-Being Index. Only Arkansas had a larger drop.
Kynect officials said about 75 percent of those who signed up for coverage in 2014 did not previously have insurance. To help people who have little experience with the health care system or health insurance, the exchange has worked to create a consumer guide called “How to Kynect” and is providing it to new enrollees in order to help them learn how to select a primary care doctor, when to seek health care, when to visit the ER, how to use the pharmacy benefits on their plan, and understand insurance terminology.
History of Kentucky’s exchange
Kynect is considered one of the nation’s best marketplaces. More than 521,000 people obtained health insurance coverage through Kynect in 2014 — either private health insurance or Medicaid.
One sign of Kynect’s success is widespread awareness: a poll from late 2014 shows that nearly 80 percent of Kentucky residents have heard of the exchange and nearly 52 percent of Kentuckians between the ages of 30 and 64 said they knew “a lot” about it.
Another sign is the Beshear administration’s inclusion of Knyect in its list of top accomplishments of 2014. The state’s uninsured rate dropped nearly 8 points, and the newly insured are taking advantage of their coverage. The state reported 26,000 more people will have cholesterol screenings, 7,000 more women will have mammograms, 10,000 more women will have pap smears, and 14,000 more people with depression will be treated.
Kynect was one of the few marketplaces established through an executive order. Beshear’s order to establish the exchange in July 2012 followed months of seeming inaction on the exchange by the executive and legislative branches in the state. Kynect is part of the state’s Cabinet for Health and Family Services, and it is overseen by 19-member board appointed by Beshear.
Gov. Steve Beshear went against public sentiment in deciding the state would run its own marketplace. In an article in The New York Times, Beshear urged state residents to set aside politics and use the marketplace to get insured. “You don’t have to like the president; you don’t have to like me. Because this isn’t about him, and it’s not about me. It’s about you, your family and your children.”
Kentucky spent about $11 million on outreach and marketing for 2014 open enrollment, and it trained 5,000 people to support enrollment — including state employees, insurance agents, volunteers and representative of various community groups and social service organizations. These outreach efforts drove Kentucky’s enrollment totals.
While the federal marketplace, HealthCare.gov, and multiple state-run marketplaces had significant technical problems in 2014, Kynect ran well from the start. Experts say those in charge of implementing Kynect made good choices. They kept the design simple and worked with well-qualified and experienced vendors.
There is still room to improve however. According to a report issued by the National Health Council in July 2015, Kentucky is an average-performing state in terms of how patient-centered the health insurance market is. The report gave Kentucky a low score for how easy it is for consumers to compare and understand plans sold through Kynect, and on all other metrics, Kentucky received an average score. Very few states received high scores.
Kentucky health insurance exchange links
Kynect – Kentucky’s Healthcare Connection
Consumer site for Kentucky’s marketplace
Kentucky Health Benefit Exchange
Administrative site for Kentucky’s marketplace
Kentucky Health Insurance Advocate, Kentucky Department of Insurance
Assists people insured by private health plans, Medicaid, or other plans in resolving problems pertaining to their health coverage; assists uninsured residents with access to care.
(877) 587-7222 /DOI.CAPOmbudsman@ky.gov