This guide provides an overview of the Kansas Health Insurance Exchange including the history of the exchange, how the exchange will operate, and exchange information for Kansas residents and small businesses.
As a quick overview, beginning in 2014 as part of the Affordable Care Act (ACA), health insurance coverage for individuals and small businesses became available through new state health insurance exchanges (also called health insurance marketplaces).
Most importantly, the key tax credits (e.g. the small business healthcare tax credits) and tax subsidies (e.g. individual health insurance tax subsidies) will only be available for coverage purchased through a public health insurance exchange.
All states had three options for setting up a state health insurance exchange:
Kansas defaulted to a federally-facilitated health insurance exchange. The Kansas Health Insurance Exchange opened for enrollment on October 1, 2013.
After the ACA was passed in 2010, Kansas initially explored establishing a state-based health insurance exchange. However, efforts slowed in 2012 as Kansas waited to see if the ACA would be upheld. On November 8, 2012, Kansas Governor Sam Brownback announced that Kansas would default to a federally-facilitated exchange.
Kansas Insurance Department (KID) will retain management of plan management activities, meaning they will have an active role in reviewing and authorizing the insurance plans and rates. This role was approved by the Center for Consumer Information and Insurance Oversight (CCIIO) on March 8, 2013.
The Kansas Health Insurance Exchange will be operated through a federally-run health insurance exchange, also referred to as the Health Insurance Marketplace. Starting in October 2013, Kansas residents will be able to access information about all the plans available through the Exchange. The SHOP Exchange will also be available to small businesses with 50 or fewer employees. Coverage from the Exchange starts in January 2014.
A key part of the Kansas Health Insurance Exchange is that eligible individuals and families will be able to access individual premium tax subsidies, capping the cost of their premium between 2% to 9.5% of income. Eligibility is based on household size and income (up to 400% FPL). The Exchange will also screen for Medicaid and public assistance programs. These premium tax subsidies are only available through the public Exchange.
According to an estimate by healthcare.gov, approximately 326,900 or 14% of Kansas’s non-elderly residents are uninsured, of whom 310,600 (95% of these) may qualify for either tax subsidies to purchase coverage in the Marketplace or for Medicaid (if Kansas participates in the Medicaid expansion).
All plans offered through the Kansas Health Insurance Exchange will meet the ACA definition of a qualified health plan (QHP). The plans will be offered by level of coverage for essential health benefits (EHB), to allow consumers to compare plans on an "apples to apples" basis.
The four metal levels are:
The Kansas Health Insurance Exchange will follow federal guidelines for insurance professionals selling policies through the Exchange and for navigators assisting consumers and small businesses.
Insurance professionals will be able to register with the Exchange and receive any commissions directly from the carriers (using their Exchange ID number and NPN).
The Kansas Health Insurance Exchange navigator program will assist consumers in making choices about their health care options and accessing their new health care coverage, including access to premium tax credits for eligible consumers.