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Choosing health care coverage is an important decision, and the options are not always straightforward. Plans can differ in cost, coverage, provider access, and rules for receiving care, and those differences can affect both access to services and total spending over time.
Reviewing available options and considering expected needs can help identify a plan that best meets an individual or family’s medical and financial needs.
Coverage Options and Household Needs
The first step is to determine what types of coverage are available. An individual may qualify for Medicaid, Medicare, coverage for military members or veterans, or employer-sponsored coverage. Some people have multiple options, while others may have only one.
For those without access to other coverage, the Affordable Care Act created the Health Insurance Marketplace. In Kentucky, the Marketplace is known as kynect.
It is important to consider who in the household needs coverage. This may be only one person or include multiple family members, such as a spouse or dependent children.
When deciding on coverage, the household’s health needs should be reviewed. The likelihood of needing medical care during the year can affect total costs. Chronic conditions, regular medications, or new symptoms that may require evaluation or treatment can all influence plan selection.
Another factor to consider is whether care may be needed outside of the area where household members live.
Costs, Benefits, and Plan Details
For most people, thinking about plan costs is essential. This includes premiums, copays, deductibles, coinsurance, and out-of-pocket maximums. Together, these costs will make up the total annual spending.
Provider networks are another key factor. Some plans limit which doctors, hospitals, and clinics are covered. Health Maintenance Organizations (HMOs) generally have more limited networks, while Preferred Provider Organizations (PPOs) often offer broader access.
Plans that include out-of-network benefits are usually more expensive, while plans without out-of-network coverage generally do not pay for non-emergency care delivered by out-of-network providers
It is also important to determine whether particular plans have attached cost-saving programs. These opportunities to use untaxed income or benefits to pay for qualified medical expenses include Health Savings Accounts (HSAs), Flexible Spending Accounts (FSAs), and Health Reimbursement Arrangements (HRAs). FSAs and HRAs are only available with coverage through an employer. HSAs must be associated with high-deductible health plans and can be found with certain Marketplace or employer-sponsored insurance plans.
Enrollment and Financial Assistance
For those purchasing coverage through the Marketplace, it is important to check eligibility for subsidies and cost-sharing reductions, which can lower monthly premiums and out-of-pocket costs.
Enrollment is limited to specific time periods. Open Enrollment is the annual window when coverage can be selected, renewed, or changed. Beginning in 2026 for plan year 2027, open enrollment for Marketplace coverage in Kentucky (kynect) runs from November 1st through December 31st, with coverage starting January 1st. Open enrollment ends on December 15th for states that use the federal Marketplace. Missing this period may result in going without coverage until the next enrollment cycle.
For employer-sponsored plans, open enrollment timing varies by employer.
Outside of open enrollment, enrollment or plan changes can only be made by those who qualify for a Special Enrollment Period. These periods are triggered by certain life events, such as losing coverage, moving, getting married, having a child, adopting a child, or experiencing a significant change in income.
Unlike Marketplace coverage, Medicaid and the Kentucky Children’s Health Insurance Program (KCHIP) allow enrollment year-round for those who qualify.
Making a Choice
Selecting health care coverage involves reviewing available options, considering household health needs, comparing plan details, and being mindful of enrollment deadlines. Taking these steps can help identify coverage that meets a person or family’s medical and financial needs.
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.