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Kentucky Health Insurance

Kentucky Medical Insurance Overview

For residents in Kentucky, there are several options for obtaining health benefits.  The rate of uninsured people in this state has dropped dramatically since 2011, but with recent reforms to the landscape of health insurance, it is expected that Kentucky will see an increase in its covered residents.

Health insurance benefit plans in Kentucky include group health coverage, individual coverage and programs that are run by the state itself.  The various programs available offer different coverage levels and have associated income requirements or job status as a determining factor in utilizing each program.

Below, we provide a look inside the health of the residents living in the state of Kentucky, along with the health insurance market.

Kentucky’s Health Care Issues
The overall health of residents in Kentucky is low compared to other states in the country.  Kentucky is ranked in 44th place overall, as reported by the United Health Foundation’s rankings.  This state has a high percentage of smokers, high rate of deaths related to cancer and a high number of hospitalizations that are considered preventable.  The state’s strengths include its low rate of criminal activity, a low rate of drinking to excess and a high percentage of kids who have graduated high school.

Understanding Kentucky’s Uninsured Population
As of 2014, the percentage of people without insurance in Kentucky is 7 percent.  This is a great drop from 83% in the year 2011.  It is believed that the enactment of the Affordable Care Act attributed to the jump in health insurance coverage for residents in the state of Kentucky.  Forty-six percent of residents in Kentucky are covered under group health plans offered by employers, but there are a lot of smaller companies in the state that do not offer insurance benefits whatsoever.

Below is some information regarding the uninsured population of the state of Kentucky:

  • 10% of poor children and 9% of low income children are not covered under an insurance policy.
  • There are over fifty thousand smaller companies in the state that have less than 50 workers and 37% of them don’t offer insurance benefits.
  • Most of the people who are uninsured in Kentucky are poor or have low incomes.  However, 5% of Kentucky residents who earn 400% or over the Federal Poverty Level are not covered under insurance.

Group Health Plans
In the state of Kentucky, HMOs and private health insurance companies are regulated by the Department of Insurance.  There are regulations in place that put the onus on the employer for providing benefits to their workers, but it has still proven difficult for smaller companies to get their employees covered.  In a lot of cases, it is also quite costly for employees to join their employer’s health insurance package.  Despite the health insurance being subsidized, it requires that the monthly premiums be automatically deducted from the employee’s paycheck.  However, if you are working in the state of Kentucky, when looking for health benefits, first speak with your employer to see if coverage is offered.

Signing Up
You may have to wait for an enrollment period to begin before you are able to join your employer’s health plan.  Enrolling into a plan for benefits is a really important choice, so you want to make sure you do all of the necessary research so that you can make an educated decision.  Before joining, contemplate all of the future possibilities with regard to what you might need from your benefits package.

Consider the following points when going through the process of selecting one of the health insurance plans available:

  • What options do you have for coverage and are they affordable?  Companies typically offer two or more selections and each have varying levels of coverage and costs.
  • Dependent children can receive insurance coverage under a parent’s plan until the age of 26.
  • Are you self-employed?  If so, you may be able to obtain group coverage under a spouse’s plan or a trade group.

Pre-Existing Condition Exclusion Periods
If you are suffering from a pre-existing condition, then you may be subject to an exclusion period before you are able to use your insurance benefits.  This period can last up to a year in the state of Kentucky and the insurance provider has a look back period of up to six months to see if you have any pre-existing medical conditions.

Because of HIPAA, your dependent children who are 19 and younger cannot be subject to wait through an exclusion period because they have a pre-existing medical condition.  Even if you have a pre-existing condition, your insurance provider cannot decline your application for coverage under your employer’s group health plan.  Lastly, just because you have a genetic predisposition to a disease or illness, it does not mean that it can be treated as a pre-existing condition.

Affiliation or Waiting Periods
Waiting periods apply after you have filled out your application to begin the enrollment process.  During this period of time you cannot use your insurance benefits, but waiting periods are usually around 60 days.  Late enrollees may have to wait for 90 days before coverage becomes active.  The rules governing waiting periods are determined by the insurance company or HMO.

Individual Health Plans
If you can afford the monthly premiums, you can obtain an individual insurance policy in the state of Kentucky.  The associated premiums can prove to be quite expensive along with high deductibles.  The Foundation for Health Coverage Education has offered an estimate for a young healthy person obtaining individual coverage in the state of Kentucky.  The website stated that the person could get insurance benefits for around $55 per month with a high deductible amount.  In the state of Kentucky, individual insurance plans are subject to underwriting on the part of the insurance company.

With some limitations in place, Kentucky residents with pre-existing conditions can still obtain coverage under individual policies.  While insurance companies in other states can flat out deny your application for enrollment, insurance providers in Kentucky don’t always do that.  However, the exclusion period for this type of plan covering a pre-existing condition is limited to a year.

Continuation Coverage
Continued insurance coverage can be obtained following a change in job or marital status.  COBRA (Consolidated Omnibus Budget Reconciliation Act) coverage offers benefits to extend the original insurance protections you had through a group health plan for a period of 18 months.  If the company employed a certain amount of workers (usually over 20 or over 50), then you can obtain this type of coverage.
Kentucky Health Benefit Exchange
Kentucky’s health insurance marketplace was established in 2012 to offer health insurance options and comparison tools to residents living in the state.  The exchange is called Kynect and it endeavors to cover all of the citizens it serves.

Kentucky’s health benefits exchange met all of the federal mandates under the Affordable Care Act and currently operates to offer guidance on the insurance choices to residents.  The website was created as an online marketplace where uninsured people can compare and obtain health benefits.

Kentucky State Insurance Programs
There are a variety of state-funded plans for low income earning individuals and families to choose from in the state of Kentucky.  Among the programs included are: PCIP (Pre-Existing Condition Insurance Plan), Medicaid, KCHIP, WIC, the Commission for Children with Special Health Care Needs, the Kentucky Women’s Cancer Screening Program, Medicare, the State Health Insurance Assistance Program, the VA Medical Benefits Package, the Partnership for Prescription Assistance and the NAMI Helpline.

Pre-Existing Condition Insurance Plan (PCIP)
This coverage is for people suffering from pre-existing conditions in the state of Kentucky.  In order to qualify, you must’ve gone without insurance for six months before enrolling and have to provide evidence of your denial for benefits because of your pre-existing condition.  Those who are eligible for this plan usually pay similar premiums to those people without pre-existing medical conditions.

The Medicaid program in the state of Kentucky is called KYHealth Choices and it offers a lot of benefits to low income individuals, families and individuals who are disabled.  Eligibility is based on your income level and you may be charged a small fee for services.

For children under the age of 19 who do not qualify for coverage under Medicaid, there is the KCHIP program.  For more information, visit the KCHIP website.  This coverage is limited to people who are at or below 200% of the Federal Poverty Level.

Women, Infants, and Children (WIC)
WIC provides pregnant women, newborns and children up to age five with resources on nutritional foods, child safety and breastfeeding.  Also offered to women and infants are food supplements that aid in the growth and development of the parties covered.

Commission for Children with Special Health Care Needs (CCSHCN)
CCNHCN is a program that covers dependent children who are suffering from chronic illnesses.  Program participants must be aged 21 and younger and to qualify, your income and medical condition is scrutinized.

Kentucky Women’s Cancer Screening Program
The Kentucky Women’s Cancer Screening Program offers free cervical and breast screening procedures to women who earn low incomes in the state of Kentucky who are between 40-64 years of age.

Medicare, the Medicare Prescription Drug Program, and the State Health Insurance Assistance Program (SHIP)
Medicare is offered to senior citizens, disabled persons and persons suffering from end-stage renal disease.  Seniors who qualify must be older than 65 and have worked in a Medicare covered job for at least ten years prior to enrollment.  SHIP is a resource for seniors and the disabled to use for counseling on the various Medicare options available.

VA Medical Benefits Package
The VA Medical Benefits Package is presented to military veterans who have completed their requirements for active duty (at least 24 months in a row of service) and have gotten honorably discharged from the service.

Partnership for Prescription Assistance
The PPA is a program that connects you with a multitude of prescription assistance resources that help you with covering the costs of prescription drugs.

National Association of Mental Illness (NAMI) Helpline
The National Association of Mental Illness Helpline is an organization that aids those with mental illness in receiving quality resources and information on the various treatment options available to them.

The Health Insurance Portability and Accountability Act (HIPAA)
HIPAA was created to protect consumers from having their medical records and information treated poorly.  This law was set forth to keep the information contained in your medical records private and away from those who were not authorized to view the material.

Since the Affordable Care Act has come into play, the scope of HIPAA has broadened to cover regulations on health insurance providers in the country.

HIPAA now regulates how insurance companies treat people with pre-existing conditions depending on the plan type, how much premiums you have to pay to receive coverage and affiliation periods.  Also regulated by this law is COBRA coverage and the ability to sign up for a conversion plan that will allow you to take your basic group contract and carry it over to an individual policy while keeping the same insurance provider.