Nobody should have to go without affordable, comprehensive health insurance in the state of Kentucky. The good news is that now more than ever, you have the greatest amount of choices available to you as a resident. But for some, this can make the process even more complicated and confusing. This article will talk about the best and most popular healthcare options you have available in Kentucky. We hope that by the time you finish reading this, you’ll know everything you need to know to make the smart health care decisions that you and your family need to make.
Major Medical Insurance in Kentucky
Major medical insurance goes by many names these days: Obamacare, the ACA, compliant coverage, and more. Ever since the passage of the Patient Protection and Affordable Care Act in the spring of 2010, these policies have been the gold standard for health care coverage in America. If you aren’t getting an approved health plan through your employer, stopping by HealthCare.gov and applying for insurance is usually the first place people go to get the health care coverage they need.
Getting started with ACA coverage is a very simple and straightforward process. All you have to do is visit HealthCare.gov during Open Enrollment (which starts November 1st and typically ends on December 15 to each year). The application is very short and contains a few simple, straightforward questions that most people have no trouble answering. Keep in mind though that some people may qualify for a special enrollment period (SEP), especially if they have recently experienced a life-changing event like the birth of a child or moving to a new zip code.
There are three main reasons why ACA health coverage is preferred over must other options today. Those reasons are: guaranteed issue, guaranteed benefits, and generous subsidies. But let’s talk about guaranteed issue first. With guaranteed issue health insurance, everyone who applies for coverage via the ACA Health Insurance Marketplace must be accepted; insurance companies are not legally allowed to reject you for coverage, even if you are currently sick or have pre-existing conditions. And they aren’t allowed to charge you more than a healthy person unless one of the following variables put you in a higher risk pool:
- Your age
- Your location
- Your use of tobacco products
- Whether you are applying for an individual policy or a family policy
Then there are the 10 guaranteed Essential Health and Wellness Benefits which are part and parcel of every ACA health insurance policy. Not everyone may need all of these benefits, but health experts have agreed that these benefits are the bare minimum necessary for optimal health, wellness, and the preemptive care necessary to catch illness early so that it will cost less to treat over the long haul:
- Ambulatory/outpatient services
- Emergency services
- maternity/newborn care
- Mental health and substance abuse
- Prescription drugs
- hab/rehab services and devices
- Lab tests
- Preventive and wellness services and chronic disease management
- Pediatrics (including oral and vision)
Lastly, there are the federal subsidies which make these insurance policies significantly more affordable for the vast majority of people who apply for coverage. If you make somewhere between 138% and 400% of the federal poverty level, you will likely qualify for one of these subsidies. If you make more than that, the government assumes you are well-off enough that you can pay for your own health care coverage. And if you make less than that, then you can apply for Medicaid in the state of Kentucky. Kentucky is one of several states which has accepted federal funding to expand Medicaid to qualifying individuals who are making 138% or less of the federal poverty limit. You can use the chart below to get a better idea of where you fall on that income spectrum, and what subsidies might be available to you.
|Household Size||Annual Income (138% of FPL)|
In Kentucky, it appears as though there are fewer requirements to qualify for Medicare compared to other states. You may be able to qualify for a low-cost Medicaid plan based on income alone; you can also qualify for Medicaid if you are a parent of a child who needs health care, if you have a permanent disability, or if you are over the age of 65. For more information on Medicaid in Kentucky, you can learn more and apply for coverage at the Kentucky Cabinet for Health and Family Services website.
Short Term Health Insurance in Kentucky
Kentucky has done a very good job make affordable ACA coverage and Medicaid available for its neediest citizens. But some people may still have some trouble affording a major medical plan, or they may simply not want to go that route. In that case, the next best option is short-term health insurance in Kentucky.
Short-term health insurance in Kentucky can be a solid option for some, but it isn’t without its caveats. One good thing about short-term health insurance is that you get the greatest amount of consumer protection if you and your provider ever get into a dispute. You can even take them to court for unpaid claims that you feel were unjustly denied you if you have a legal basis to do so. Short-term health insurance won’t guarantee you the Essential Health and Wellness Benefits that you’ll get through the ACA, but you can try and negotiate with your insurance provider in order to purchase as many of the necessary benefits as they are willing to sell you. There are no regulations or stipulations that would prevent you from adding supplemental coverage such as dental, vision, or an indemnity plan to your short-term health insurance policy. You don’t need to apply via HealthCare.gov to get short-term health insurance, because these insurance policies are not subject to as much government regulation as a major medical plan. Lastly, if you fall into the category of people in Kentucky who do not qualify for a subsidy and cannot qualify for Medicaid, you might want to know that short-term health insurance monthly premiums cost up to 1/3 less than an unsubsidized ACA health insurance plan.
Out-of-pocket costs tend to be a little bit higher with short-term health insurance, though. The vast majority of these plants start with a high deductible, usually around $5,000 or more. This deductible is the amount of out-of-pocket costs you must pay before your insurance carrier starts paying out your medical claims. Then there are the caps on annual and lifetime benefits to consider. On that note, nearly every short-term health insurance policy won’t set a limit on the out-of-pocket costs you are subject to. But if your monthly premiums are affordable and you don’t see yourself requiring a lot of medical care, short-term health insurance could be the insurance policy you need to protect yourself from an unexpected and catastrophically expensive medical emergency.
Christian Health Plans/Health-Sharing Plans in Kentucky
Christian health plans made a lot more sense during the early days of the ACA with the individual mandate. The individual mandate required every tax-paying American to get some form of qualifying major medical coverage either through the ACA, their employer, or a form of health care coverage which qualified them for an exemption. The religious nature of Christian health plans qualified many for a religious exemption to the individual mandate. But the individual mandate is no longer a federal requirement. And Kentucky is one of many states who have not implemented their own state mandates. So a Christian health plan, while optional, isn’t a legal necessity for people who can’t or won’t get qualifying major medical coverage anywhere else.
Health share plans like these offer a similar level of affordability as short-term health insurance coverage for people who can’t afford an unsubsidized ACA plan. Health share plans also have the following in common with short-term health insurance:
- These plans are NOT guaranteed issue
- Unlimited out-of-pocket costs
- Lifetime and annual benefit caps
- No guaranteed essential health benefits
But the differences between short-term health insurance and Christian health plans are significant – and you should know what they are before you try to decide between the two. Short-term health insurance has some federal and state government regulations; Christian health plans, however, have none. And there is no formal contract between you and your Christian health plan provider, either. In short, all of this means that if you get into a claim dispute, you won’t have any legal recourse to take your provider to court in order to get the money you are owed. You’ll just have to accept their decision. You’ll also have to accept whatever “participation guidelines” your plan provider sets for you to follow. This could involve declaring a specific faith, the immediate cessation of all tobacco use, and other biblical lifestyle changes. Lastly, some of the terminology is different – mostly for legal reasons. You pay your monthly premium in the form of a “monthly share amount”, and you pay for things like coinsurance, co-pays, and deductibles in the form of a “personal responsibility amount” or an “unshared amount”.
Fixed Indemnity Plans in Kentucky
Although short-term health insurance and health share plans aren’t legally considered adequate replacements for major medical coverage, they at least come close. Fixed indemnity plans, on the other hand, are more supplemental in nature than they are comprehensive. You can try purchasing a hospital or doctor fixed indemnity plan if you need a little extra money to help you cover medical expenses on a per day, per week, per month, per incident, or per visit basis. Just keep in mind that these work better in conjunction with major medical, short-term health insurance, or a healthcare plan; they don’t come close to replacing such coverage.
Like the previous two options we just discussed, you will likely run into annual and lifetime benefit caps if you use your fixed indemnity plan too frequently. There is also medical underwriting, which means you have no protection if your insurance company decides it wants to charge you more or deny you coverage based on pre-existing conditions. However, these plans can still help you keep your out-of-pocket costs from getting out of control. And you can purchase one of these plans whether or not you already have major medical coverage or some other equivalent.
Discount Cards in Kentucky
In Kentucky, it appears as though the vast majority of medical discount cards are associated with making prescription drugs more affordable; but you may be able to find medical discount cards which help with other expenses if you look hard enough. Just remember that these, too, are not an adequate substitute for major medical insurance – and any company who tells you otherwise is both lying and potentially breaking the law.
Once you find a medical discount card company who offers the services and discounts you want, all you have to do is pay your membership fee (usually paid on either an annual or monthly basis) and wait for your car to arrive in the mail. Once you get your card, present it whenever you purchase products or services from a participating business or medical organization in order to receive your discounts. You will still have to pay for your medical costs out-of-pocket as there are no claims to file and you won’t be reimbursed for any expenses. Also, be sure to shop intelligently and make sure you don’t accidentally fall for any scams. Some companies have been known to exaggerate their discounts or lie about who is participating in their discount card program. But making a few quick phone calls to their listed participants to double-check and make sure that the claims the company makes are true is an easy way to protect yourself from fraud.