Here’s what you need to know about health insurance in Kentucky
Kentuckians, rest assured: you can still get health insurance and tax credits. The big difference this year is that you need to use a different website to enroll for 2017 coverage. You need to create a new account and do your application at HealthCare.gov, instead of kynect, which is being phased out.
Here are a few things that have not changed:
- You can still get help for free here in Kentucky.
- You can still enroll on online (HealthCare.gov), by phone (1-800-318-2596) or in person with an insurance agent or application assister.
- You need to enroll before January 31st which is the end of open enrollment for anyone that did not have kynect coverage last year. If you had kynect QHP coverage in December, you have until March 1st to sign up due to a special enrollment period.
Below you’ll find a thorough list of questions and answers to help you get started and to help you through the process.
An agent and application assister will help you for free and could save you money.
Q: If you’re don’t have health care, what should your first steps be? A: Find an agent or application assister to guide you through enrollment or go to HealthCare.gov and enroll online. You can also get help 24 hours a day, 7 days a week from a HealthCare.gov customer service representative at 1-800-318-2596.
Q: What’s the difference between an agent and an application assister? A: Agents are people who have completed the appropriate training to obtain their insurance licenses. They can help you with your application process and then help you pick a plan based on your specific needs. They are the only people who can recommend a plan to you. However, they can only enroll you in a plan from an insurance company that they work with which may not be the insurance company you want. You can ask your agent to recommend another agent if you need or want a plan from a different insurance company. Application assisters can guide you through the many details of the application process. They can help you narrow down your choices, but they cannot pick a plan for you. They can help you with Medicaid and KCHIP enrollment.
Q: How can you find an agent and/or application assister? A: You can go to kynect.ky.gov and click on “Insurance Agents” or “kynectors/Application Assisters” to find an agent or application assister in your county, or you can call the Kentucky Health Benefit Exchange at 1-855-459-6328.
Q: Does it cost anything to use an agent or application assister? A: No! Services from both agents and assisters are free of charge.
Q: Can you receive help in person? A: Yes, agents and application assisters are located in every county across the state. Use kynect.ky.gov to find the one nearest you. In addition, you can call the Kentucky Health Benefit Exchange customer service line at 1-855-459-6328 to find one in your area.
Q: Will an agent help you with claims? A: Yes! Agents can assist with billing issues, claim questions, and many other helpful services to help you manage your insurance plan. This is part of their daily job.
Many factors go into deciding which plan is right for you and your family.
Q: How do you find the best policy at the best price? A: The easiest way is to talk to an agent who is an expert in health insurance policies. Agents will help you decide between high or low deductibles, high or low premiums, tax credits, cost sharing reductions, and other items. They can help find you the best policy for your specific health needs and budget. You can also apply for coverage yourself through HealthCare.gov or by calling 1-800-318-2596. Whether working with an agent, application assister or on your own, you may find you’re eligible for advanced premium tax credits – which will help reduce your monthly premiums – and cost-sharing reductions — which offer lower co-pays, deductibles and max out-of-pocket payments.
Q: What health benefits can I expect to be covered? A: It’s hard to be specific without looking at the individual plans being considered, but generally, they include essential benefits like doctors visits, lab work, hospitalization, maternity care, prescriptions, and preventative care such as mammograms and pap smears. They do not include experimental medicine, acupuncture and other types of alternative medicine along with certain kinds of prescription drugs.
Q: How do you know whether your doctor is in your plan’s network? A: You can go to your health insurance company’s website and use its search tools to search for your doctor. You can also call the Member Services number on the back of your insurance id card. Or, you can also ask your agent or application assister who have provider look-up tools he or she can use to help you. It is very important to find out if your doctors are available on your plan before you sign-up for that plan.
Q: What about my family? How do I make sure everyone is covered? A: Talk to an agent or an application assister. They can make sure you find the right plan to cover your entire family. And don’t forget, adult children up to age 26 can stay on their parents’ plan even if they are married or living away from home.
Q: What kind of insurance should you get if you don’t think you “need” it except for catastrophic circumstances (i.e., a car accident or cancer)? A: This is an extremely common question. You can afford routine doctor visits (even though you don’t go much), but you could use insurance if you suddenly needed a major surgery, an extended hospital stay, or an expensive test. Talk to an agent about your needs. There are different ways that you could meet your needs and still stay within your budget. And, keep in mind, in the case of a catastrophic event, health insurance could save you thousands of dollars and keep you out of bankruptcy. Even a sprained ankle, could cost you close to $2,000 in medical costs.
Q: What is a PPO versus an HMO? A: A PPO (Preferred Provider Organization) is a kind of health insurance where you pay less if you use providers in the plan’s network. You can use doctors, hospitals, and providers outside of the network without a referral for an additional cost. An HMO (Health Maintenance Organization) is a type of health insurance that requires you to go to its in-network doctors. It generally won’t cover out-of-network care except in an emergency. Kentuckians should be aware that most of the PPOs offered last year are no longer available regardless of whether they were offered through the Exchange. If you’re in one of the 96 of 122 counties that no longer offer PPOs, you can speak to an insurance agent and switch plans during the open enrollment period through January 31, 2017.
Q: How can you decide when there are so many plans to choose from? A: Your insurance agent can be a big help because they are the experts on health insurance. They can help you sort through the information and will recommend a plan for you. That said, the provider network is usually a big deciding factor, so think about how important it is for you to keep your doctors. You should also consider the prescription coverage, especially if there are certain prescriptions you already know you need. Finally, the cost of the plan, including the premium and cost-sharing (deductible, co-pays, co-insurance) that’s required, is a huge consideration for everyone.
Money, money, money! It’s all about the money. Understand what you’re going to owe and how to minimize your costs
Q: What are monthly premiums, deductibles, co-pays, and coinsurance? A: A monthly premium is the amount you pay to your health insurance company every month to have insurance. A deductible is the amount you pay for services before your health insurance starts paying claims. A co-pay is a fixed fee you pay for a service and applies when you, for example, visit your doctor or fill your prescription. Co-pay amounts will also apply toward the plan deductible amount throughout the plan year. Co-insurance is your share of the costs of a service that goes into effect after you’ve paid your plan’s deductible. For example, your insurance company pays 80% of your claims and you pay the other 20%, with the exception of co-pays, which remain the same.
Q: Is it better to have a high deductible with a lower premium or a low deductible and a higher premium? A: It depends. For some people, a high deductible and a low premium make sense because they’re relatively healthy, and they don’t visit doctors often. For people who see multiple doctors regularly and take multiple prescriptions, however, paying a higher premium with a lower deductibles could save hundreds of dollars. Talk to an agent to determine the best plan for your needs.
Q: How does the tax credit lower the premium cost? A: If approved for the advanced premium tax credit, you have the option to use it monthly, and it will be sent directly to your health insurance company to go toward subsidizing your monthly premium. Talk to an agent or application assister, or go to HealthCare.gov and use it’s prescreening tools to learn whether you quality.
Q: How do you save money on your prescriptions? A: Make sure the health insurance plan you choose covers your prescription, buy generics when possible, and use in-network pharmacies.
Q: Can you find a plan in the right price range? A: You should speak to an agent for help, but there are three levels of coverage for Kentuckians (Bronze, Silver, and Gold), which help everyone find a plan in his or her price range. If you qualify for a tax credit, you can find a plan that’s generally around 9.5% of your household annual income.
Q: How can I afford health insurance with the increase in monthly premium costs? A: If you qualify for the advanced premium tax credit, the increase in monthly premiums will be mostly offset by an increase in your tax credit. (Your plan shouldn’t cost more than about 9.5 percent of your annual household income if you’re eligible for a tax credit.) Furthermore, if you have a PPO, switching to a HMO will save you money on monthly premiums.
If you’re low income, Medicaid and KCHIP are still available.
Q: How do you know whether you qualify for Medicaid? A: Medicaid and KCHIP (Kentucky Children’s Health Insurance Program) are programs for low-income families. You can see whether you qualify by contacting an application assister or visiting your local Family Support offices (the same place where you might apply for your food stamps). You can also go to HealthCare.gov and go through its prescreening process to see whether you qualify. If you qualify for Medicaid or KCHIP, it will be faster to apply at benefind.ky.gov, find an application assister or call the Kentucky Health Benefit Exchange customer service line at 1-855-459-6328.
Q: If you qualify, can someone help you apply for Medicaid? A: Yes! Application assisters that you find through kynect.ky.gov, and your local Family Support office can help you enroll. You can also go to benefind.ky.gov, the new portal used in Kentucky for people looking to apply directly for Medicaid or KCHIP.
Q: Where can you call for help with Medicaid? A: You can dial 1-855-306-8959, and you’ll reach the Family Support line. They can help you with benefind.ky.gov, the new portal for Kentuckians to enroll in Medicaid services.
Q: What should you do if you already have Medicaid or KCHIP? A: First, it is very important that you keep your address up to date. Call the Family Support line at 1-855-306-8959 if your address changes. You will be sent a notice when it is time for you to renew your Medicaid or KCHIP.
If you still have questions or concerns about health insurance, call 1-800-318- 2596, visit HealthCare.gov, or go to or call your local Family Support office. You can find in-person help in every Kentucky county across the state! There are agents, application assisters, local family support offices, 24-hour call centers, and more, all of which are waiting to help Kentuckians get and stay covered.