How Healthcare Reform is changing the Kentucky Health Insurance Scene

Beginning in January 2014, almost all Americans and legal residents are required to purchase health insurance or pay a fine. To help middle and low income Americans abide by this individual mandate, health reform proposed the setting up of health insurance exchanges in all the states. Kentucky was one of the first states to go ahead with the creation of a health insurance exchange. This exchange is expected to be an online market place where individuals and businesses can purchase subsidized Kentucky health insurance plans. The healthcare scene in Kentucky will see many changes as health care reform is implemented:

• The Kentucky health insurance exchange will change the way individuals and businesses purchase coverage. This online marketplace is where consumers who are underinsured or uninsured can buy subsidized Kentucky health insurance plans. Small businesses can purchase affordable Kentucky group health insurance plans for their workers at the health insurance exchange and receive tax concessions.

• Reducing the numbers of uninsured will reduce the burden on the healthcare system. It is estimated that up to 14.8% of Kentuckians do not have health insurance and suffer from chronic conditions such as obesity, diabetes, and high blood pressure. Many depend on the Emergency Room (ER) as their regular caregiver.  ER care is the most expensive, so this high reliance on emergency departments increases the burden on healthcare providers, who often end up in debt when they treat uninsured patients. This is expected to change as more people get access to affordable Kentucky health insurance through the health exchange.

• Kentucky health plans sold through the health exchange will have to cover ‘minimum essential benefits’ which include ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.  Kentucky has chosen Anthem’s Preferred Provider Organization Plan as its benchmark plan.  The benefits offered by this plan will serve as the model for all other plans that will be available through the exchange.

• Consumers with pre-existing conditions cannot be denied health insurance. While the law is already effective for children in Kentucky, it will apply to adults in 2014. Also, women cannot be charged higher premiums. However, these provisions may result in a rise in the cost of Kentucky health insurance for young, healthy adults as insurers raise premiums to cover the cost of covering and providing benefits to sick people and women.

• Children under age 28 without job-based or other coverage can now stay on their parents’ plan. The U.S. Department of Health and Human Services estimated that, as of December 2011, this provision of health care law allowed 48,000 young adults in Kentucky to gain health insurance coverage.

Starting 2014, Kentuckians without health coverage will have to pay penalties as follows:

-          Individuals: up to $95 in 2014, rising to $625 in 2016

-          Families: up to $285 per family, or 1% of income, whichever is greater; in 2016, the penalty will rise to $2085 per family, or 1% of income, whichever is greater.  

-          Businesses with 50 or more employees: $2,000 per uninsured employee.

It’s not just about the penalties. Going without coverage is risky and can put a great strain on your financial resources if you fall sick. While health care law seeks to offer many protections to safeguard your health and resources, it is up to you to find a plan that meets your needs. Affordable Kentucky health insurance plans are available. An experienced, licensed Kentucky health insurance broker can help you learn more about your options and enroll in the right plan.