About the Marketplace
Provisions under the Affordable Care Act established a statewide Health Insurance Marketplace that would provide a way for individuals and businesses to buy health insurance. This marketplace makes it possible for you to find all of your health insurance options on one website, easily compare the coverage that each plan offers, and purchase your insurance policy. This website is not the Marketplace, but will answer your questions and provide links to the Marketplace.
Four health insurers have entered into agreements with the federal Marketplace to offer qualified health plans in Kansas. Two are Blue Cross and Blue Shield, and two are Coventry companies. The Kansas Insurance Department has reviewed 72 plans offered by the companies and approved them for sale in Kansas.
What will the Markeplace look like?
The Health Insurance Marketplace is a website. Many times this website is compared to travel websites that let you compare flight or hotel rooms by cost and benefit. This marketplace shows you all of the health insurance policies that you are eligible to buy and provides side-by-side comparisons. There is even a cost comparison calculator that helps you figure out how much each policy will cost you. The comparison tools help you figure out which plan is suited for you based on where you live, what kind of coverage you need, and any special considerations you might have, such as whether the doctor you already see accepts the plan, or whether the plan includes specialists for certain conditions, like asthma or diabetes.
Why should I buy my health insurance from the online Marketplace?
This online marketplace is the only way you can get financial help in paying for your health insurance. You can still buy health insurance directly from companies or from insurance agents, but if you don’t use the marketplace you cannot receive tax credits or subsidies to help you pay for your insurance.
Who runs the Health Insurance Marketplace?
In Kansas, the marketplace is run by the Centers for Medicare & Medicaid Services (CMS), which is a federal government agency. The Kansas Insurance Department (KID) does not run the health insurance marketplace. However, you can always call KID with questions or concerns you have about your health insurance in general.
How can I get help when using the online Marketplace?
There are several different ways you can get help when using the marketplace. There is a toll-free telephone number set up to help. You can call 800-318-2596 to get help when using the marketplace.
Additionally, face-to-face assistance is available through insurance agents and the Health Insurance Marketplace’s Navigator and Certified Application Counselor (CAC) programs.
A local insurance agent can assist you with the application & selection of a plan, and also continue to assist with claims issues, billing issues, provider issues and general customer service. Ask your insurance agent if he or she can help you choose and enroll in a plan that is right for you.
Navigators and CACs are trained individuals who can help you prepare applications to establish eligibility and enroll in coverage through the Marketplace and potentially qualify for other programs like Medicaid and CHIP. They cannot sell or recommend that you buy a particular plan.
What kinds of insurance plans are available on the Marketplace?
All health insurance plans offered on the marketplace are qualified health plans and cover all essential health benefits required by law. Plans are categorized into four different types: bronze, silver, gold and platinum. All plans offer the same set of essential health benefits. The different levels do not reflect the quality or amount of care the plans cover. The categories differ as to how much your premium costs each month and the total amount of out-of-pocket costs you’ll have.
As with all health insurance, the amount of premium a company charges will depend on that company’s claims experiences. Because of this, costs for each plan in each tier level will vary. The following is a general guideline for how to select coverage.
In general, plans with lower premiums will have higher out-of-pocket costs. The bronze level plans tend to have the lowest premiums but higher out-of-pocket costs. Plans like this may be good for individuals who are relatively healthy and do not need a lot of medical care or prescription drugs.
On the other hand, plans with higher premiums generally have lower out-of-pocket costs. The platinum level plans tend to have the highest premiums on the marketplace, but you will pay less out-of-pocket costs with these plans. A platinum level plan may be right for you if you expect a lot of doctor or hospital visits or require many prescription drugs.
Additionally, catastrophic plans will also be available on the marketplace for individuals exempt from the requirement to purchase insurance and for individuals under the age of 30. Catastrophic plans have a lower premium cost, but generally require you to pay all of your medical costs out-of-pocket up to a certain amount - usually several thousand dollars. Catastrophic plans are intended to protect from major injuries or illnesses, not for everyday doctor visits. Individuals buying catastrophic plans are not eligible to get tax credits or subsidies to help pay for this coverage.
Information you will need to complete the enrollment process
- Social Security numbers (or document numbers for any legal immigrants who need insurance)
- Birth dates of all the family members you are going to enroll
- Employer and income information for everyone in your family (for example, from paystubs or W-2 forms, wage and tax statements)
- Policy numbers for any current health insurance
- Information about any job-related health insurance available to your family