All states will be working for the next two years to bring their insurance policies in line with the requirements of the 2010 Patient Protection and Affordable Care Act, the federal law enacting national health care reform. Significant initial changes affect children, who can no longer be excluded from coverage due to pre-existing condition, and can remain on their parents’ health insurance up to age 26. (This is regardless of educational or marital status.)
Immediately after the passage of the law, high risk pools were formed in most states to allow people with pre-existing conditions to have access to coverage until January 2014 when the planned health insurance exchanges will go into effect.
General Insurance Regulations
Under a group plan in Kentucky, an individual cannot be denied or limited coverage due to health status or age, and most insurance policies have a guaranteed renewability clause. As long as the premiums have been paid, the coverage cannot be canceled.
Private insurers are required by law to cover certain medical services including mammograms, diabetic care, coverage for pregnant women, and hearing aids for children. There are also coverage limits and maximums for mental health conditions.
Health Care Exchange
No significant progress has been made in Kentucky toward establishing a health insurance exchange, and the state continues to study its options. In all likelihood, though, Kentucky will not meet the January 1, 2014 federal deadline for implementation of a functional exchange. If the deadline is missed, the U.S. Department of Health and Human Services will assume responsibility for the project.
Pre-Existing Condition Insurance
The Kentucky Pre-Existing Condition Insurance Plan program is run by the U.S. Department of Health and Human Services, and includes primary and specialty care benefits, hospitalization, and prescription drug coverage. Depending on age and option chosen, premiums range from $98 to $424. Deductibles run from $1000 to $3000, and some plans have separate drug deductibles. The maximum out-of-pocket expenses in and out of the network cannot exceed $7,000.
Medicaid
Medicaid eligibility is figured on the basis of a percentage of the Federal Poverty Level, as are Children’s CHIP-funded Medicaid Expansions. In Kentucky, infants under 1 year of age qualify at 185% FPL, while those age 1 to 5 are eligible at 133% FLP for Medicaid and 150% for CHIP. In the 6 to 19 age bracket the percentages are 100 and 150% respectively.
Pregnant women qualify for medicare at 185% FLP, parents at 25%, and disabled Social Security recipients at 74%.
The Kentucky Children’s Health Program (KCHIP) serves the needs of uninsured low-income children under 19 who do not qualify for Medicaid. Women are protected with free breast and cervical cancer screenings through the Kentucky Women’s Cancer Screening Program. Low-income women who have been diagnosed with cancers can draw full coverage from the Breast and Cervical Cancer Treatment program.
Medicare
Approximately 17 percent of the total population of Kentucky draws Medicare benefits, with 730,000 accessing prescription drug coverage. More than $6,800 is spent per enrollee in the state each year.
