UPDATE, JANUARY 2015:
Whether you're on Medicaid or an insurance plan you purchased through Kynect, the Affordable Care Act makes all FDA-approved contraceptives available to you without a co-pay. If you've been charged a co-pay for any contraceptives, you should file a complaint! If you're a Medicaid patient, call Member Services at 1-800-635-2570. If your insurance is through Kynect, call the Kentucky Dept. of Insurance at 1-800-595-6053.
by Clare Gervasi, KHJN volunteer
This little essay is intended to inform you about the Kentucky health exchange, called Kynect (pronounced “connect”), and how we Kentuckians can access health insurance through the system and even find out if we are eligible for Medicaid. Furthermore, this piece includes information about how to get the kinds of reproductive and contraceptive care we need through Kynect and Medicaid. This essay also includes my own reflections on the Affordable Care Act and how it affects individual Kentuckians, especially women, from a first-person perspective.
To begin, here is a little about me and the US health care system: I am a white cis woman in her early 30s. I live in Louisville and am a life-long US citizen. I have a graduate degree and come from an educated, middle class background. I am a birth doula and have long experience dealing with the health care system (especially reproductive health) as an advocate as well as a patient. I have been interacting continuously with Medicaid since 2010, when I became pregnant and subsequently became a mother to a child who has health insurance through Medicaid. I have been interacting with the Kynect Exchange system since March of this year, when I first signed up for health care under the new Affordable Care Act (ACA).
So when I tell you this next part, I want you to understand the full frustration of what I mean: accessing health insurance information through Medicaid, its managed care organizations, and Kynect is like trying to break into Fort Knox. If neither my educational, racial, or class privilege, nor my professional experience, can save me confusion or time or money in navigating our health care exchange and managed care companies, what is required to succeed in getting the information an insurance user needs to be healthy?
As someone who lived most of her 20s without health insurance, except for a brief period when I had insurance through my graduate school program, I was very excited about the passage of the ACA (commonly called Obamacare). The concept of the “health insurance exchange,” the centerpiece of Obama’s legislation, promised essentially a free market shopping experience, and rendered all of us who need health care (read: every living human) “consumers” in a “health care marketplace.” Through this state-run marketplace, called Kynect in Kentucky, we consumers could “shop” for the best health insurance plan for us. Obamacare provided free benefits agents, called “Kynectors,” to help us if we desired professional consultation in making our choice. We were supposed to access this marketplace online or by phone and to shop around as pleasantly as if we were surfing amazon.com or walking through the grocery, comparing prices and contents and making the best selection for ourselves and our families.
Yeah, that all sounds like an improvement over the pre-Obamacare days... But the ease and pleasantness so touted by Governor Beshear and even the Obama administration, as they hold up Kentucky’s state exchange as a model for the nation, have not been my experience as a user or an investigator. If the appeal of state-run exchanges is greater transparency in shopping for options, Kynect and Obamacare have a long way to go. An ideal free market shopping experience includes clear pricing among competitors, so that consumers can make the best decision in their own best interest. It also guarantees privacy and freedom while shopping. I don’t have to tell Amazon my personal information to see how much it costs to order lightbulbs from them, for example. The Kynect exchange and the companies I dealt with in doing this research, Anthem and Humana, were anything but transparent or respectful of privacy. I spent many hours on the phone with both corporations, who refused to tell me almost any concrete, financial information unless I gave them my name, birth date, social security number, and phone number. That is a far cry from the free market.
In sum, although attempting to access information about contraceptive care was a time-consuming, murky, and generally user-unfriendly experience for me, here is a run-down of some of what I did manage to find out for Medicaid users seeking contraceptive care:
Here are some important notes to remember when deciding what care and coverage are best for you:
1. To find out whether or not a drug is covered, you can refer to this formulary, which is occasionally updated. Here is the most recent one as of the date of publication of this chart: http://www.anthem.com/Exchangedruglist4.pdf. You can always find the updated forumlary by clicking on the form “Anthem Select Drug List (4-Tier)” in the forms library on Anthem’s website: https://www.anthem.com/health-insurance/customer-care/forms-library
2. To find out whether or not a drug is covered, you can use this search tool on the Humana website. It will tell you which Tier the drug falls under if it is covered, and will also tell any dispensing limits associated with the drug. Here is the link to the search: http://apps.humana.com/UnsecuredDrugListSearch/Search.aspx
3. With the pill (“oral contraceptives”), there are so many different brand names and generics that these copays may or may not apply to your specific choice of drug. Look up your prescription in the formularies listed above to see if your drugs are covered. If they are listed as “Tier 1” drugs, then the copays listed above are true. If not, they may cost more or not be covered at all.
If you are looking for more information, here are some useful tools:
Friends of KHJN.