Kentucky

Private Health Insurance & the Marketplace

Open Enrollment Period

Kentucky’s Marketplace is state-run and residents should use Kynect.ky.gov to enroll in Marketplace plans. Open enrollment runs from November 1, 2023 until January 16, 2024.

Special Enrollment Periods

  • Under federal law, individuals may enroll in the Marketplace outside of the open enrollment period if they experience certain qualifying events, such as the loss of employer-based insurance, marriage, or having a baby (see a more complete list here). Kentucky offers additional special enrollment periods (SEPs), including when the following occurs:
    • Having a household income at or below 150 percent of the federal poverty level ($21,870 for an individual, $45,000 for a family of four) and being eligible for Marketplace subsidies.
    • Losing Medicaid between March 31, 2023 and July 31, 2024—the Marketplace offers an extended SEP for these individuals, allowing them to apply for Marketplace coverage at any point within this period and giving them 60 days once they submit an application to select a plan.
  • Restrictions may apply, including those outlined in this FAQ. Some SEPs may only be available to individuals who have current Marketplace coverage, and some SEPs may only be accessible through the Marketplace call center. The list of SEPs on our website is not an exhaustive one. If you recently experienced a change in circumstances that you think may qualify you for a SEP, check with Marketplace site, Kynect Benefits to see if any other special enrollment opportunities are available.

Short-term Plans

  • Under federal law, short-term plans are not required to cover services for pre-existing conditions and therefore typically provide far fewer benefits and cost-sharing protections compared to health plans available through the Marketplace. Federal rules allow these plans to last up to 12 months and be marketed as a substitute for Affordable Care Act coverage. However, states may modify these federal standards to make them more strict and also require short-term plans to follow additional consumer protections.
  • Kentucky allows short-term plans to be sold during the open enrollment period and to be offered as year-round coverage.

Individual Mandate

Kentucky does not require individuals to pay a penalty or tax for failing to maintain minimum essential coverage.

State-funded Financial Assistance

Under the Affordable Care Act, individuals may qualify for premium tax credits and plans with reduced cost-sharing based on their income and other factors. Kentucky does not provide state funds to supplement those federal premium tax credits or cost-sharing reductions.

Coverage for Young Adults

Under the Affordable Care Act, individual and group health plans that offer dependent benefits must allow parents to keep their children up to age 26 on their plan. Kentucky law is consistent with this requirement.

Medicaid/CHIP

Medicaid Expansion

The Affordable Care Act gives states the option to expand Medicaid to adults with household income at or below 138 percent of the federal poverty level. Kentucky has taken advantage of this option so adults with household incomes at or below 138 percent of the federal poverty level ($20,120 for an individual, $41,400 for a family of four annually) are eligible for Medicaid in Kentucky.

Other Medicaid Eligibility Categories

  • In Kentucky, children under age 19 are eligible for Medicaid or the Children’s Health Insurance Program (CHIP) with household incomes at or below 218 percent of the federal poverty level ($65,400 for a family of four annually).
  • Pregnant people are eligible for Medicaid with household incomes at or below 218 percent of the federal poverty level ($65,400 for a family of four annually).
  • Consumers can learn about what coverage options they are eligible for, including Medicaid, through Kentucky’s state-based Marketplace Kynect.

Immigrant Eligibility

  • Generally, lawfully residing immigrants are eligible for Medicaid after a 5-year waiting period.
  • In Kentucky, lawfully residing children are exempt from this 5-year waiting period.

Postpartum Coverage

Federal law gives states the opportunity to optionally extend Medicaid eligibility for postpartum individuals up to 12 months. Kentucky has implemented this coverage expansion.

Where to Go for Help

Marketplace

Personalized Assistnace

Individuals with no coverage
Individuals with coverage
Coverage for small employers
Post enrollment issues