Trying to understand health care coverage can feel overwhelming, but knowing your options is important for your health and your money. The Asclepius Initiative offers resources to help you better understand the basics of health care coverage so you can make informed choices.
Why Health Care Coverage Matters
Health care coverage acts like a safety net. It makes medical care more affordable and helps people get care when they need it. Without coverage, people are less likely to see a doctor for check-ups, which can lead to health problems being found too late. Not having adequate coverage can also bring big medical bills that cause debt or even bankruptcy.
Understanding Your Coverage Options
Your situation – like your age, income, or job – affects what kind of coverage you can get:
- Medicaid: Health coverage for people and families with low incomes.
- Medicare: For people 65 and older or younger people with certain disabilities.
Tip: Medicaid is based on income. Medicare is based on age or disability.
- Marketplace Plans: For people who don’t have affordable coverage through work and don’t qualify for other programs, such as Medicaid or Medicare. In Kentucky, the Marketplace is called kynect. Many people can get discounts to lower the cost, but unless Congress acts, some of those savings may end after 2025.
- Employer-Provided Coverage: Many jobs offer health care coverage. Employers usually pay most of the monthly premium cost. Some plans also allow you to use HSAs, FSAs, or HRAs. These accounts help pay for health care using money that you don’t pay taxes on.
Comparing plans, understanding terms, and knowing ways to save money will help you choose what works best for you. The Asclepius Initiative can help explain confusing terms and give you tools and materials to make the process easier.
Key Terms to Know
Learning a few common coverage words can help you avoid surprises:
- Premium: The amount you pay each month for your coverage plan.
- Deductible: What you pay out-of-pocket before coverage starts paying most costs.
- Co-payment (copay): A set amount you pay for a service, like a doctor’s visit.
- Co-insurance: A percentage of the allowable cost you pay for certain services.
- Out-of-pocket maximum: The most you’ll pay in a year for covered care. After this, your plan covers 100%.
Check out our glossary for more health care coverage terms explained.
Enrollment Periods
When you can sign up matters:
- Open Enrollment Period: The main time to sign up or change your coverage.
- Marketplace Open Enrollment: Usually November 1 to January 15. Starting in fall 2026 for the 2027 plan year, it will be shortened to 45 days, running from November 1 to December 15.
- Medicare Open Enrollment: October 15 to December 7. During this time, you can switch between Traditional Medicare and Medicare Advantage.
- Medicare Advantage Open Enrollment: January 1 to March 31. You can change Advantage plans or return to Traditional Medicare. You CANNOT switch from Traditional Medicare to Medicare Advantage
- Medicaid: You can sign up anytime.
- Employer Plans: Dates vary, but usually toward the end of the calendar year.
- Special Enrollment Period: If big life changes happen – like getting married, having a baby, or losing a job – you may get extra time to sign up.
Missing enrollment windows can mean waiting months for coverage, so knowing the dates is important.
Taking the Next Step
Choosing a health care coverage plan means thinking about your health needs, your budget, and the choices available to you. The Asclepius Initiative has tools and resources to guide you through the process. When you understand your options, you can find coverage that better protects both your health and your finances.