Healthcare Reform: What Insurance Agents Say


Anyone who's tried to wind their way through kynect.ky.gov, knows how daunting it can be. But if you think it's hard for us, try being the insurance agent who has to explain it.

Auston McCay says some insurance agents aren't even selling the Affordable Care Act policies. "Quite a few of the agents are gonna say there's so much hassle to it," says McCay, "just like with the Medicare D, they don't want to spend the time it takes to get the so-called 'certifications,' to spend the time doing the studies to offer the different plans that are available."

But every agent we talked to who is selling them, said the same thing. Get an agent to help you. It won't cost you any more. "I'd recommend talking to a licensed agent," says agent Alex Rios, "and letting someone hold your hand through the process because it is complicated."

In Kentucky, kynect.ky.gov is the website serving as the marketplace to purchase your health insurance if you don't have any.

Susan Dunlap with Kentucky Health Cooperatve says, "Think of it as if you choose an airline ticket. And you choose the city and your departure place, and time and date, and which carrier and how much you want to pay. The concept will be very much like that."

And what will it cost? Well, in Kentucky, that depends.

Mallory Pendleton with Insurance Specialists says, "The premiums vary on a couple of factors. First it's where you live, your age, and if you use tobacco or not. And then, of course, depending on your income you may or may not qualify for a subsidy in the marketplace. And she says, "Overall premiums are going up some, due to the new regulations and expanded coverage."

But if you currently don't have health insurance, you may qualify for financial assistance.

"Anybody that is single in the commonwealth of Kentucky," says Marcus Woodward with the Kentucky Health Benefits Exchange Advisory Board, "making less than $45,000 a year, can get some assistance. At the higher level, at 40-some thousand, the assistance is very small, but at the bottom limit which is about $19,000 it's very high, like 90%."

And Woodward says if you make less than $15,800 a year, you may qualify for Medicaid and pay no premium and no deductible.

A new regulation in the Affordable Care Act is the requirement for individuals and companies with fewer than 50 employees to cover ten essential health benefits, including hospitalization, pediatric care, and prescriptions. Another regulation says no one can be denied medical treatment for a preexisting condition.

If you do call or log on to Kynect Kentucky and you live in Warren County, you will have two companies from which to select your coverage, either Anthem Blue Cross/Blue Shield or Kentucky Health Cooperative.

Agents say to be sure you find out if your doctor is in the network of whichever company you choose, otherwise you may wind up paying more for out-of-network treatment. But overall agents say, have someone help you.

Agents tell me the more money you make, the higher your premium will probably be.

If you should decide not to purchase health insurance for 2014, you will have to pay a penalty of either $95 per adult or 1% of your annual income, whichever is higher. In 2015, it goes up to $325 or 2% of your annual income, and in 2016, it rises to $695 or 2-1/2% of your annual income. And, of course, you would also have to pay for whatever treatment you needed if you did become sick or injured.

To learn more about Kentucky's health exchange marketplace, call the phone numbers or click on the links below.

Kentucky Health Insurance Advisors 888-788-7575
Insurance Specialists 855-293-4111
Kentucky Health Cooperative 1-877-334-1726
Kynect Kentucky 1-855-4kynect (459-6328)


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