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The Affordable Care Act (ACA) changed the way many people receive and use health care coverage. It created the Health Insurance Marketplace, which expanded access to insurance, introduced financial assistance for those who qualify, and created a more standardized approach to benefits across plans.
Marketplace coverage 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.
Review Marketplace Coverage Each Year
Marketplace plans can change from year to year. If a plan is no longer available, the Marketplace may show a suggested replacement plan in the renewal notice. That suggested plan is usually based on technical details, such as how much the plan is expected to cover overall. It is not based on each person’s or family’s particular needs, such as doctors, medications, health needs, or budget.
Plans that are presented as “similar” may not actually meet individual needs in the same way. The new plan may have a different provider network, which means doctors, hospitals, or pharmacies may no longer be covered the same way. Premiums, deductibles, copays, coinsurance, and out-of-pocket costs may also be higher. In some cases, a plan in a different tier may offer more generous savings, such as cost-sharing reductions, which are only available with Silver-tier options.
This is why it is important to review Marketplace choices during every open enrollment period. The Asclepius Initiative has created a free, downloadable spreadsheet and step-by-step instructions to help compare costs side by side.
If no action is taken during open enrollment, a person may be automatically enrolled in the suggested plan. In some situations, coverage may end if renewal steps are not completed. The best time to review options, compare plans, and make changes is before open enrollment ends.
Watch for Marketplace Scams and Deceptive Marketing
Open enrollment can be stressful, especially when premiums and other costs are rising. Scammers and deceptive agents may try to use that stress to collect personal information, sell plans that do not offer full coverage, are not Marketplace plans, or charge fees for help that should be free.
Some scams look or sound official. A caller, email, text message, or website may use words like “Health Insurance Marketplace,” “renewal,” “final notice,” or “discounted plan.” The goal is often to make someone act quickly before checking whether the message is real.
Marketplace enrollment help through kynect in Kentucky is free. Be careful if someone asks for a consultation fee, payment over the phone, gift cards, cryptocurrency, or other unusual forms of payment. Marketplace programs will not threaten people or demand payment to keep or qualify for health coverage. Healthcare.gov also warns individuals not to share personal information with anyone they did not contact directly. This includes Social Security numbers, banking information, credit card numbers, or health information.
Phone Calls That Ask for Personal Information
One common scam is a phone call that sounds official. The caller may say they are from the Marketplace and claim that a renewal is “stuck,” “incomplete,” or about to be canceled. They may ask for a Social Security number, credit card number, or payment to keep coverage active.
If a call comes unexpectedly and asks for sensitive information or money, hang up. Then go directly to Healthcare.gov or the state’s official Marketplace, contact a trusted navigator or enrollment assister, or call the Health Insurance Marketplace Call Center at 1-800-318-2596. Do not use a phone number provided by the suspicious caller.
Fake Websites, Emails, and Text Messages
Some deceptive websites are designed to look like real Marketplace or kynect pages. They may use similar colors, logos, fonts, or page layouts. Emails and text messages may also look official and ask people to “verify” an account or “finish” a renewal by clicking a link.
Before entering personal information, check the website address carefully. Kentucky residents should use kynect.ky.gov for Marketplace coverage. Many official Marketplace websites end in .gov, but when there is any doubt, it is safest to type the address directly into the browser or start from a trusted government website. Be cautious of misspelled words, strange sender addresses, links that do not match the official website, or messages that create pressure to act right away.
Pressure Tactics During Open Enrollment
Scammers often use urgency to make people panic. They may say things like “your plan expires at midnight,” “this is your final notice,” or “you must pay now to avoid losing coverage.” These messages are designed to make people respond before they have time to check the facts.
A real renewal deadline is important, but legitimate Marketplace information should not require payment through gift cards, cryptocurrency, wire transfers, or other unusual methods. If a message feels high-pressure, confusing, or threatening, stop before sharing information. Close the browser, delete the message, or hang up the phone. Then go directly to Healthcare.gov or the state’s official Marketplace website or contact trusted enrollment help.
Marketplace consumer fraud can be reported by calling the Health Insurance Marketplace Call Center at 1-800-318-2596. Healthcare.gov lists this number for Marketplace questions and fraud concerns.
A Note for People with Medicare
Medicare beneficiaries do not get coverage through the Marketplace. If someone has Medicare, they should be careful of anyone trying to sell them a Marketplace plan. Questions about Medicare should be handled through Medicare, a trusted SHIP counselor, or another reliable Medicare resource.
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.
For a more in-depth look at Marketplace coverage, click here to watch our webinar.
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.