Kentuckians are likely to need help signing up for health insurance on the federal exchange, especially in east and south

Kentuckians looking for a 2017 health plan on the federal exchange will likely need some help signing up, if a study of last year's need for support on the former Kynect exchange is any indication.

The Foundation for a Healthy Kentucky study found that more than half of Kentuckians (52.3 percent) who got their health insurance through Kynect last year worked with a kynector, a person who helped them sign up. The study also found that 41.7 percent contacted the Kynect call center and 38 percent visited the Kynect website.

"As the commonwealth transitions away from Kynect and into a supported state-based marketplace using the federal portal Healthcare.gov, this report tells us that more than half may be reaching out for one-on-one assistance, either in person or by phone, during the process," Ben Chandler, president and CEO of the foundation, said in a news release.

The report comes from the State Health Access Data Assistance Center at the University of Minnesota, which the foundation is paying more than $280,000 to study the impact of the Patient Protection and Affordable Care Act over three years. This study shows a quarterly snapshot of April, May June 2016.

Kentuckians who qualify for insurance subsidized by federal tax credits, called qualified health plans, are signing up on HealthCare.gov during this year's open enrollment, which began Nov. 1 and goes through Jan. 31. (Individuals must sign up by Dec. 15 to get coverage that begins Jan. 1.)

The state has extended contracts with the same organizations that provided kynectors for Kynect, but they are now called "application assisters" and every county in Kentucky is served by one of these organizations, according to the Cabinet for Health and Family Services. You can find an application assister by clicking on a search button on the Kynect website or by calling Kynect's customer services at 855-459-6328.

Use of Kynect was higher in Eastern and Southern Kentucky.

Chandler said the need for assistance "is likely to be greatest in Eastern Kentucky, where a larger proportion of residents accessed their 2016 coverage through Kynect."

The report found that the highest rate of Kynect enrollment in 2016 was in Eastern Kentucky, at 33.9 percent, and the lowest was in Northern Kentucky at 16 percent. Western Kentucky (27.8 percent), greater Louisville (22.5 percent), and greater Lexington (21.9 percent) were all closer to the state average of 25.8 percent.

Of the nearly 26 percent of Kentucky adults who got their health coverage for 2016 through Kynect, just 5 percent enrolled in private individual-market coverage and 95 percent enrolled in Medicaid, the report said.

WFPL of Louisville reported in early November that an application assister in Manchester, Sharon Bush, said many people in southeastern Kentucky don't have or use information technology, adding to the challenge of getting people signed up in the region. For example, HealthCare.gov requires an e-mail account to sign up. Another challenge is that application assisters can no longer get into the system to enroll their clients as they could on Kynect, so consumers must be able to do it themselves or work with a company that has bought the software to do so.

Health Status of Kynect Enrollees

Kentuckians who used Kynect tended to have poorer health. "If last year's numbers hold true, those looking to buy insurance or sign up for Medicaid via the federal portal will have poorer health than their counterparts who already have insurance," Chandler said.

The report said 45 percent of those who enrolled through Kynect said they were in fair or poor health, compared to 28 percent of Kentucky's non-elderly adult population.

Click here for tips on picking a health plan on Healthcare.gov, including the types of plans available and quality ratings.

Kentuckians who qualify for tax-subsidized health plans will sign up on HealthCare.gov this year; open enrollment begins Nov. 1

By Melissa Patrick
Kentucky Health News

Kentuckians who qualify for health plans subsidized by tax credits, called Qualified Health Plans, will sign up on HealthCare.gov instead of Kynect during the open enrollment that begins Nov. 1.

Some Kynect advocates have voiced concern that the changeover will be troublesome, but Cabinet for Health and Family Services spokesman Doug Hogan said in an e-mail, "We expect a smooth transition to HealthCare.gov. People should be aware that Kynect is not health insurance, it is a website. This transition changes the web portal people use to enroll."

Hogan said the state has sent letters about the transition to Kentuckians who have previously applied or been enrolled in health coverage through Kynect, to guide them through the process. He said the state will continue to send informational postcards throughout open enrollment, which ends Jan. 31.

"Only about 2 percent of Kentucky’s population purchases a QHP in a given year, so targeting resources to this group and doing it in the final month leading up to open enrollment and continuing through open enrollment is the most effective use of resources," Hogan said.

Hogan said that starting Nov. 1, Kynect's website will offer detailed messages about the transition and directions on when and were to apply for coverage. The HealthCare.gov website also has messages for Kentucky residents.

Where to get answers to your questions

The Kynect call center (855-459-6328) will remain available to help tell Kentuckians where to go for coverage, answer questions, pre-screen for program eligibility, and assist with Medicaid applications. The HealthCare.gov customer service call center (800-318-2596) is also available to help and is open 24 hours a day, seven days a week.

Hogan said insurers are also sending notices to their enrollees about the changes; insurance agents and application assisters have advertising tool kits for their outreach efforts; and agents and assisters have been given lists of their QHP enrollees. Also, social media campaigns, media advertising and other measures have different start times around the state in strategically placed target areas with the highest uninsured rates and QHP eligible populations, he said.

If you qualify for a QHP in 2017, which is a plan that offers a tax credit to help cover out-of-pocket costs, you must sign up for your health insurance through HealthCare.gov this year instead of Kynect, as you have in the past.

"Kentuckians can only get the tax credit, called APTC or Advanced Premium Tax Credit or a Cost Sharing Reduction that helps cover out-of-pocket costs, by enrolling through HealthCare.gov," Hogan said.

Open enrollment for these plans is Nov. 1 through Jan. 31, but to get coverage on Jan. 1, you must enroll by Dec. 15.

Can I preview the 2017 plans and prices?

HealthCare.gov offers a user-friendly tool to preview 2017 plans and prices. Access the tool by clicking on the bright green "Preview 2017 Plans and Prices" button on the HealthCare.gov website and follow the prompts.

To fill in the prompts you will need to know your ZIP code, your county, whether you have enrolled in a 2016 Marketplace plan, the ages and the sex of those in your household, your marriage status, and your expected income. It will also request some other information, including whether you are eligible for health coverage elsewhere, if you are a parent of a child under 19, or if you are pregnant or a tobacco user.

After answering these prompts, the website will tell you what your estimated premium tax credit is if you qualify for one. A tax credit is how much you can save on your premium each month and not the amount of the premium itself.

The next portion of the website tool takes you to your plan choices available based on the information provided. It will ask a few questions to help narrow your choices and will then ask you to choose a bronze, silver or gold plan. After choosing a plan type, it will bring all of the plans in that category up for you to review and choose from. Your exact premium, reduced by the tax credit you qualify for, will be stated when you complete or update your application.

Why aren't there as many choices as last year?

In 59 of the state's 120 counties, residents will have only one health insurance option on the exchange. Anthem Health Plans of Kentucky is the only company offering coverage on the exchange in every county for 2017. CareSource will offer plans in 61 counties, up from 46 in 2016 and Humana Health Plan will offer exchange plans in nine counties, down from 15 in 2016.

Baptist Health Plan, United HealthCare, WellCare and Aetna, which offered plans on the exchange in 2016, will not in 2017. Most have cited unsustainable losses.

"People should know that this transition to HealthCare.gov did not affect plan choice," Hogan said. "All insurers made the same offerings regardless of the enrollment website we selected which is the same as in prior years."

Hogan added, "Cost increases were not driven by the transition to HealthCare.gov." He said premiums on exchange policies are increasing by more than 20 percent.

People whose current insurers are not offering a plan in 2017 on HealthCare.gov will be given more time to choose a plan for 2017 due to a "special enrollment period for loss of minimum essential coverage," Hogan said.

Do we still have Kynectors?

The state has extended contracts with the same organizations that provided Kynectors, which are now called "application assisters," Hogan said. Application assisters work with Kentuckians either in person or over the phone to answer questions or get assistance with the application and enrollment process.

"We are confident our assister agencies will have the ability to provide the same exceptional service," Hogan said. "Every county in Kentucky is served by a contracted organization for in person assistance. Kynectors have a very active outreach program that includes sign up events, advertising, and education opportunities. They will continue to be very active in the communities they serve."

You can find an Application assister in your area by using the "search" function on the Kynect website or by calling Kynect's customer service.

Many Kynectors are still in the process of being trained to help clients on the federal marketplace, so Hogan said there isn't a firm number of participating application assisters for 2017.

What about Medicaid?

The Medicaid program for low-income and disabled people, and its application process, will stay the same. It was moved from Kynect earlier this year.

Medicaid-eligible Kentuckians can apply anytime during the year through Benefind, a one-stop-shop website for public benefits. But if you are already enrolled, you don't need to do anything until your renewal or recertification date.

"If a citizen believes they may be eligible for Medicaid (any type), we would recommend that they apply through Benefind," Hogan said. "This would be the quickest route to receive Medicaid eligibility."

Benefind also has an anonymous pre-screening tool to assist in determining if you are eligible for Medicaid or a QHP.

Consumers may ask, "What happens if I apply for the wrong type of coverage?" Hogan answered, "Consumers cannot apply in the wrong way or place." He said if an application is started in Benefind, but the applicant is over the income limit, the application will be transferred to the federal marketplace and Benefind will send a notification letter to the participant indicating Medicaid eligibility was denied and that the client information was sent to HealthCare.gov.

If a consumer submits an application to HealthCare.gov, it will be entered, but if the applicant is deemed Medicaid-eligible, the application will be transferred to the state for final eligibility determination. If the participant is determined eligible, Benefind will notify the participant. If more information is needed, Benefind will ask the participant for it, indicating the next steps to take.

Baptist Health Plan will no longer sell individual health plans in Kentucky; about 7,000 people will be affected

Baptist Health Plan is withdrawing from the individual health insurance market in Kentucky for 2017, according to a state Department of Insurance news release.

Baptist is the state's fourth largest health-insurance provider and serves around 7,000 Kentuckians. It had planned to offer plans in 20 counties on the government exchange and 38 counties off the exchange.

The withdrawal means 59 of the state's 120 counties will have only one health insurance option on the exchange, where tax subsidies are available to reduce premiums. Most Kentucky counties will have two options off the exchange.

The state news release said James S. Fritz, president of Baptist Health Plan, indicated in a letter to state Insurance Commissioner Brian Maynard that "Baptist enrolled more members in the individual market than anticipated in 2016, but "the federal risk assessments placed upon the organization under the Affordable Care Act is unsustainable by a corporation the size of Baptist Health Plan."

The decision by Baptist comes just one month after Aetna announced that it will pull out of the state exchange in 2017, citing financial reasons. Its withdrawal will affect 10 counties in three major metropolitan areas.

Policyholders in Baptist plans can continue coverage through Dec. 31 if they are on the exchange and through March 31 if they are off the exchange. Baptist will notify them of its withdrawal.

Kentuckians signing up for health insurance through the exchange will enroll on Healthcare.gov this year, instead of Kynect, the state's health insurance exchange. Open enrollment begins Nov. 1 and goes through Jan. 31.

In Ky. and elsewhere, elections may decide Medicaid expansion

In Texas, Brandi DeFrank's Medicaid
coverage ended when her baby, Gabriel,
was born. His coverage continued.

Voters' choices on Tuesday about who sits in statehouses may matter more in the long run than who they have chosen for president. Two of the biggest provisions of the Patient Protection and Affordable Care Act -- offering Medicaid to more people and setting up state health exchanges -- are in the hands of state officials who can either disrupt implementation of the law or move it forward. In Kentucky, Republicans are pressing to take over the state House and their leader, Rep. Jeff Hoover of Jamestown, has said the expansion would be too expensive, even with heavy federal subsidies.

Maggie Fox for NBC News contrasts the approach of Texas, which has refused $76 billion in federal matching funds to help it expand Medicaid in the next five years, to that of Vermont, which is wholeheartedly embracing the expansion. Texas has 6.3 million uninsured, reports Fox, a quarter of the state's population and the highest percentage of uninsured people in the country. "We're not going to part of socializing health care," said  Texas Gov. Rick Perry, a Republican.

“There are states referred to as ‘Hell, no’states,” said David Smith, an analyst at Leavitt Partners, a health-care consulting firm. And while 11 governorships are on the ballot on Tuesday, “a lot of those states don’t necessarily have governors who are up for election,” said Smith. In those states, voters have to decide whether to help governors by electing members of the same party to the state house.

In other states, it's more straightforward. Alabama, Florida, Montana and Wyoming have ballot measures asking residents whether they want to block the mandate requiring people to get health insurance.  (Read more)