The Health Insurance Marketplace, often referred to as the “exchange,” is an online site where Kansas consumers can go to research, compare and buy health insurance. To make shopping easier, all insurance companies must offer the same set of comprehensive benefits. These include coverage for doctor’s visits, hospital stays and medication.
The plans fall into four metal coverage levels: Bronze, Silver, Gold and Platinum. Each tier has a different amount of out-of-pocket costs so you can pick a premium amount and out-of-pocket combination that you are comfortable with. If you choose to pay less out-of-pocket, meaning you want to pay less for deductibles, coinsurance and copays when you need services, your premiums will be higher.
For example, plans at the Platinum level will have the lowest out-of-pocket costs, but the highest monthly premiums. You could lower the premium you pay each month by purchasing a plan at the Bronze level, but keep in mind you'll have more out-of-pocket costs should you need services.
In Kansas, our Marketplace is run by the federal government, but our own Kansas Insurance Department carefully reviews the products and rates filed by participating insurance companies.
If you purchase your health plan from the Marketplace, you may qualify for a tax credit and cost-sharing to help you pay for your insurance. Your tax credit or cost-sharing amount is determined by where you fall on the federal poverty level scale, and is set to make sure you don’t pay more than a certain percentage of your income on premiums. If you make between 100 percent and 400 percent of the Federal Poverty Level (FPL) you likely qualify to receive a tax credit to help pay your premium.
The Affordable Care Act also helps qualified Kansans with the cost of insurance by helping them pay their deductibles, coinsurance and copay amounts. How do you qualify for cost-sharing subsidies? Kansans with incomes up to 250 percent of the federal poverty level can receive help paying for out-of-pocket costs, based on a sliding scale. Like the tax credit, you must purchase a plan through the Health Insurance Marketplace and it must be at the Silver tier to qualify for the cost-sharing subsidy.
There are a few important things to keep in mind before you begin the process. First, you need to find out if you already qualify for an existing program like KanCare (Medicaid). Do you have coverage through your employer? If so, ask if it will continue to be offered in 2015. Finally, start gathering information about your household income and family members.
Kansans who choose not to use the Marketplace can continue to purchase their health plan directly from an insurance company. They will not, however, qualify for a tax credit to help pay their premiums. These companies might have open enrollment periods similar to the Marketplace, so understand when you can purchase coverage and when you can not.
Since March 31, 2014, Kansans can only shop for health insurance in the Marketplace under special circumstances, also known as triggering events, such as losing one’s current coverage, getting married or moving. However, if one is eligible or becomes eligible for Medicaid, they can enroll in KanCare at any time.
The open enrollment period for 2015 coverage will be from Nov. 15 to Feb. 15, 2015, with coverage effective Jan. 1, Feb. 1 or March 1, 2015, depending on when you enroll.
Kansans need to remember that if you did not enroll during the open enrollment period, and you do not have a triggering event, you will have to wait to purchase health insurance until the next open enrollment period for coverage beginning Jan. 1, 2015.