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Kentucky has a state-run health insurance exchange. Residents use Kynect (not HealthCare.gov) to enroll in health coverage. Four carriers offer individual/family plans through Kynect: Anthem, CareSource, Molina, and Ambetter/Wellcare. Open enrollment runs from November 1 to January 15.
Kentucky had planned to create a Basic Health Program (BHP) that was to become available as of 2024, but that is no longer in the works as of early 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:
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:
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.
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):
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:
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:
Under the Affordable Care Act, states have the option to create a Basic Health Program (BHP) that serves people with income a little above the Medicaid eligibility level. Thus far, only New York and Minnesota have created BHPs, and Oregon is considering one.
Kentucky had planned to join them in 2024, but work on the state’s new BHP stopped in late 2022, and the Kentucky Cabinet for Health and Family Services confirmed in early 2023 that work on the BHP was still stopped. It’s unclear whether it might resume at some point.
If Kentucky were to again move forward with a BHP at a later date, the coverage would be available to adults with income between 138% and 200% of the poverty level. Adults with income up to 138% of the poverty level would continue to be eligible for Medicaid. But instead of transitioning directly to subsidized private plans in the exchange with income above that, people would instead have BHP coverage unless their income exceeds 200% of the poverty level. Above that point, subsidized private plans in the exchange would continue to be available.
Here’s more about the poverty level, which is indexed each year by the federal government.
For the first three years of ACA implementation, Kentucky operated its own exchange and enrollment website. Kynect, the state-run exchange, was widely considered one of the most successful state-run exchanges in the country.
But former Governor Matt Bevin, who took office in late 2015, campaigned on an anti-Obamacare platform, and spent much of 2016 transitioning the Kentucky exchange to the Healthcare.gov platform. Bevin was able to shut down Kynect via executive order, as the exchange was created with an executive order from former Governor Steve Beshear (as opposed to some state-run exchanges that were created via state legislation).
The enrollment platform switch took effect in November 2016, for enrollment in 2017 coverage. It got off to a rocky start, with brokers and enrollees finding the process more cumbersome and time-consuming than what they were accustomed to with Kynect. Enrollment, not surprisingly, was considerably lower in 2017. And although it rebounded somewhat in 2018, it has not yet reached the levels it was at in 2015 and 2016.
In June 2020, however, Governor Andy Beshear notified CMS that Kentucky planned to transition back to the Kynect system, with a fully state-run exchange operational by the fall of 2021. So for 2022 coverage and beyond, Kentucky residents are once again using Kynect.
Beshear’s office noted that the state will save at least $2.8 million in the first year of using Kynect, with additional savings after that. The 3% user fee that HealthCare.gov charged in 2018 amounted to $9.8 million in 2018 in Kentucky. The user fee has since dropped to 2.25% for state-based exchanges that use HealthCare.gov (Bevin had opted to keep Kentucky’s state-run exchange, but switch to the federal enrollment platform; this was still the approach that the state used as of 2021, before transitioning back to Kynect).
By transitioning back to a fully state-run exchange, Kentucky gains much more control over exchange operations, including outreach and enrollment as well as the option to extend open enrollment or add additional special enrollment periods.
Transitional, or grandmothered, health plans are allowed to continue to renew in Kentucky, and remain in force until further notice.
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.
The extension of grandmothered plans has contributed to higher-than-expected claims costs for ACA-compliant plans across the country, since the people who remained on grandmothered plans were healthy enough to get those plans — despite medical underwriting — between 2010 and 2013. Since those individuals did not transition to ACA-compliant plans, the overall risk pool for the ACA-compliant plans ended up being sicker than expected.
According to the Kentucky Department of Insurance, there were still more than 38,000 people with individual market transitional (grandmothered) plans as of April 2016, and more than 86,000 with transitional small group coverage.
That’s in addition to grandfathered plans. As of March 2105, there were 25,491 people in Kentucky who still had coverage under grandfathered plans in the individual market, and 19,595 with grandfathered group coverage (this included 4,571 people on grandfathered small group plans, and the rest on large group plans).
Kynect was 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. During the open enrollment period for 2015 coverage, another 152,529 people enrolled in Medicaid through Kynect (Medicaid enrollment continues year-round), and 106,330 people enrolled in private plans through Kynect, 26 percent of whom were new to the exchange for 2015.
One sign of Kynect’s success was widespread awareness: a poll from late 2014 showed that nearly 80 percent of Kentucky residents had 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 was 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 were taking advantage of their coverage. The state reported that in 2014, 26,000 more people would have cholesterol screenings, 7,000 more women would have mammograms, 10,000 more women would have pap smears, and 14,000 more people with depression would 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 (this also made it highly susceptible to being dismantled via executive order, which is what Governor Bevin did when he took office). Kynect was part of the state’s Cabinet for Health and Family Services, and it was overseen by a 19-member board appointed by Beshear.
Then-Governor 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 representatives 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.
Ultimately, however, a new governor with an anti-Obamacare approach was able to unravel Kynect and switch Kentucky to HealthCare.gov. That change was temporary though, as the next governor opted to switch Kentucky back to the Kynect platform as of November 2021.
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 /[email protected]
In Kentucky, federal regulations regarding short-term health insurance apply.
Medicaid enrollment in Kentucky has increased 162% since 2013
57 insurers offer Medigap plans in Kentucky, and as many as 45 Medicare Advantage plans are available, depending on the county
Find affordable individual and family plans, small-group, short-term or Medicare plans.
Kentucky's Medicaid spend-down for the aged, blind, and disabled is determined in three-month intervals
Learn about adult and pediatric dental insurance options in Kentucky, including stand-alone dental and coverage through Kynect.
Our state guides offer up-to-date information about ACA-compliant individual and family plans and marketplace enrollment; Medicaid expansion status and Medicaid eligibility; short-term health insurance regulations and short-term plan availability; and Medicare plan options.