With most of the Affordable Care Act’s major provisions now in effect, the nation’s health insurance marketplace has undergone a significant transformation. Obamacare impacts individuals, families and small business owners alike. Most Americans are required to have minimum essential coverage unless they qualify for an exemption; however, the law is designed to make health insurance more accessible and affordable with income-based financial assistance and one-stop shopping via state-based and federally facilitated exchanges. Meanwhile, the private marketplace remains a place to shop for quality, affordable health insurance plans that meet ACA requirements.
The following guide offers a glimpse at the various types of ACA-compliant health insurance in Kansas, including individual and family health plans, small group health plans, coverage for high-risk applicants, mini-COBRA continuation coverage, Medicaid, and CHIP.
Health and healthcare in Kansas
Kansas ranked 27th in United Health Foundation’s 2014 America’s Health Rankings.8 Its strengths include a low rate of drug deaths, a high rate of high school graduation, and few poor mental and physical health days per month. Its challenges were listed as a high prevalence of obesity, low per capita public health funding, and low immunization coverage among children and adolescents.
The U.S. Department of Health and Human Services reported that 57,013 individuals in Kansas selected a marketplace plan through the exchange from Oct. 1, 2013, through April 19, 2014.2 In 2015, the number of individuals in Kansas enrolled in a marketplace plan increased to 96,197 during the open enrollment period.3
Kansas individual and family health insurance
Kansas was among the many states that opted for a federally facilitated health insurance exchange, as opposed to running a state-based or partnership exchange. Those who buy health insurance through Kansas’ federally facilitated exchange may be eligible for income-based subsidies, including premium tax credits that may be applied to any metal plan and cost-sharing subsidies that apply to silver plans. Individuals who go without health insurance may face a tax penalty known as the shared responsibility payment.
However, individuals and families living in Kansas may also find ACA-compliant coverage in the private marketplace using websites such as HealthCare.com. Find out if you qualify for a premium tax credit using HealthCare.com’s tax credit subsidy calculator. If you do, visit Kansas’ Health Insurance Marketplace to shop and apply for health insurance.
|Kansas health insurance exchange:||healthcare.gov|
|Kansas department of insurance:||ksinsurance.org|
Kansas small group health insurance plans
Small business owners with 50 or fewer employees may purchase group health insurance plans through Kansas’ federally facilitated Small Business Health Options Program marketplace, as well as in the private marketplace. Small businesses that use SHOP and have 25 or fewer employees may qualify for the Small Business Healthcare Tax Credit.
Self-employed individuals with no employees must apply for an individual health insurance plan on or away from the federally facilitated exchange.
Kansas state COBRA variations for small groups
The Consolidated Omnibus Reconciliation Act (COBRA) allows those employed by businesses with 20 or more employees to continue their group health insurance plan for a limited time should they lose coverage due to qualifying events such as termination of employment due to reasons other than gross misconduct, a reduction in work hours, divorce or legal separation, and loss of dependency status. To learn more about the federal COBRA program, visit dol.gov/ebsa/cobra.html.
In some states, those who work for a small business and lose health insurance coverage due to a qualifying event may be eligible for health insurance continuation through mini-COBRA or a similar state continuation program. In a few states, these programs may also be extended to those who work for larger companies and exhaust their federal COBRA continuation coverage limit. Mini-COBRA generally works like the federal COBRA continuation coverage, but its terms may vary.
Kansas’ small group COBRA continuation variations are as follows4:
|Eligible group sizes||All group sizes; excludes those eligible for COBRA coverage|
|Maximum continuation period – standard||18 months|
|Maximum premium Increase||100 percent|
|State legislation reference||Miss. Code Ann. § 83-9-51 (2014)|
|Additional notes||Employees and their dependents must have been covered by the group policy for at least three months prior to the qualifying event.|
Kansas high-risk pools
It used to be that health insurance companies could deny applicants or charge them more based on health history and preexisting conditions. When the Affordable Care Act was passed in 2010, many states created federally funded preexisting condition insurance programs or accepted federal funding to assist with similar high-risk pool programs they already operated.5
The Affordable Care Act prohibits this practice for health insurance plans considered minimum essential coverage with effective dates beginning Jan. 1, 2014, and later. As such, the PCIPs and state high-risk pools created to provide health insurance for those once considered uninsurable are being phased out.
Medicaid is a state health insurance program for low-income individuals under age 65, pregnant women, children, disabled individuals, and seniors over age 65; it is partially funded by the federal government. In 2014, states were given the option to accept additional federal funding and expand their Medicaid program eligibility to those who make up to 133 percent of the federal poverty level (effectively 138 percent due to how it is calculated, according to HealthCare.gov).6
Kansas decided not expand its Medicaid program in 2014.7 As a result, there is a coverage gap that includes Kansans who are not eligible for Medicaid under the state’s current qualification criteria but earn too little to receive premium tax credits when shopping the health insurance exchange—those earning 100 to 400 percent of the federal poverty level qualify for marketplace subsidies. Medicaid/CHIP open enrollment takes place year-round.
The information below is specific to Kansas’ Medicaid program, KanCare:
|Governing agency||Centers for Medicare & Medicaid|
|Administrator||State of Kansas|
|Where to apply online||healthcare.gov / cssp.kees.ks.gov/apspssp/|
|Additional application options||kancare.ks.gov/apply.htm|
|Open-enrollment period||Year-round in all states|
|Eligibility||Eligibility guidelines vary by population and program. Visit kdheks.gov/hcf/Medicaid/eligibility_guidelines.html.|
The Children’s Health Insurance Program is a partnership between the states and federal government. CHIP provides health insurance to uninsured children who meet certain eligibility guidelines.
The information below is specific to Kansas’ health insurance program for low-income children:
|Where to apply||healthcare.gov / cssp.kees.ks.gov/apspssp/|
|Additional application options||kancare.ks.gov/apply.htm|
|Eligibility8||Low-income children under age 19 living in Kansas; U.S. citizens and qualifying non-citizens; income standards apply|
1 United Health Foundation. 2014 America’s Health Rankings Annual Edition. “Annual State Health Rankings.” http://www.americashealthrankings.org
2 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2014/.
3 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2015/.
4 Kan. Stat. Ann. § 40-2209. jhttp://kansasstatutes.lesterama.org/Chapter_40/Article_22/40-2209.html.
5 National Conference of State Legislators. Coverage of Uninsurable Pre-Existing Conditions: State and Federal High-Risk Pools. Updated April 2014. http://www.ncsl.org/research/health/high-risk-pools-for-health-coverage.aspx.
6 Centers for Medicare & Medicaid Services. “Medicaid Expansion & What It Means for You.” HealthCare.gov. N.D. https://www.healthcare.gov/what-if-my-state-is-not-expanding-medicaid/.
7 Centers for Medicare & Medicaid Services. “Kansas.” Medicaid.gov. http://www.medicaid.gov/medicaid-chip-program-information/by-state/kansas.html.
8 Kansas Medical Assistance. “Medical Coverage for Children.” http://www.kdheks.gov/hcf/Medicaid/download/Medical_Coverage_for_children.pdf.