KENTUCKY · 120 COUNTIES · 2027 FILINGS · SEPTEMBER 2026
What does employer health coverage cost in Kentucky?
Kentucky marketplace plans cost less per member than group plans. The catch is the network.
Employer group plans asked for 10.7%. No Kentucky county has a PPO or POS plan on the marketplace or off it, so a move to marketplace plans puts every employee on a network-only plan.
Kentucky, by the filings
What did insurers actually file for Kentucky?
Every figure below comes from the filings insurers submitted to regulators. 2027 numbers are requested, not approved. Approvals land in October.
| Kentucky | Figure | What it tells you |
|---|---|---|
| 2027 requested change, marketplace plans | +20.7% +16.9% to +21.2% across 3 insurers | 8th steepest in the country. The national median is 15.3%. |
| 2027 requested change, employer group plans | +10.7% +10.6% to +10.8% across 3 insurers | Group asked for 10.0 points less than marketplace here. |
| 2026 approved change | +23.8% marketplace +13.3% group | Compounded with 2027, that's roughly 25% to 49% on top of 2025. |
| Lowest cost silver plan, age 40, typical county | $609 per month $521 to $740 across counties | The number a CHOICE Arrangement contribution has to cover to pass the IRS affordability test. |
| Counties with a PPO or POS plan filed | 0 of 120 | Out-of-network coverage is not purchasable anywhere in Kentucky on the marketplace. Nothing is filed off the marketplace either. |
| Typical county, lowest cost silver by plan type | $609 HMO · no PPO | There is no PPO price to compare, because no insurer files one. |
| Marketplace vs group cost per member per month, 2026 | $823 marketplace $1,103 group | Marketplace plans cost less per member here. Kentucky is one of 22 states where that's true. |
| Insurers competing per county | 1 to 3 | At least one Kentucky county has a single insurer, so there's no competition on price there. |
| Out-of-network plans sold off the marketplace | none filed | No insurer sells an out-of-network plan off the marketplace in Kentucky either, so this route is closed here. |
What it means for a Kentucky employer
Your renewal is going to be ugly. What are you allowed to change about it?
A 20.7% request on top of 23.8% approved last year is the kind of number that ends up as a benefit cut or a cost shift onto staff. Neither is the only option.
The Kentucky-specific read: marketplace plans cost less per member per month than group plans here, which makes a CHOICE Arrangement look obvious on a spreadsheet. Then the network answer lands. No Kentucky county has a PPO or POS plan on the marketplace, so every employee moves to a network-only plan. Kentucky is one of 11 states with nothing filed on or off the marketplace, so that trade can't be bought around.
Where the money actually is at these rates: not the plan type, the design changes inside it. Sourcing 2,000+ medications at a $0 copay for the whole household. Unlimited virtual primary and behavioral care so a $0 visit replaces an urgent care trip. A supplemental layer that pays the employer back every pay period instead of adding a line item.
Those have landed at $2,000+ per employee per year in real client projects, with about $988 per employee per year in new cashflow on top of that and independent of it. About $100K per year for every 50 people. $0 upfront, billed out of savings, live in 30 to 45 days. Same broker, same doctors, same cards.
Compare the 12 plan designs · All 50 states and DC · PPO availability by county · Benchmark your cost
If your Kentucky renewal came back flat instead of 20.7%, what would you put the difference into first?
Results vary by group size, plan design, and utilization.
Sounds concerning? You have options.
Nothing on or off the marketplace in Kentucky. So what's actually left?
No insurer sells out-of-network coverage in Kentucky on the individual market at all. That closes one route. It doesn't close the group side, where most of the money is anyway.
Here's the part that isn't anyone's fault. The systems that surface plan options only surface what's already inside them. The marketplace shows you what insurers filed for the marketplace. Your broker shows you the markets their appointments reach. Both are doing their job. Neither one can show you what sits outside it.
99% of the brokers we talk to have never had visibility to our programs. They sit outside their commissioned channels.
| What you run today | What changes | Range observed |
|---|---|---|
| Fully insured, mid-market | Level-funded, shelf-rated, or a partially self-funded design, so a good claims year comes back to you instead of staying with the carrier. | 15 to 25% of plan cost |
| Already self-funded | Stop-loss restructured, a captive layer, and claims priced off a defensible benchmark instead of a billed charge. | 20 to 30% of plan cost |
| Any plan, any funding | Layers that sit on top of what you already run. 2,000+ medications at $0 to the whole household. Unlimited virtual primary and behavioral care. A supplemental layer that pays the employer back every pay period. | $2,000+ per employee per year plus up to about $988 per employee per year in new cashflow about $100K per year for every 50 people |
| A group plan you can't move yet | A GCHRA or EBHRA running alongside it, so people buy what they actually need with pretax dollars without touching the plan itself. | No audited range published. Depends entirely on take-up. We won't print a number we haven't measured. |
| Ready to leave the group plan | A CHOICE Arrangement. Defined contribution instead of a defined plan. Your cost becomes a number you set rather than a renewal you receive. | Priced per census. Whether it beats your group plan depends on the county mix in your census, not the state average. |
Why the ranges are keyed to what you run today and not to a product name: that's how they were measured. Every range above comes from completed client projects, grouped by the employer's starting point. We don't publish a savings percentage next to "level-funding" or "captive" as a category, because nobody measured a category. If you see a number like that anywhere, ask what it was measured on.
$0 upfront. Billed out of savings. Live in 30 to 45 days. Same broker, same doctors, same cards. First-year ROI has landed at 10 to 16x across completed projects.
Compare all 12 plan designs · Benchmark your own cost · Get it priced on your census
If one of these came back at the low end of its range for your Kentucky group, which line in your budget would you want it to pay for first?
Ranges are what we have observed across completed engagements. They are not a guarantee, not a quote, and not an offer of coverage. Your result depends on group size, plan design, census, and utilization.
Where these Kentucky numbers come from
Rate changes are the midpoint of what each insurer requested in Kentucky, from the CMS rate review service, pulled September 17, 2026. 2027 figures are proposed and still under review; regulators can trim them before approvals land in October. County premiums are the lowest cost plan per metal level for a 40-year-old non-smoker before any subsidy, from the CMS marketplace plan and rate files for plan year 2026, covering all 120 Kentucky counties.
The marketplace versus group cost comparison uses the 2026 average premium per member per month from the insurers own filings on both sides, weighted by enrollment. It is an average across each plan's enrolled mix, not a same-metal, same-plan-type quote. Plan-type availability counts every marketplace plan filed in every Kentucky county and asks whether any of them is a PPO or POS, because the split that matters is whether a doctor outside the network is covered at all. Off-marketplace plans are counted separately, at state level, from the insurers' 2026 rate filings.
Nothing here is a quote.
