Frequently asked questions about health insurance
coverage options in Kentucky
Kentucky initially operated its own exchange and enrollment website, Kynect, and the state-run exchange was widely considered one of the most successful state-run exchanges in the country. But former Gov. Matt Bevin, who was in office from late 2015 through late 2019, followed through on a campaign promise to transition the Kentucky exchange to the HealthCare.gov platform.
Kentucky technically still maintained a state-run exchange throughout that time, however, and is one of several states that have state-run exchanges but use the HealthCare.gov website for enrollment. And as of the 2022 plan year, Kentucky will once again have a fully state-run exchange. Gov. Andy Beshear has notified CMS that Kentucky will transition back to Kynect as of November 2021 (the website is up and running, although consumers still enroll via HealthCare.gov for 2021 coverage).
The marketplace in Kentucky — Kynect or HealthCare.gov, depending on the year — serves individuals and families that purchase their own health insurance, including people employed by a small business that doesn’t offer health benefits, people who retired prior to Medicare eligibility, and people who are self-employed and thus don’t have an option for employer-sponsored health coverage.
Kentucky’s marketplace also serves as an enrollment platform for people who are eligible for income-based Medicaid and CHIP. And for people who buy their own health insurance, it’s the only place where these applicants can qualify for subsidies to help offset the monthly cost of their coverage and their out-of-pocket costs.
Read more about the Kentucky health insurance marketplace.
Open enrollment for 2021 coverage in Kentucky ran from November 1 through December 15, 2020. Outside of that window, residents can normally only enroll (on-exchange or off-exchange) if they experience a qualifying event.
But there’s a one-time COVID-related enrollment window available in 2021, running from February 15 to August 15. Anyone eligible to use the exchange (HealthCare.gov) can do so during this window, including people who are uninsured or underinsured, as well as current enrollees who would like to switch to a different plan. This is an excellent opportunity for Kentucky residents to take advantage of the enhanced premium subsidies created by the American Rescue Plan.
After August 15, a qualifying event will be necessary to enroll or make a plan change for 2021. The open enrollment period for 2022 coverage will start on November 1, 2021.
For 2021, the state’s exchange continues to offer individual plans from two health insurance companies (Anthem and CareSource). CareSource and Anthem both expanded their coverage areas for 2021. In 94 of the state’s 120 counties, residents can choose from plans offered by both insurers; in the other 26 counties, Anthem is the only option.
The average approved rate changes for 2021 were a 5.7 percent increase for Anthem and a 4 percent decrease for CareSource, amounting to a weighted average rate increase of 4.95 percent.
77,821 people enrolled in private individual market plans through Kentucky’s exchange during the open enrollment period for 2021 coverage. This was by far the lowest enrollment count Kentucky’s exchange has ever had, but the decline is likely driven in large part by the COVID pandemic and the resulting transition to Medicaid for people who have lost their incomes.
During the first several weeks of the COVID-related enrollment window in 2021 (before the American Rescue Plan’s new subsidies had been activated on HealthCare.gov), 4,280 people enrolled in plans through Kentucky’s exchange.
Before the ACA reformed the individual health insurance market, pre-existing conditions were a barrier to obtaining coverage in nearly all states, including Kentucky. Medical histories were scrutinized during the application process, and people who didn’t meet the health eligibility guidelines were unable to purchase private coverage. Kentucky Access was established in 2001 to offer coverage to people who were not able to get policies in the individual market because of pre-existing conditions.
Under the ACA, all new health insurance policies became guaranteed issue starting on January 1, 2014. This aspect of reform largely eliminated the need for high-risk pools, and Kentucky Access notified their members that the plan would cease operations at the end of 2013. Insureds were able to transition to private coverage through Kynect instead.
In 2013, Kentucky’s uninsured rate was 14.3% – just slightly lower than the national average at that point. But by 2016, the state’s uninsured rate had dropped to 5.1%, which was well below the 8.6% national average at that point. This reduction was due in large part to the state’s highly successful state-run exchange (Kynect) and the expansion of Medicaid under the ACA.
But when the 2017 open enrollment period began on November 1, 2016, Kentucky residents switched to using HealthCare.gov for enrollment. Former Gov. Matt Bevin, who took office in 2015, transitioned the state to the federal enrollment platform in an effort to curtail costs and take advantage of HealthCare.gov’s economies of scale.
Kentucky still has a state-based exchange, but they no longer have the autonomy that goes along with having a state-run enrollment platform (that will change in the fall of 2021, when Kentucky will once again use Kynect and have full autonomy over its exchange). As an example, when the open enrollment period for 2018 coverage was cut in half, 10 of the 12 states with state-run enrollment platforms opted for longer enrollment periods, and most continued to do so for enrollment in subsequent years (for the 2021 plan year, there are 15 fully state-run exchanges). But because Kentucky has been using HealthCare.gov for the last few years, they haven’t had that level of flexibility. This is part of the state’s motivation for transitioning away from HealthCare.gov in the fall of 2021 and reactivating the Kynect enrollment platform and website.
The ACA established a federal loan program to encourage the creation of Consumer Operated and Oriented Plans (CO-OPs), which are nonprofit, consumer-run health insurance companies. Through the program, 23 CO-OPs were set up as of January 2014, including the Kentucky Health Care Cooperative. However, 20 of them, including Kentucky’s, have folded.
Kentucky Health CO-OP had robust enrollment in 2014, and had planned to expand into neighboring West Virginia for 2016. But the CO-OP shut down at the end of 2015, along with several others that closed at the same time, due in large part to the significant shortfalls in risk corridors funding that year.
Read more about the Affordable Care Act’s CO-OPs.
In the 2010 vote on the Affordable Care Act (aka Obamacare), Kentucky’s two Republican senators voted “no.” Kentucky’s current senators – Mitch McConnell and Rand Paul – remain firmly opposed to the ACA.
Kentucky’s representatives in the House split their votes on the ACA along party lines, with two yes votes and four no votes. Kentucky’s current Representatives include five Republicans and just one Democrat. One of the Republicans, Thomas Massie, was among 20 Republicans in the House of Representatives who voted no on the American Health Care Act in 2017, which would have repealed several major portions of the ACA. That bill passed in the House, but failed to pass in the Senate and was never enacted.
At the state level, former Gov. Steve Beshear’s support of the ACA repeatedly drew national attention, with even President Obama making note of it during his 2014 State of the Union address. Beshear used an executive order to establish Kentucky’s state-run health insurance marketplace, Kynect.
Kynect was viewed as a model for state-run marketplaces. Beshear also fully supported Medicaid expansion, calling it the “single most important decision” for improving the health of Kentucky residents.
Kentucky elected Republican Matt Bevin as governor in the 2015 election. Bevin campaigned on an anti-Obamacare platform, and shut down the state-run exchange platform less than a year after taking office. But Steve Beshear’s son, Andy Beshear, defeated Bevin in the 2019 election, and is planning to switch the state back to the Kynect platform in the fall of 2021.
In addition to implementing a state-run health insurance exchange, Kentucky expanded Medicaid under the Affordable Care Act. Under the Medicaid eligibility expansion, Kentucky adults (up to age 64) with household income up to 138% of the federal poverty level are eligible for Medicaid.
Kentucky Medicaid enrollment more than doubled between 2013 and mid-2020, growing by 153% – by far the largest percentage increase of any state, and four times as much as the national average increase of 38%. Kentucky has long led the country in terms of Medicaid enrollment growth as a result of the ACA, but enrollment has spiked during the COVID pandemic, growing faster in Kentucky than the rest of the country, in part because Kentucky has taken an active role in helping people understand their eligibility and get enrolled.
But under the Bevin administration, Kentucky was less eager to boost enrollment in Medicaid. After the Trump administration clarified that they would be open to the possibility of work requirements for Medicaid, Kentucky was the first state to receive federal approval to implement a Medicaid work requirement, which was slated to take effect in July 2018. But the month before it was to take effect, a federal judge blocked implementation Kentucky HEALTH.
The waiver was reapproved by HHS in November 2018, with an effective date of April 2019. but the work requirement was blocked again, just days before it was to take effect. And in December 2019, just days after taking office, Gov. Andy Beshear terminated the Kentucky HEALTH waiver, officially rescinding the state’s Medicaid work requirement.
Read more about Medicaid expansion in Kentucky.
Kentucky defaults to the federal rules regarding short-term health insurance. That means plans sold in the state can have initial terms up to 364 days and a total duration of up to three years, although many of the plans for sale are limited to six months.
Read more about the availability of short-term health insurance in Kentucky.
Medicare is a health insurance program run by the federal government to provide coverage to elderly and disabled Americans. There were 944,201 Kentucky residents enrolled in Medicare as of February 2021.
Most are eligible due to age, but 22% are under the age of 65 and eligible because of a disability, including ALS or end-stage renal disease. Kentucky is tied with a handful of other states for the highest percentage of Medicare beneficiaries under age 65 (the average nationwide is just 15%).
Learn more about Medicare in Kentucky, including details about Medicare Advantage plans, Medicare Part D prescription drug plans, and the state’s rules for Medigap plans.
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