Frequently asked questions about health insurance
coverage options in Kentucky
As of the 2022 plan year, Kentucky is once again utilizing a fully state-run exchange, known as Kynect. This is the same approach that the state used in the early years of ACA implementation.
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 was 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 once again has a fully state-run exchange.
The marketplace in Kentucky 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.
The open enrollment period for 2022 coverage in Kentucky began November 1, 2021 and continues through January 31, 2022. (This was a last-minute extension; it had previously been scheduled to end January 15). Kentucky residents are once again using Kynect to sign up for coverage, instead of HealthCare.gov.
Outside of that open enrollment period, residents need a qualifying event in order to enroll in coverage or make a change to their plan.
The average approved rate changes for 2022 amounted to an overall average decrease of about 4% for the two existing insurers (Anthem and CareSource). And there are also two new insurers offering plans in Kentucky’s exchange for 2022.
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 COVID-related enrollment window in 2021, which ran from mid-February to mid-August, nearly 21,000 Kentucky residents enrolled in coverage.
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.
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 switched 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-2021, growing by 163% – by far the largest percentage increase of any state, and nearly four times as much as the national average increase of 45%. 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.
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]