Do you have health insurance? If you don’t, you might be putting yourself and your family at risk if you’re involved in an accident or you get sick. Here’s everything you need to know about getting great health insurance in KY.
The Best Health Insurance in KY
What is Health Insurance?
Health insurance is a type of coverage that reimburses you for a portion of your medical care bills after an accident, injury or illness. Most Americans get health insurance through their employer, but it’s also possible to buy an individual health care plan as well. Health insurance is very important because hospital bills can quickly reach thousands of dollars — and an accident can happen at any time.
In order to fully understand how health insurance works, we first need to cover some of the lingo that the insurance industry uses. Here are some terms you’ll need to know before you start shopping for plans.
- Premium: This is the amount of money you pay to your health insurance company to keep your coverage current. Your premium is usually due every month, but you might be able to save if you pay a year’s worth of your premium in a lump sum.
- Deductible: Your plan deductible is the minimum amount of money you need to pay towards your health insurance costs before your insurance “kicks in” and starts covering your bills. For example, if you have a plan with a $1,000 deductible, you need to spend $1,000 on your own medical care costs before your insurance contributes. The specific deductible you’ll pay depends on your plan and provider — the best health insurance plans often have $0 deductibles.
- Coinsurance: Your coinsurance is the percentage of your care costs you pay after you meet your deductible. For example, let’s say you’ve met your deductible and your plan has a 20% coinsurance rate. You might get a doctor’s bill for $100 and your insurance will pay 80% of your bill ($80) and you’ll pay the remaining 20% ($20).
- Out-of-pocket maximum: Your out-of-pocket maximum is the maximum amount of money you’ll pay for your health care costs in a single year. Once you hit your out-of-pocket maximum, your co-insurance no longer applies and your insurance provide covers 100% of your health care costs.
Average Cost of Health Insurance in Kentucky
If you’re a Kentucky resident with an individual health insurance plan, you’ll pay about $445 per month for your monthly premium. You may qualify for health care subsidies when you enroll in a Marketplace plan if you’re a very low-income individual. Visit Healthcare.gov and sign up for a Marketplace account to see if you qualify.
Types of Health Coverage
There are a few different types of health insurance plan packages. One of the first decisions you’ll need to make before you start to shop for health insurance is on the type of plan that works best for your needs. Some common types of health insurance plans include:
- Health maintenance organizations (HMOs) are the most limited type of health insurance option. Your insurance provider will give you a list of approved primary care providers. You must see doctors within your HMO’s network if you want to use your benefits. You usually must also get a referral before you see a specialist. HMOs are often the least expensive type of health insurance, though you have the least amount of freedom to choose which doctors you see.
- Preferred provider organizations (PPOs) give you more freedom to choose which medical service providers you see. You can usually save money by seeing a doctor in your network but you’re free to see any licensed medical service provider you prefer and still use your benefits. You also usually don’t need a referral to see a specialist. PPOs are more expensive but give you more freedom to use your plan.
- Point of Service (POS) plans are like a combination between an HMO and a PPO. If you have a POS plan, you can see any doctor or specialist you prefer (though, like a PPO, you can still save if you stay in your network). You will need a referral from your primary care provider before you can see a specialist. POS plans are a great way to balance costs and coverage when you select a plan.
What Does Health Insurance Cover?
The Affordable Care Act (ACA) requires long-term health insurance plan providers to offer coverage for 10 essential benefits:
- Ambulatory patient services: This includes services and medical care that you receive outside of a hospital.
- Emergency services: Your insurance provider must cover emergency room visits and urgent medical care. It’s against the law for your insurance provider to force you to visit a specific hospital in the event of an emergency, no matter which type of plan you have.
- Hospitalization: This includes extended periods of time you must stay in the hospital.
- Pregnancy, maternal care and breastfeeding support: Your insurance provider must offer coverage for maternity-related doctors’ visits and medical care before and after you have your child. Your insurance provider cannot apply a “waiting period” to your pregnancy benefits, nor can it deny you coverage because you were pregnant before you enrolled.
- Mental health and substance abuse treatment: This includes care and medications for chronic mental health and addiction issues. Counseling, psychotherapy and in-patient rehabilitation services must also be covered.
- Prescription drugs: Your insurance provider must offer coverage for prescription drugs. However, your insurance provider doesn’t need to cover all drug tiers. If there’s a viable generic version of a drug that your doctor prescribes, your insurance provider may require you to try the less-expensive version before moving up a tier.
- Rehabilitative services: This includes services like physical and occupational therapy. It also covers medical devices required for mobility, like crutches and wheelchairs.
- Laboratory services: This benefit includes things like bloodwork and lipid screening panels.
- Preventive treatments and services: The most common example of preventive services is your annual physical. Medically-mandated vaccinations and breast cancer screenings are also examples of preventive services that your insurance provider must cover.
- Pediatric services. Your health insurance plan must include all the above coverage for children on your plan, plus vision and dental coverage.
Your coverage must also extend to birth control if you’re female. Birth control pills, IUDs and emergency contraceptives must also be covered by your insurance in addition to the listed benefits. You may not have access to these benefits if you work for a religious institution or nonprofit and you get your insurance through your employer.
What Does Health Insurance not Cover?
Many plans exclude coverage for services and treatments not considered essential benefits. Some things you’ll likely see excluded on your insurance plan include:
- Dental and vision services: Insurance providers are only legally required to offer these services to children on your plan who are under the age of 18. If you want coverage for yourself, your spouse or an older child, you’ll need to buy an individual plan for both dental and vision.
- Non-essential vaccinations and travel vaccines: The ACA requires that insurance providers cover vaccinations. But only medically necessary vaccines are covered. Almost every health insurance provider excludes coverage for elective or travel vaccines (even if they’re required to enter a certain country).
- Male birth control: Most health insurance companies don’t cover male birth control methods, like condoms and vasectomies.
Best Health Insurance Providers in KY
Now that you understand how health insurance works, let’s take a look at some of your plan options. We’ll take a look at a few of our favorite insurance companies that provide robust and affordable health insurance in Kentucky.
UnitedHealthcare is one of the largest health insurance providers in the United States. It offers doctor and specialist choices throughout Kentucky.
UnitedHealthcare offers a number of plan options and tiers and allows you more control over your deductible, premium and out-of-pocket maximum costs. You can also find some unique benefits for your situation if you’re self-employed, a small business owner or enrolled in Medicare. UnitedHealthcare is an excellent choice when it comes to health insurance in Kentucky.
2. CareSource Kentucky
CareSource Kentucky is a Kentucky-based health insurance provider that offers plans for both individuals and families on the ACA marketplace.
CareSource has recently expanded its operations into nearly every county in Kentucky — this means that if you didn’t qualify for coverage last year, it can be worth it to try again. CareSource policyholders enjoy lower deductibles than competing plans and many plans also include $0 deductibles for preventive care. You’ll enjoy $0 deductibles on most generic prescriptions when you choose a plan through CareSource.
Aetna is a health insurance provider that offers individual ACA-approved insurance plans, Medicare supplemental coverage and employer-based coverage in Kentucky.
When you enroll in a plan with Aetna, you gain access to its simple online portal. Your portal can help you find a doctor, see your coverage and benefits, track your deductible and manage your claims. Aetna’s website is also intuitive and easy to understand — plan options and terms are laid out clearly.
4. Anthem Blue Cross
Anthem Blue Shield is a subsidiary of Blue Cross Blue Shield, one of the largest insurance providers in the country. You can bundle your coverage together with a dental and vision package. You can have your entire family covered with just a few clicks. Preventive care and screenings also come with $0 deductibles through Anthem as well.
Humana no longer offers individual and family health insurance plans in most areas of Kentucky but it does offer a number of valuable medical insurance options.
Supplement your Marketplace plan with a dental or vision package from Humana from just $17 a month. You can also supplement your Medicare insurance with additional coverage options from Humana. Finally, Humana offers a wide range of health insurance choices for business owners that balance both coverage and affordability.
There are even wellness-focused programs you can add to your employee’s list of benefits to encourage lifelong healthy habits.
Protect Your Health in Kentucky
Still wondering how to get health insurance? Start by visiting the ACA Marketplace via Healthcare.gov. Sign up for an account and the Marketplace will automatically introduce you to the options available in your state. But act fast — open enrollment ends in December, which means you’ll need to enroll in a Marketplace plan before then to have coverage for 2020.