Kentucky Health Insurance Consumer Guide

To qualify for health coverage through the Kentucky Marketplace, you must:⁴

• Live in Kentucky
• Be lawfully present in the United States
• Not be incarcerated
• Not be enrolled in Medicare

Eligibility for financial assistance (premium subsidies and cost-sharing reductions) depends on your income and how it compares with the cost of the second-lowest-cost Silver plan in your area – which depends on your age and location. In addition, to qualify for financial assistance with your Marketplace plan you must:

• Not have access to affordable health coverage through your employer. If your employer offers coverage but you feel it’s too expensive, you can use our Employer Health Plan Affordability Calculator to see if you might qualify for premium subsidies in the Marketplace. 
• Not be eligible for Medicaid or CHIP.
• Not be eligible for premium-free Medicare Part A.⁵
• File a joint tax return, if you’re married.⁶ (with very limited exceptions)⁷
• Not be able to be claimed by someone else as a tax dependent.⁸

In Kentucky, the open enrollment period for individual and family health insurance runs from November 1 to January 15.⁹

Enrollments must be submitted by December 15 to have coverage effective January 1. Enrollments submitted in the final month of the open enrollment window have an effective date of February 1 instead.⁴

Outside of open enrollment, a special enrollment period (usually linked to a specific qualifying life event) is necessary to enroll or change your coverage. If you have questions about open enrollment, you can learn more in our comprehensive guide to open enrollment. We also have a comprehensive guide to special enrollment periods.

Several bills were considered in 2024 in Kentucky that would have made pregnancy a qualifying life event, but none of them passed.¹⁰ Similar legislation was considered in 2023 but did not pass.¹¹ (There are several state-run exchanges where pregnancy is a qualifying life event.)

To enroll in an ACA Marketplace plan in Kentucky, you can: 

• Visit Kynect to access Kentucky’s state-run health insurance Marketplace. Here you will find an online platform to shop, compare, and choose the best health plans.
• Purchase individual and family health coverage with the help of an insurance agent or broker, or a kynector (Kynect-certified enrollment assister).¹²

You may find affordable health insurance options in Kentucky through its state-run health insurance exchange. Kentucky residents use Kynect (not HealthCare.gov) to shop, review, and enroll in health coverage as well as to determine any available subsidies. 

Of the nearly 72,000 people with effectuated coverage through Kynect in early 2024, 86% were saving money on premium payments amounting to an average savings of $517/month. The subsidies resulted in an average net premium of $198/month (including the enrollees who paid full price).¹

(Note that the chart below shows some different metrics, and uses data from all enrollments submitted during the open enrollment period, whereas the numbers above are based on effectuated enrollment in early 2024.)

People with household incomes of no more than 250% of the federal poverty level also qualify for cost-sharing reductions (CSR). CSR benefits reduce deductibles and other out-of-pocket expenses, as long as the enrollee selects a Silver plan.¹³ Forty percent of the people with effectuated enrollments through Kynect had CSR benefits as of early 2024.¹ 

Between the premium subsidies and cost-sharing reductions, you may find that an ACA plan is the cheapest health insurance option for you.

Source: CMS.gov¹⁴

There are four insurers offering individual and family health plans through Kynect for 2024.¹⁵ All four will continue to offer Marketplace coverage in 2025.¹⁶

There are 20 counties in Kentucky where Anthem is the only option for 2024. In the rest of Kentucky’s counties, at least one additional carrier offers plans on the exchange.¹⁵

The following average rate changes have been approved for 2025 for Kentucky’s individual market insurers:¹⁷ (Average rate changes are calculated before subsidies are applied.)

Source: Kentucky SERFF Filings¹⁷

According to the SERFF filings, the carriers have the following enrollment in 2024:¹⁷

• Anthem: 34,403 members
• CareSource: 15,202 members
• Molina: 1,186 members
• WellCare: 14,535 members

Using those enrollment numbers, the weighted average approved rate increase for 2025 is about 7.9%, applicable to full-price plans. But most enrollees receive premium subsidies, and thus do not pay full price. The net premium change from one year to the next depends on how a specific plan’s premium changes as well as how much the premium subsidy amount changes.

For perspective, here’s a summary of how average pre-subsidy premiums have changed in Kentucky’s individual/family market over the years:

• 2015: Average increase of 7%.¹⁸
• 2016: Average increase of 14%.¹⁹
• 2017: Average increase of 24.5%.²⁰
• 2018: Average increase of 45%.²¹
• 2019: Average increase of 12.5%.²²
• 2020: Average increase of 3.7%.²³
• 2021: Average increase of 5%.²⁴
• 2022: Average decrease of 3.8%.²⁵
• 2023: Average increase of 6.25%.²⁶
• 2024: Average increase of 3.5% (unweighted)²⁷

74,882 people enrolled in private coverage through Kynect during the open enrollment period for 2024 coverage.²⁸

Most states have experienced record-high Marketplace enrollment in 2023 and 2024 — due in large part to the American Rescue Plan (ARP), which expanded enrollee access to ACA’s premium subsidies.²⁹ However, Kentucky has not followed that trend (see chart below for prior year enrollment data).

Enrollment in Kentucky’s Marketplace declined for several years, from 2019 through 2023. Although it did grow in 2024, the enrollment total was still well below the record high set in 2015, before Kentucky transitioned to the HealthCare.gov platform for a few years.

Source: 2014,³⁰ 2015,³¹ 2016,³² 2017,³³ 2018,³⁴ 2019,³⁵ 2020,³⁶ 2021,³⁷ 2022,³⁸ 2023,³⁹ 2024⁴⁰

Kynect – Kentucky’s Healthcare Connection
855-4kynect (855-459-6328)

Kentucky Health Benefit Exchange
Administrative site for Kentucky’s Marketplace

Foundation for a Healthier Kentucky

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]