Looking for health insurance in the Bluegrass State? According to a study by US News, Kentucky has the fifth-worst health care in the nation. That study was based on access, quality, and good public health. Not to worry though, as the state still has plenty of health care options.
Health insurance options in Kentucky
The Kentucky Department of Insurance is a great resource for health care, but you can also find coverage through these options:
- From your employer
- Through your spouse's employer
Individual or family plans
- Through HealthCare.gov
- Directly from a health insurance company
Where do most Kentucky residents get their health insurance coverage?
|Individual or family
|Source: Kaiser Family Foundation, Health Insurance Coverage of the Total Population
Six percent of Americans are uninsured, meaning Kentucky is ahead of the national curve. That's good news for policyholders, as more uninsured people leads to higher rates for insured people.
Kentucky health insurance companies
There are a few options to choose from when it comes to health insurance companies in Kentucky:
- Anthem Blue Cross Blue Shield Kentucky
These insurance companies offer individual and family plans. Check company websites to find out more about how plans may vary based on your zip code.
Kentucky health insurance costs and rate factors
Kentucky residents spend an average of $8,004 per year on health care expenditures, only a few dollars less than the national average. What determines your rates in KY? Health care costs vary from person to person, but here’s what insurers primarily look at:
It’s no surprise that the more health insurance coverage you want, the more you’ll have to dish out in monthly premiums. Marketplace plans come in metal tiers: bronze, silver, gold, and platinum.
So, how much is health insurance in Kentucky? These are the average monthly costs for a middle-aged KY resident in 2020:
|Source: Kaiser Family Foundation, Change in Average Marketplace Premiums by Metal Tier
A gold plan costs almost 74 percent more than a bronze plan. That's because gold plans cover 80 percent of costs, whereas bronze plans cover 60 percent of costs.
You may qualify for a catastrophic plan, the lowest level of coverage. These types of plans have a yearly deductible of $8,150 but make up for that cost with low monthly premiums. Still, it may be worth it to get a bronze or silver plan to avoid that cost when you need to use your insurance.
Body mass index
According to the CDC, a high body mass makes you more likely to suffer from serious health conditions. That's why insurers will look at your body mass to determine your risk-level. People with higher BMIs pay more for health insurance.
In 2019, KY had a 36.5 percent obesity rate, the fifth highest in the country. 42 percent of state residents who used QuoteWizard to shop for health insurance have a BMI in the obese range.
Smokers pay more for health insurance because of the high risks that come from tobacco use. About 24.5 percent of KY residents are smokers, the second-highest rate in the nation.
According to HealthCare.gov, health insurance plans cost up to three times more for older people than for younger people. Kentucky residents who used QuoteWizard to compare health care plans are, on average, 41 years old.
Your zip code plays a larger role in your health care costs than you may think. Every state has different rules, regulations, and providers surrounding their health care marketplace.
Also, health insurance rates tend to be community-rated. That means your rates can depend in part on the combined claims everyone files. So, if your neighbors file an abnormally high number of claims, your prices could inflate.
That means how health-conscious your state is also plays a role in your premium. According to America’s Health Rankings, KY is the eighth unhealthiest state in the country.
Kentucky health insurance laws
The Affordable Care Act limits what insurers can use to price your policy.
- Pre-existing conditions: Thanks to the ACA, insurance companies can’t charge you more because of a pre-existing condition. This didn’t used to be the case, and people who fell into this category paid significantly more for health care.
- Gender: Insurance companies aren’t allowed to charge women and men different prices for the same plan. That’s good news, especially since women historically pay more for health care.
- Insurance and medical history: Insurance companies also used to analyze your past insurance coverage and medical history. Now, they can’t charge you more for lapses in insurance or previous medical problems.
There’s a limit to how much you can pay out-of-pocket for a marketplace plan. In 2020, the out-of-pocket maximum is $8,150 for an individual plan and $16,300 for a family plan.
Kentucky state law requires that insurance companies provide some coverage for the following services:
- Home health care
- Diabetes education
- Autism spectrum disorders
- Reconstructive surgery
- OB/GYN annual visit
- Hearing aids
There are additional services that providers need to offer coverage for. Find the full list on cms.gov.
Medicare and Medicaid in Kentucky
Medicare and Medicaid are both government-funded programs. The coverage and specifics vary state to state, but the programs always cover two different groups of people. Medicare aids seniors, whereas Medicaid helps low-income families and children.
Medicare is meant for seniors 65 years and older. There are plenty of coverage options within Medicare. These categories include parts A, B, C, D, and supplemental coverage plans. You may also qualify for one of these Medicare Savings Programs:
- Individual monthly income limit: $1,456
- Married couple monthly income limit: $1,960
The number of uninsured Americans has improved considerably since the Affordable Care Act (ACA) became law in 2010. Medicaid expansion was influential in reducing Kentucky’s overall uninsured rate.
In 2008, 14.1% of Kentucky’s residents did not have medical insurance. After Kentucky expanded its Medicaid program, between 2014 and 2019, the state’s uninsured rate dropped to 6.4%. The primary cause of this was a 41% increase — or 1,101,300 Kentucky residents — in Medicaid enrollment from 2008 to 2019.
KY is a state with expanded Medicaid, called Kentucky HEALTH. These are the state’s Medicaid financial requirements:
|Maximum Yearly Income
Kentucky Office of the Insurance Commissioner
- Insurance Commissioner:
- Nancy G. Atkins
- Insurance Hotline:
- (800) 595 - 6053
- Office Hours:
- Monday - Friday
8:00 am to 5:00 pm
- File a Consumer Insurance Complaint
- Complaint Page
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