Kentucky health insurance marketplace guide 2023

The open enrollment period for individual/family health insurance runs from November 1 through January 15 in Kentucky.

Outside of open enrollment, a qualifying event is generally necessary in order to enroll in private coverage. Learn more about enrollment opportunities in our comprehensive guides:

• Open enrollment
• Special enrollment periods

For 2023 coverage, four insurers are offering individual/family health plans through Kynect, Kentucky’s state-run marketplace; all four also offered coverage in 2022.  The following insurers offer plans in the Kentucky exchange, with plan availability varying from one location to another:

• Anthem
• Caresource
• Molina 
• Ambetter/Wellcare 

Molina and Ambetter/Wellcare were both new to the exchange as of 2022. There are just six counties in Kentucky where Anthem is the only option for 2023, down from 14 counties in 2023 and 26 counties in 2021. 

2014: Plans were available in Kentucky’s exchange from Anthem, Humana, and Kentucky Health Cooperative (an ACA-created CO-OP). 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.

2015: CareSource and Wellcare joined the exchange for 2015, bringing the total number of participating insurers to five, although Anthem and the CO-OP were the only insurers offering plans statewide; the other three insurers each had much more limited coverage areas.

In October 2015, Kentucky Health Cooperative announced that they would cease operations by the end of 2015. At that point, the CO-OP had about 51,000 members, all of whom had to secure coverage with another carrier for 2016.

Kentucky Health CO-OP’s demise was cemented when the federal government announced on October 1 that risk corridor payments nationwide would be just 12.6 percent of the expected amount. Risk corridors were one of the ACA’s mechanisms for ensuring that carriers were on a somewhat level playing field in the first few years of ACA implementation. In 2014, 2015, and 2016, carriers that experienced lower-than-expected claims paid into the risk corridors fund, while carriers that experienced higher-than-expected claims were supposed to payouts from the fund. If the latter exceeded the former, the idea was that the government would make up the shortfall. And in the opposite scenario, the government would get to keep the overage.

But in late 2014 — after a full year of ACA claims and after 2105 rates had already been set — lawmakers retroactively made the risk corridors program budget neutral, which meant it could only pay out as much as it took in. For 2014, the risk corridors program ended up about $2.5 billion in the red, which meant that carriers got just a fraction of what they are owed. In the case of Kentucky Health CO-OP, that was $9.7 million, out of $77 million they were supposed to receive. Funds were to be paid in December 2015, but once it was determined that they would not be coming, the CO-OP had no choice but to close.

2016: Anthem offered exchange plans statewide, while CareSource offered plans in 46 counties. Plans were also available from Humana, Baptist Health, UnitedHealthcare, Wellcare, and Aetna, but four of those insurers exited the exchange at the end of 2016.

• Baptist Health stopped offering plans in the exchange at the end of 2016, although their off-exchange enrollees could keep their coverage through March 2017 (Baptist Health has subsequently dissolved altogether).
• UnitedHealthcare exited the Kentucky exchange and also exited the individual market in Kentucky outside the exchange. 2016 was the first year that United had offered plans in the Kentucky exchange, although they exited the exchanges in most states at the end of 2016.
• In late 2016, Wellcare’s website had a notice for marketplace plan members, letting them know that their coverage would end December 31, 2016, and that they would need to enroll in a new plan during open enrollment.
• Aetna had offered on-exchange plans in 10 Kentucky counties in 2016, but they stopped doing so at the end of that year.

2017: Anthem continued to offer coverage in all 120 counties in Kentucky in 2017 (and was the only carrier doing so), but in 74 of those counties, they only offered HMO plans for 2017. Anthem continued to offer PPO plans in 46 counties in Kentucky. CareSource added 15 more counties to their coverage area for 2017, offering plans in just over half the state’s counties. Humana also continued to offer coverage in Kentucky’s exchange, but reduced their coverage area to only Jefferson County. And Humana announced in February 2017 that they would exit the individual market nationwide at the end of 2017.

2018: CareSource continued to offer plans in 61 counties in 2018, but Anthem’s revised rate filing for 2018 reduced their coverage area to include only the 59 counties where CareSource did not offer coverage. So all counties in Kentucky had just a single insurer offering exchange plans for 2018. Residents who had Humana coverage in Jefferson County, as well as those who had Anthem coverage in the 61 counties where CareSource also offered plans, needed to select new plans for 2018.

2019: Anthem expanded its coverage area to include 93 counties, giving residents in 34 counties the opportunity to select a plan from either insurer (in the other 86 counties, just one insurer offers plans for 2019).

2020: CareSource expanded its coverage area to a total of 83 counties, overlapping with Anthem in 56 of those counties. So for 2020, there are 56 counties where Anthem and CareSource plans are available, 27 counties where only CareSource is available, and 37 counties where only Anthem is available.

2021: Both insurers expanded their coverage area, giving residents in 94 counties a choice between Anthem and CareSource.

2022: Wellcare and Molina joined the exchange, bringing the total number of participating insurers to four. There were only 14 counties where residents had access to only Anthem’s plans for 2022; in the rest of the state, two or more insurers offered plans.

Kentucky’s rate review page has a good overview of the rate changes that were proposed and approved for 2023. In some cases, the approved rates were lower than the insurers initially proposed, but one insurer’s rates were approved as filed and another ended up with rates that were higher than they proposed. The following average rate changes were approved for 2023 for Kentucky’s individual market insurers (membership numbers are from SERFF filings):

• Anthem: 5.3% increase (29,904 members)
• CareSource: 7.1% increase (40,652 members)
• Ambetter/Wellcare: 3.4% increase (2,189 members)
• Molina: 7.1% increase (503 members)

Initially, the insurers had proposed an overall average rate increase of 8.2%. But once the final rates were approved, the overall average rate increase amounted to 6.25%.

However, when we talk about rate changes, we’re referring to pre-subsidy premiums. Premium subsidies fluctuate from one year to the next based on changes in the benchmark plan premium. People who receive premium subsidies can still see changes in their after-subsidy premiums from one year to the next, but the changes won’t necessarily mirror the percentage by which the full-price premiums change.

It’s also important to note that average rate changes don’t account for the fact that premiums increase with age (so even if your plan’s average rates are not increasing, your premium will be higher just because you’re a year older), although subsidies also grow to keep pace with age-related premium increases.

For perspective, here’s a look at how premiums have changed in prior years in Kentucky’s exchange:

• 2015: Average increase of 10.5%. Three-quarters of Kynect’s enrollees had coverage under Kentucky’s CO-OP in 2014, and their rates increased by an average of 12.5 percent for 2015. The remaining quarter of the enrollees were split between Anthem (which reduced premiums by 4.3 percent) and CareSource (which increased premiums by 12.8 percent).
• 2016: Average increase of 14-15%. The Kentucky Department of Insurance initially finalized rates for eight individual market carriers for 2016, but that dropped to seven once the CO-OP dropped out. Despite the loss of Kentucky Health CO-OP, seven carriers in the individual market was more than Kentucky had had since the late 1990s, and it was an increase from just three carriers offering plans through Kynect in 2014. In addition to the carriers that were already offering individual plans through Kynect, the exchange added three more carriers for 2016: UnitedHealthcare offered plans statewide, Aetna offered plans in 10 counties, and Baptist Health (Bluegrass Family Health) offered plans in 79 counties.
• 2017: Average increase of 24.5%. Four carriers that offered plans in the Kentucky exchange in 2016 — Aetna, WellCare, Baptist Health (Bluegrass Family Health), and UnitedHealthcare — did not offer plans in 2017. Three insurers continued to offer coverage: Anthem, CareSource, and Humana. Anthem (available statewide in 2017), increased premiums by about 23 percent; CareSource offered plans in 61 counties and increased premiums by about 23 percent; Humana was only available in Jefferson county, and increased premiums by an average of 31 percent.
• 2018: Average increase of 45%: Anthem and CareSource both initially filed 2018 rates based on the assumption that cost-sharing reduction (CSR) funding would continue. But they both later filed revised rates with the cost of CSR added to silver plan premiums, which accounted for about a third of the total rate increase of 2018 (the Trump administration terminated CSR funding in October 2017, just before enrollment in 2018 plans began; insurers in Kentucky have continued to add the cost of CSR to silver plan rates in subsequent years).
  Everyone eligible for CSR benefits continued to receive them (and that is still the case) as long as they selected silver plans; nothing changed about eligibility for CSR benefits or the benefits themselves. But instead of federal funding to cover their cost, the cost is now added to premiums. But adding the cost of CSR to silver plan premiums results in larger premium subsidies for all enrollees who are eligible for premium subsidies. That’s because premium subsidies are based on the cost of the second-lowest-cost silver plan, so the subsidies grow to keep pace with silver plan premiums. For people who receive premium subsidies, this change meant that bronze and gold plans became particularly affordable starting in 2018.
• 2019: Average increase of 12.5%. Much of the rate increase was likely due to the elimination of the individual mandate penalty after the end of 2018, and the Trump administration’s efforts to expand access to short-term plans and association health plans. Consumers in 34 counties could choose from both CareSource and Anthem, while the rest of the state had just one or the other.
• 2020: Average increase of 3.7%. Anthem’s rates increased by an average of 9.7 percent, and CareSource’s increased by an average of 4.5 percent. As of 2020, there were plans available from both insurers in 56 counties; in 37 counties there were only plans from Anthem, and in 27 counties there were only plans from CareSource.
• 2021: Average increase of 5%. Anthem and CareSource filed average rate changes for 2021 individual market plans that amounted to a proposed average increase of 11 percent. But the Kentucky Department of Insurance approved a much smaller increase than Anthem had proposed, bringing the final approved overall average increase down to 5 percent for 2021 (in the small group market, most insurers’ rates were approved as filed, amounting to an average increase of 8.8 percent).
• 2022: average decrease of 3.8%. This was for the two existing insurers. Two additional insurers (Molina and Ambetter/Wellcare) also joined the Kentucky exchange for 2022.

73,935 people enrolled in individual/family plans through Kentucky’s exchange during the open enrollment period for 2022 coverage. This was a little lower than the year before, when nearly 78,000 people had enrolled. Nationwide, there was record-high enrollment for 2022, so the decline in enrollment that Kentucky experienced was quite unusual.

By the end of December 2022, there were 60,784 people who had enrolled in coverage through Kentucky’s exchange for 2023. At that point, there were still 15 days remaining in the open enrollment period.

Here’s a summary of how enrollment in Kentucky’s exchange has fluctuated over the years:

• 2014: 82,747 people enrolled
• 2015: 106,330 people enrolled
• 2016: 93,687 people enrolled (Kynect was one of just a handful of states with lower enrollment in 2016 than in 2015, and most of the others had special circumstances, such as newly-expanded Medicaid or Basic Health Programs. But on December 18, 2015, Kynect’s successful advertising campaign was shut down after a contract extension was rejected by the state Finance and Administration Cabinet and the prior contract expired November 30. The advertising campaign was funded with $5 million in federal funding, and any unused portion was to be returned to the federal government. State outreach directors expressed dismay that the advertising campaign was shuttered mid-way through the open enrollment period. But it was not unexpected, as newly-elected Governor Matt Bevin had promised to shutter Kynect and switch to Healthcare.gov as one of his first priorities upon taking office.)
• 2017: 81,155 people enrolled (The transition to HealthCare.gov resulted in further declines for 2017, compounded by the Trump administration’s decision to cut advertising and outreach for HealthCare.gov in the final week of 2017 open enrollment (Trump took office on January 20, 2017; open enrollment for 2017 coverage ended January 31).
• 2018: 89,569 people enrolled
• 2019: 84,620 people enrolled
• 2020: 83,139 people enrolled
• 2021: 77,821 people enrolled
• 2022: 73,935 people enrolled

Two insurers (Anthem and BEST Life and Health Insurance Company) currently offer dental plans through the Kentucky marketplace. Learn about dental coverage options in Kentucky.