Health Insurance Marketplace in Kansas
Choosing the Right Health Insurance Plan
There are 5 categories of Marketplace insurance plans: Bronze, Silver, Gold, Platinum, and Catastrophic.
Plans range from bare bones “bronze” plans which cover 60% of pocket medical costs to “platinum” plans which have greater coverage but come with higher premiums. In general higher premiums mean lower out-of-pocket costs and a wider insurer network of doctors and hospitals.The plans are as listed below:
NOTE: All cost sharing is of out of pocket costs. Please see ObamaCare health benefits for services that are covered at no out of pocket charge on all plans. The maximum out-of-pocket costs for any Marketplace plan for 2014 are $6,350 for an individual plan and $12,700 for a family plan.
Bronze Plan: The bronze plan is the lowest cost plan available. It has the lowest premiums and in exchange has the lowest actuarial value. The actuarial value of a bronze plan is 60%. This means that 60% of medical costs are paid for by the insurance company, leaving the other 40% to be paid by you.
Silver Plan: The Silver plan is the second lowest cost plan, it has an actuarial value of 70%. This means that 70% of medical costs are paid for by the insurance company, leaving the other 30% to be paid by you. The Silver plan is the standard choice for most reasonably healthy families who historically use medical services.
Gold Plan: The Gold plan is the second most expensive plan, it has an actuarial value of 80%. This means that 80% of medical costs are paid for by the insurance company, leaving the other 20% to be paid by you.
Platinum Plan: The Platinum plan is the plan with the highest premiums offered on the insurance exchange. The Platinum plan as an actuarial value of 90%. This means that 90% of medical costs are paid for by the insurance company, leaving the other 10% to be paid by you. This plan is suggested to those with high incomes and those in poor health. Although coverage is more expensive up front the 90% coverage of costs will help those who use medical services frequently.
Catastrophic plans – which have very high deductibles and essentially provide protection from worst-case scenarios, like a serious accident or extended illness — are available to people under 30 years old and to people who have hardship exemptions from the fee that most people without health coverage must pay.
Kansas has not chosen to expand its Medicaid program at this time. Read “What if my state isn’t expanding Medicaid?” to learn more. You can find out whether you qualify for Medicaid under Kansas’ current rules 2 ways: Contact your state Medicaid agency right now or fill out an application for coverage in the Health Insurance Marketplace.
Who can help you (the Navigators)
For nearly 14 years, Advanced Patient Advocacy has partnered with health care providers and state and local governments in 21 states to provide services to communities to help educate and enroll uninsured consumers. Advanced Patient Advocacy will work with medical centers to identify uninsured individuals and provide education and assistance to help them make informed decisions about enrollment in the Marketplaces.
Ascension Health is the nation’s largest Catholic and nonprofit health system. The Ascension Health Navigator project will assist consumers (individuals and small employers) in understanding new programs, taking advantage of consumer protections, and navigating the health insurance system to find the most affordable coverage that meets their needs.
The Kansas Association for the Medically Underserved (KAMU) will serve as the lead agency and grantee for the Kansas Marketplace Consortium, a coalition of 427 safety net clinic, health department, hospital, Community Mental Health Center and Area Agency on Aging locations. The Consortium will provide assistance to at least 48,000 eligible Kansans statewide.
Who you can contact for more help
If you need more detailed analysis, identification of issues, solutions, and implementation of your health insurance plan please let us know with the form below and we’ll get right back to you.
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Accountable Care Organizations in Kansas
ACOs are profit-driven health innovators primarily serving Medicare patients who are financially rewarded by the government and private insurance companies for delivering medical services that lead to better health outcomes for less money.
- TransforMED KS – Health Care Innovation Award
- University Of North Texas Health Science Center KS – Health Care Innovation Award
Health care facilities where Innovation Models are being tested
- Midwest Orthopaedics Shawnee Mission, KS – BPCI Initiative: Model 2
- Kansas City Bone & Joint and Carondelet Orthopaedic Surgeons Overland Park, KS – BPCI Initiative: Model 2
- St. Francis Health Center Topeka, KS – BCPI Initiative: Model 4
- Brewster Place Topeka, KS – Community-based Care Transition Program
- GraceMed Health Clinic, Inc. Wichita, KS – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Konza Prairie Community Health Center Junction City, KS – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
What has been done, not been done, or left up to the federal government to do.
Establishing the Exchange in Kansas
After placing health insurance exchange planning on hold until after the November elections, Governor Sam Brownback (R) announced on November 9, 2012, Kansas would default to a federally-facilitated exchange.1,2
With the initial endorsement of the Governor in 2011, Kansas Insurance Commissioner Sandy Praeger, had established eight exchange planning work groups comprised of hundreds of volunteers across civic groups, government agencies, and the insurance and health care industries. The work groups met regularly from the spring of 2011. The work groups reported to the Health Benefit Exchange Steering Committee, housed within the Insurance Department. Work group reports adopted by the Steering Committee include recommendations regarding oversight of navigators, limiting the number of insurance carriers in the exchange, the role of agents and brokers, the number of exchanges the state should have, and a consumer outreach and education plan.3
In May 2011, Governor Brownback signed into law a measure prohibiting health plans operating within a Kansas exchange from offering abortion services unless the pregnant woman’s life is in danger (HB 2075).4 The purchase of optional riders for abortion coverage in these plans is not allowed.
Contracting with Plans: On February 15, 2013, Commissioner Praeger sent a letter to the Center for Consumer Information and Insurance Oversight (CCIIO) requesting to maintain control over plan management functions despite not having entered into a state-federal partnership exchange. The Kansas Insurance Department (KID) intends to utilize the System for Electronic Rate and Form Filing (SERFF) to review health plan rates, covered benefits, and cost-sharing requirements for purposes of certifying qualified health plans (QHPs). KID will also manage consumer complaints, ensure continued plan compliance, and oversee decertification of issuers. Commissioner Praeger attested that Kansas has the legal authority to conduct plan management functions necessary to support certification of QHPs, as required by the Affordable Care Act.5
Essential Health Benefits (EHB): The Affordable Care Act requires that all individual and small-group plans sold in a state, including those offered through the Exchange, cover certain defined health benefits. States must decide whether to benchmark their EHB plan to one of ten plans operating in the state or default to the largest small-group plan in the state. In October 2012, the Insurance Department submitted an EHB benchmark plan recommendation to the Governor of Blue Cross Blue Shield of Kansas Comprehensive Plan.6
In September 2010, the Kansas Insurance Department received a $1 million federal Exchange Planning grant. The Department also received a $31.5 million federal Early Innovator grant to develop an exchange information technology infrastructure that could be replicated by other states. The state planned to extend the new Kansas Medicaid/Children’s Health Insurance Program eligibility system to provide eligibility and enrollment services for an exchange.7 However, on August 9, 2011, the Governor announced the state would return all Early Innovator grant funding.8
Expansion of Medicaid
From 2014 to 2017, the federal government will pay for 100% of the difference between a state’s current Medicaid eligibility level and the ACA minimum. Federal contributions to the expansion will drop to 95% in 2017 and remain at 90% after 2020, according to the ACA.
As the ACA was originally written, states would lose all Medicaid funding if they refused to expand their program to the ACA minimum.
However, the Supreme Court in June 2012 ruled that the federal government could not withhold Medicaid funding for states that chose not to expand their programs. The decision effectively allowed state officials to opt out of the expansion, and some have said they will do just that.
Kansas is not participating in Medicaid expansion.
On March 8, 2013, Kansas received approval from CCIIO to perform plan management activities. The federal government will retain control over all other Exchange functions.9
For additional information on the Kansas health insurance exchange visit:http://www.ksinsurance.org/consumers/healthreform/aca.htm
1. Wistrom, Brent. “Brownback: Kansas won’t partner with federal government on health insurance exchange.” November 8, 2012. The Wichita Eagle. http://www.kansas.com/2012/11/08/2561344/brownback-kansas-wont-partner.html
2. Twiddy, David. “Health reform ruling divides Brownback, insurance agency on Exchanges.” Kansas City Business Journal. July 6, 2012. http://www.bizjournals.com/kansascity/print-edition/2012/07/06/health-reform-ruling-divides.html?page=all
3. Reference Materials for the 2011 Special Legislative Committee on Financial Institutions and Insurance. November 14, 2011 Testimony and October 24, 2011 Testimonyhttp://www.ksinsurance.org/hbexplan/instandinsurance10242011.php (Accessed January 25, 2012)
4. House Bill 2075. Approved by the Governor May 25, 2011. http://www.kslegislature.org/li/b2011_12/year1/measures/documents/hb2075_enrolled.pdf
5. Letter from Commissioner Praeger to Gary Cohen. February 15, 2013. http://cciio.cms.gov/Archive/Technical-Implementation-Letters/ks-exchange-letter-2-15-2013.pdf
6. Kansas Insurance Department. Letter from Sandy Praeger Insurance Commissioner to Governor Sam Brownback. September 24, 2012. http://www.statereforum.org/sites/default/files/lt_governor_re_ehb_analysis_09-24-2012.pdf
7HealthCare.gov. “States Leading the Way on Implementation: HHS Awards “Early Innovator” Grants to Seven States.” http://www.healthcare.gov/news/factsheets/exchanges02162011a.html (Accessed August 18, 2011)
8. Millman, J. and Nocera, K. “Kansas returns $31.5M exchange grant.” Politico. August 9, 2011. http://www.politico.com/news/stories/0811/60967.html
9. Letter from Gary Cohen to Commissioner Praeger. March 8. 2013. http://cciio.cms.gov/Archive/Technical-Implementation-Letters/ks-pm-letter-3-8-2013.pdf
Also of interest
Provided by the Henry J. Kaiser Family Foundation