Healthcare coverage is confusing.
It doesn't have to be.
Our 2024 survey found that 87% of uninsured Kentuckians and 55% of those with insurance have skipped or delayed care or medications due to cost.
What's standing in your way?
Coverage and Enrollment Confusion
Wondering when you can sign up? Lost a job or had a big life change? Learn about how, and under what circumstances, you can change plans.
Choosing Coverage and Plan Comparisons
Not sure which type of coverage or plan to choose? It can be confusing and overwhelming. We explain what terms such as HMO, PPO, and COBRA mean.
Medicare vs. Medicare Advantage
Medicare or Medicare Advantage – which one is better for me? Learn the pros and cons so you can decide what fits your needs.
Understanding Insurance Benefits & Terms
Deductibles, networks, referrals… what do they mean? We explain the words and terms you need to know so you can pick a plan that works for you.
Stress About Medical Costs
Worried about medical bills or not being able to afford your prescriptions? We’ll show how your plan details impact cost, and what help you might qualify for.
Real Questions.
Real Answers
"Insurance has slowed my care and limited access to treatments and medications."
"It still took months of working as my own care manager and trying to navigate the intricacies of our healthcare system before making any progress with insurance, doctors and other care."
"If I had not taken steps to secure insurance coverage for {an EGD} procedure, I would have been responsible for the cost or would have had to postpone the test."
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Enrollment Information:
Enrollment FAQs
Healthcare coverage helps pay for doctor visits, medicine, and hospital stays. It also helps protect you from big medical bills if you get sick or have an accident.
For Medicare, Marketplace, and employer-sponsored coverage, you can usually sign up during Open Enrollment. However, if you’ve had a big life change, you may qualify for a Special Enrollment Period.
Things like getting married or divorced, having a baby, losing your job, or turning 26 (which means you’re too old to be covered under a parent’s insurance) all count. These changes can give you a chance to sign up outside the regular time.
Yes! Even healthy people can have accidents or get sick. Insurance helps cover the cost one trip to the ER doesn’t turn into a huge bill.
Coverage Information
Coverage FAQs
Think about your budget, how often you go to the doctor, and if you have favorite doctors or hospitals. We can help you compare plans so you can decide which one fits you best.
kynect is a website for people who live in Kentucky to sign up for health insurance plans on the Marketplace or Medicaid. You can compare health plans, apply for coverage, and see if you qualify for cost savings. It’s a one-stop shop for finding the right plan.
It depends on your age, income, job, and health needs. Medicare is for people 65 and older and people who have certain disabilities. Medicaid helps people with lower income. Marketplace plans are for those who do not qualify for government programs, who do not have access to affordable coverage through their employer, or who are self- or non-employed.
No. Depending on your eligibility, coverage is available through your state’s Marketplace (kynect in Kentucky), Medicaid, Medicare, or other programs—even if you don’t have a job or your job doesn’t offer insurance. However, it’s important to know what the qualifications are, as they may vary based on age, income, and other factors.
Medicare & Medicaid Information:
Medicare & Medicaid FAQs
Medicaid provides a broad range of health care services to eligible individuals and families, with a mix of federally required and state-specific benefits. Coverage details may vary by state, but most Medicaid programs include inpatient and outpatient hospital services, preventative care, doctor visits, lab tests and X-rays, nursing facility care, home health care services, family planning and birth control, certified nurse midwife services, transportation to and from medical appointments, and tobacco cessation counseling for pregnant women.
For the most accurate information, check with your state’s Medicaid office or website.
Yes, individuals who qualify for both programs are known as “dual eligible.” Medicare typically covers medical services, while Medicaid may help with premiums, co-payments, and services not covered by Medicare, such as long-term care.
Medicare Open Enrollment runs from October 15th to December 7th. During this time, you can change from Medicare Advantage to Traditional Medicare or from Traditional Medicare to Medicare Advantage, join, change, or discontinue Medicare Advantage plans, or change Medicare Part D drug plans (under Traditional Medicare only).
Medicare Advantage Open Enrollment is January 1st through March 31st. During this time, you can change from one Medicare Advantage plan to another Medicare Advantage plan (with or without drug coverage) or discontinue Medicare Advantage to return to Traditional Medicare. You cannot change from Traditional Medicare to Medicare Advantage during Medicare Advantage Open Enrollment unless you are within the first three months of Medicare eligibility.
Traditional Medicare has three components: A (hospital, skilled nursing care), B (outpatient services), and D (drug coverage). Medicare Advantage (also known as Medicare Part C) is offered by private insurers and includes the services covered under Medicare Parts A and B, frequently includes drug coverage, and may also include additional benefits, such as vision, dental, hearing services or products not covered under Traditional Medicare.
Yes, during specific enrollment periods. The Annual Election Period (October 15th to December 7th) allows you to switch from Traditional Medicare to Medicare Advantage or from Medicare Advantage to Traditional Medicare. Additionally, during the Medicare Advantage Open Enrollment Period (January 1st to March 31st) you can switch from Medicare Advantage to Traditional Medicare or switch from one Medicare Advantage plan to another.
Insurance Terms
Insurance Terms FAQs
A deductible is the amount you pay before your insurance starts helping to pay for anything other than preventive care. For example, if your deductible is $1,000, you will generally pay that much of the allowed costs for non-preventive covered services, then your plan kicks in.
A co-pay is a set amount you pay each time you get care, such as $25 for a doctor’s visit. Co-insurance is a percentage you pay; for example, your plan may require that you pay 20% of the allowed charges.
They use a lot of codes and confusing terms. We can help you de-code what the charges mean and how to spot billing or insurance errors.
No. Depending on your eligibility, coverage is available through your state’s Marketplace (kynect in Kentucky), Medicaid, Medicare, or other programs—even if you don’t have a job or your job doesn’t offer insurance. However, it’s important to know what the qualifications are, as they may vary based on age, income, and other factors.
Make sure you understand the charges. Check both the bill and the explanation of benefits document from your insurance company for mistakes. Ask your doctor or insurance company to explain anything that you don’t understand or that doesn’t seem quite right. Our online information can help you know what to look for.
You can save money by using in-network providers, asking for cost estimates before receiving care, and reviewing your bills for errors. If the providers you want, or need, to see are out-of-network or you are uninsured, you may be able to negotiate a discount from the provider. Using programs such as FSAs or HSAs can also help with out-of-pocket costs.
Not usually. Insurance helps with costs, but you may still have to pay things like co-pays, deductibles, or co-insurance until you’ve met your out-of-pocket maximum. Also, insurance doesn’t pay for things the insurer classifies as uncovered services.
Still have questions?
Our resources are designed to help you make sense of your healthcare options, no matter where you’re starting from. We also want to hear about your experiences and stories. Not only can this help TAI’s mission to make healthcare more affordable, accessible, and equitable, but it can also help others who may be experiencing similar situations.