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The Affordable Care Act (ACA) changed the way many people receive and use health care coverage. It expanded access to insurance, introduced financial assistance for those who qualify, and created a more standardized approach to benefits across plans.
The Health Insurance Marketplace is a key part of the ACA. It provides an option for people who do not have affordable employer-sponsored coverage and who do not qualify for public programs. In Kentucky, the Marketplace is known as kynect.
What Marketplace Plans Include
Marketplace plans, also known as Qualified Health Plans (QHPs), must meet federal standards for coverage. All insurance plans offered on the Marketplace must include defined essential health benefits.
There are ten things ACA-compliant plans on the Marketplace must cover:
Preventive and wellness services, including chronic disease management
Mental health and substance use disorder services, including behavioral health treatment
Prescription drugs
Hospitalization
Maternity and newborn care
Emergency services
Pediatric services, including oral and vision care
Rehabilitative and habilitative services and devices to help patients get, maintain, or improve skills necessary for daily functioning
Laboratory services
Ambulatory patient services
Plan Options and Enrollment Support
Marketplace plans are grouped into four metal tiers – Bronze, Silver, Gold, and Platinum – which reflect how costs are shared between the insurance plan and the enrollee. In general, plans with lower premiums have higher out-of-pocket costs, while plans with higher premiums have lower out-of-pocket costs. Kentucky’s Marketplace does not offer Platinum plans.
For those who need assistance, kynect provides access to trained navigators, known as kynectors, who can help with eligibility, enrollment, and applications for both Medicaid and Marketplace plans.
Financial Help for Marketplace Coverage
Financial assistance is available for many people who enroll in Marketplace coverage. Eligibility is based on household size (including the applicant, a spouse, and any dependents) and household income.
Premium tax credits, or subsidies, can reduce monthly premium costs and are only available for plans purchased through the Marketplace.
Cost-sharing reductions (CSRs) provide additional savings by lowering out-of-pocket costs, such as those paid at the time of care. These cost savings apply to deductibles, copays, coinsurance, and out-of-pocket maximums and are available only to those enrolled in Silver-tier Marketplace plans.
Comparing plans with these savings applied provides a more accurate picture of total costs.
To learn more about how deductibles, copays, and other cost-sharing features work, click here.
Changes Beginning in 2026
Several policy changes will affect Marketplace coverage beginning in 2026.
The open enrollment period is being shortened. For the 2027 plan year, enrollment on the federal Marketplace will run from November 1st through December 15th. State-based Marketplaces may extend this period through December 31st. In Kentucky, open enrollment for Marketplace coverage through kynect will run through December 31st with coverage beginning January 1st.
The law known as the “One Big Beautiful Bill Act” (OBBBA) introduces new eligibility restrictions for premium tax credits. These credits will be limited to U.S. citizens and certain lawfully present immigrants, including lawful permanent residents and specific groups such as individuals from Haiti, Cuba, and certain Pacific Island nations. Refugees, asylees, and some other legally present individuals will no longer qualify.
Additional changes include new requirements for annual eligibility verification, which will reduce the use of automatic renewals, and restrictions on premium tax credit eligibility for certain low-income individuals who do not qualify for Medicaid.
Access Through the Marketplace
The Marketplace remains an important option for people who do not have access to affordable employer-sponsored coverage or public programs such as Medicare or Medicaid.
Reviewing plan details, available financial assistance, and enrollment timelines can help maintain consistent access to coverage.
These materials were supported by funds made available by the Kentucky Department for Public Health’s Office of Population Health from the Centers for Disease Control and Prevention, National Center for STLT Public Health Infrastructure and Workforce, under RFA-OT21-2103.
The contents of these materials are those of the authors and do not necessarily represent the official position of or endorsement by the Kentucky Department for Public Health or the Centers for Disease Control and Prevention.