Health Insurance in Kentucky

Health insurance is crucial from the point of view of financial planning. However, buying suitable health insurance coverage for your family is expensive as well as requires a good consideration of all future risks and its influence on your finances. More than 47 million Americans are uninsured, majority of whom are the working families. These families often wind up on the receiving end when it comes to paying huge medical expenses due to the lack of proper health coverage. However, for those families who are not covered under their employers’ group plan, there are low-cost state sponsored health insurance programs.

According to the America’s 2008 Health Rankings, Kentucky is on the 37th spot on the healthiest states list. The state has witnessed remarkable improvement in its healthcare score after being ranked 43rd and 39th in 2007 and 2006 respectively. Predominantly, increased public health funding, decreased percentage in the prevalence of binge drinking and the low percentage of children in poverty brought a positive change in the state’s health system. Kentucky, having the population of more than four million citizens, boasts of both private-market and public health insurance alternatives. The private-market health insurance comprises of numerous types of health plans including family, Medicare supplemental, short-term, student, group and dental. Additionally, the state and federal government sponsored programs provide low-priced health coverage to the uninsurable residents of Kentucky who meet specific eligibility requirements.

The Kentucky Department of Insurance is in charge for regulating all types of insurance sold in the state of Kentucky including health insurance policies offered by private-market health insurers or public health coverage programs. However, approximately 14.6% of the population remains uninsured, which is the biggest health issue for the Kentucky lawmakers. According to the Censor Bureau’s 2007 and 2008 Current Population Survey, approximately 28.5% uninsured Kentucky residents come under the above 200% FPL category.

Health insurance is an inevitable alternative and choosing a health plan can be quite tedious and confusing. Before buying a particular health policy, consult with a licensed health insurance agent/broker to avail the benefits of various health insurance alternatives.

Individual/Family Health Insurance

Below is the guidelines for applying for and obtaining individual health insurance in the state of Kentucky. These regulations apply to all insurance companies offering individual or family health insurance in Kentucky:

Medical Underwriting
Pre-Existing Condition Exclusion Period
12 months
Look Back Period
6 months
Look Back Standard
Objective standard
Mandatory Benefits
Cancer screening for women including breast cancer, mastectomy stay as prescribed by the surgeon, reconstructive surgery after mastectomy, osteoporosis screening, direct access to OB/GYNs, OB/GYNs as primary care providers, eating disorder parity
Market Rate Restrictions
Guaranteed Issue Options
Small Group Health Insurance

Below is the guidelines for small group health insurance in the state of Kentucky. These regulations apply to all insurance companies offering small group health insurance in Kentucky:

Small Group Size
Employee Qualifications
Owner can count as an employee
Guaranteed Issue
Premium Rating Factors
Rate Bands
Rate Adjustment Factors
Look-Back Period
6 months
Pre-existing condition exclusionary period
12 months
Mandatory Benefits
Same as individual
State Cobra Variations for Small Groups

Below are the COBRA guidelines for small groups in the state of Kentucky. For employer groups of more than 20 employees, refer to the federal COBRA guidelines:

Mini-Cobra Option
Eligible Group Sizes
Extension of Benefits Period – Standard
18 months
Extension of Benefits Period – Disabled
Additional 12 months
Maximum Premium Increase
State Legislation Reference

Additional Notes
Eligible employees terminated from the group coverage can receive the mini-cobra coverage as long as they have been insured under that plan for 3 months prior to the date of termination. Election to accept continuation coverage must be made within 31 days.
State Sponsored Health Insurance Programs

There are several state sponsored health insurance programs in the State of Kentucky to assist those without insurance in obtaining adequate coverage.

High-Risk Pools

Some states offer special state sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. The guidelines for enrollment in these programs vary by state. The high-risk pool in the State of Kentucky is summarized in the chart below:

Plan Name
Kentucky Access
Phone Number
HIPPA Eligibility Required?
Available Carriers
Anthem Blue Cross Blue Shield
Pre-Existing Condition Waiting Period
12 months
Enrollment Periods
Open to new enrollment
Premium Limits
No more than 175% of standard risk
Lifetime Maximum Benefit
$2 million
Special Notes
Eligibility for the program :
HIPAA; Federally eligible Individuals coming off of group, governmental, church plan, COBRA or state continuation;
If you are rejected for private medical coverage;
If you can prove higher premium rates than KY Access;
If you have a high cost condition
Children’s Health Insurance Program

Through shared funding from the federal government, the State of Kentucky provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below:

Program Name
Kentucky Children’s Health Insurance Program (5KCHIP)
Phone Number
Apply Online
Age Limits
Under 19
Insurance Carrier

Length of Coverage
12 months
Residency Requirements
Kentucky resident and U.S. citizen
Other Eligibility Requirements
Must not be eligible for any other insurance, including individual, group or public
Family income should be at or below 200% FPL
Possible waiting periods apply for some children at certain income levels
Pre-Existing Condition Exclusions
$0 or $20 monthly premium depending on income

Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of Kentucky:

Governing Agency
Department of Medicaid Services
Phone Number
Residency Requirements
Kentucky resident and U.S. citizen
Federal Poverty Line Income Limits
Ages 1-19 up to 200% FPL
Pregnant women and infants up to 185% FPL
Working parents up to 70% FPL
Non-working parents up to 40%
Medically needy individuals up to 30%, couples 28%
Limits on family resources such as savings accounts, cash, etc. for all but children and pregnant women
Additional Resources

Kentucky Health Care Options Matrix™ Guide
Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines Kentucky’s public and private health care choices for individuals and groups with various demographic profiles.
Family Health Insurance Guide by
The guide created by provides useful information regarding health insurance coverage such as individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families.
Kentucky: At-A-Glance
Provides all-inclusive health data of Kentucky. is a project of the Henry J. Kaiser Family Foundation and is designed to provide free, up-to-date, and easy-to-use health data on all 50 states.