Kentucky Access

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Kentucky has a high-risk pool program, called Kentucky Access that offers insurance for people with health conditions who are unable to buy private health insurance coverage and for people who are HIPAA eligible.

When can I get coverage from Kentucky Access?

· If you are HIPAA eligible, you can buy health insurance from Kentucky Access.

To be HIPAA eligible, you must meet certain criteria

No matter where you live in the U.S., if you are HIPAA eligible you are guaranteed the right to buy individual coverage of some kind with no pre-existing condition exclusion periods. In Kentucky, you are guaranteed the right to buy coverage only from Kentucky Access. To be HIPAA eligible, you must meet all of the following:

· You must have had 18 months of continuous creditable coverage, at least the last day of which was under a group health plan.

· You also must have used up any COBRA for which you were eligible.

· You must not be eligible for Medicare, Medicaid, or a group health plan.

· You must not have health insurance. (Note, however, if you know your group coverage is about to end, you can apply for coverage for which you will be HIPAA eligible.)

· You must apply for health insurance for which you are HIPAA eligible within 63 days of losing your prior coverage.

Your eligibility ends when you enroll Kentucky Access or an individual health insurance policy, because the last day of your continuous health coverage must have been in a group plan. You can become HIPAA eligible again by maintaining continuous coverage and rejoining a group health plan.

· If you are not HIPAA eligible, you can buy coverage from Kentucky Access if you are a Kentucky resident for at least 12 months and can demonstrate eligibility in one of the following ways:

o You have been turned down for individual health insurance by an insurer;


o You have been offered individual health insurance that is substantially similar to those offered by Kentucky Access, but it would cost more than Kentucky Access coverage;


o You have been diagnosed with a serious health condition such as multiple sclerosis, some cancers, or AIDS (contact Kentucky Access for a complete listing of qualifying conditions); or


o You are a GAP-qualified individual.

You are not eligible for Kentucky Access coverage if you already have or are eligible for any other health insurance, including individual health insurance, group health plan, Medicaid, or Medicare. Note that you may still be eligible even if you are offered an individual health insurance policy so long as the policy is substantially similar to those offered through Kentucky Access and the rates are higher than what you would pay in Kentucky Access.

· If one person in your family qualifies for Kentucky Access coverage, the other members of your family are eligible for Kentucky Access coverage as long as they are Kentucky residents.

What does Kentucky Access cover?

· Kentucky Access offers three plan options – one fee-for-service (FFS) plan and two preferred provider organization (PPO) plans. Various deductible options are available for some of these plans. The plans cover hospitalization, surgical expenses, doctor visits, preventive care, maternity services, and home health care. Enhanced benefits for prescription drugs and mental health/substance abuse coverage can be added to your package for an additional premium. Plan options are subject to change. Please contact Kentucky Access for more information.

What about coverage for my pre-existing condition?

· If you are HIPAA eligible, you will not have a pre-existing condition exclusion when you enroll in Kentucky Access. Elimination riders are not permitted on Kentucky Access plans.

· If you are not HIPAA eligible, you will have a 12-month pre-existing condition exclusion period when you first enroll in Kentucky Access. When you enroll, Kentucky Access will look back 6 months see if you had a condition for which you actually received medical advice, diagnosis, care or treatment. Kentucky Access will give you credit for prior continuous coverage if your break in coverage is not 63 days or more.

How much can I be charged for Kentucky Access coverage?

· Premiums will vary based on the plan you choose. In addition, Kentucky Access charges enrollees different rates based on their age and gender. For example, a 24-year-old man could pay between $188 and $320 per month, depending on the plan and deductible option he chooses, and a 64-year-old man could pay between $753 and $1,278. An additional monthly premium is required if adding pharmacy benefits and/or mental health/substance abuse coverage. These figures are current as of the writing of this guide. Check with Kentucky Access for the most up-to-date information on premium rates and plan options.

How long does coverage last?

· Kentucky Access policies are renewable as long as you pay your premiums, continue to reside in Kentucky, and meet other eligibility requirements.


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