Before you start

Kentucky residence
Income information for subsidy or Medicaid eligibility
An SSN or ITIN for marketplace applications
A qualifying life event, if enrolling outside the annual window

Step-by-step

1
Enrol in your employer's plan within the new-hire window
Typically 30 days from your start date. Compare the deductible and out-of-pocket maximum rather than the premium alone — the university and the hospital systems generally offer the strongest plans in the city.
Via employerWho: YouFirst 30 days of employment
2
Without an employer plan, use kynect
Kentucky runs its own exchange rather than HealthCare.gov, so the federal site will not enrol you. kynect handles marketplace plans, subsidies and the Medicaid application in one place, which is unusual and genuinely simpler.
OnlineWho: You
3
Check Kentucky Medicaid eligibility first
Kentucky expanded Medicaid, covering adults up to 138% of the federal poverty level with no premium. Newcomers on modest early incomes frequently qualify without realising it, and kynect screens for it automatically.
OnlineWho: You
4
Register with a primary care practice early
Community health centres operate on a sliding fee scale regardless of insurance status, and the HRSA finder lists the ones in Fayette County. Getting onto a list while healthy is far easier than during an episode.
In personWho: You
5
Learn where the trauma centre is before you need it
UK Chandler Hospital is the Level I trauma centre for the region and the referral point for most of eastern Kentucky. Baptist Health Lexington and CHI Saint Joseph cover most other acute care. Knowing which is nearest, and that an emergency department visit is not the cheap option, is worth five minutes now.
In personWho: You
6
Understand the urgent care versus emergency room distinction
An emergency department visit for something a clinic could treat can run to thousands of dollars even when insured. Urgent care handles fractures, stitches and infections far more cheaply, and Lexington has them across the ring roads.
In personWho: You

Documents you’ll need

Proof of Kentucky residence
Income documentation for subsidies or Medicaid
SSN or ITIN
Immigration documents for marketplace eligibility categories
Evidence of losing prior coverage, if using a special enrolment period

Things most newcomers don’t know

Do not go to HealthCare.gov.

Kentucky is a state-based marketplace and runs kynect instead. The federal site will not enrol you, and kynect uniquely combines marketplace plans, subsidies and the Medicaid application into a single screening, so you find out which one you qualify for without applying twice.

Source: kynect — Kentucky's health coverage marketplace

Kentucky expanded Medicaid, and that is not true of its neighbours.

Coverage runs to 138% of the federal poverty level with no premium, so there is no coverage gap for low earners. Tennessee, immediately south, did not expand. For a newcomer starting on a modest income, or between jobs, that is one of the more consequential state-line differences in this part of the country.

Source: Kentucky Cabinet for Health and Family Services — Department for Medicaid Services

The specialist depth here is disproportionate to the city's size.

UK Chandler is the Level I trauma centre and the academic referral hospital for most of eastern Kentucky, with tertiary services a city of this size would not otherwise sustain. If you have a condition needing subspecialty care, Lexington punches far above its population — which is not true of most similarly priced US cities.

Source: community-reported

Your employer's plan may be the reason to choose the employer.

In a city where the university and two hospital systems are the largest employers, benefit packages vary far more between them than salaries do. Compare the deductible, the out-of-pocket maximum and the network before comparing the offer.

Source: community-reported