For uninsured Kansans, a window of opportunity opens next month.
The open enrollment period for 2021 health insurance plans is set to begin Nov. 1 and run through Dec. 15. During that time, Kansans without health insurance may browse options available to them and purchase plans on the Health Insurance Marketplace.
Plans available on the marketplace are compliant with regulations set forth in the Affordable Care Act, former President Barack Obama’s health care law. There aren’t repercussions for not purchasing a plan, as the ACA’s individual mandate penalty has been $0 since the beginning of 2019, but health insurance experts like Louise Norris say it is important to get coverage.
Norris has written about health insurance and health care reform since 2006 and authors “The Insider’s Guide to Obamacare’s Open Enrollment,” which is published on healthinsurance.org
Norris said when searching for a plan, Kansans should pay attention to premiums, out-of-pocket costs beyond just the deductible, providers covered by a network and a plan’s drug formulary, which is the list of drugs covered by a policy.
“If you’re buying your own health insurance and you’re shopping in the marketplace, you can rest assured that all of the plans cover the essential health benefits,” Norris said. “They cap your out-of-pocket costs as long as you stay in network. They don’t have lifetime or annual benefit maximums. Those sort of ‘Gotchas’ that used to exist in the individual market — you don’t have to worry about that anymore. And also, pre-existing conditions are covered from day one.”
According to data provided by the Centers for Medicare & Medicaid Services, nearly 86,000 people in Kansas enrolled in coverage for 2020 during the open enrollment period last year. That was down some from the almost 90,000 people in Kansas who had enrolled the year before.
Norris said it is difficult to know how the pandemic will affect enrollment — as it has been marked by both heightened health concerns and greater economic uncertainty — but she doesn’t expect enrollment to drop again.
“I would really hesitate to give a prediction on what I think is going to happen with enrollment,” Norris said, “but I would say we do still have definitely lower employment than we had last year at this time, heading into the last open enrollment period.”
And without employer-provided coverage, those individuals could be looking for care on their own.
KanCare, the state’s Medicaid program, is available for low-income individuals who also fall into one of several different eligibility categories: children, pregnant women, adult parents and caregivers, and seniors and the disabled.
“In states where they’ve expanded Medicaid, low income is enough, as long as you’re a non-elderly adult,” Norris said. “That’s not the case in Kansas.”
That leaves many people who fall short of KanCare guidelines searching for private plans on the marketplace.
She said one of the concerns many people have about individual-market coverage is that premiums and out-of-pocket costs are too high.
Plans that have higher premiums, Norris said, will usually have lower out-of-pocket costs, and plans with lower premiums tend to have high out-of-pocket costs.
“But the ACA does include two mechanisms for protecting people from those,” Norris said. “If your income is under 400% of the poverty level, in most cases you’ll qualify for premium subsidies, and if your income is under 250% of the poverty level, you can get these plans with lower out-of-pocket costs as long as you pick a silver plan.”
Norris recommends steering clear of anything that isn’t an ACA-compliant major medical plan, as consumers might not get the same protections under those non-compliant policies. Those include short-term plans that some people see as an alternative to ACA-compliant plans, she said.
In Kansas, there are five insurers that offer ACA-compliant plans on the Health Insurance Marketplace. Those insurers include Blue Cross Blue Shield of Kansas, Cigna, Medica, Oscar and Sunflower Health Plan/Ambetter from Sunflower Health.
“In most states, the companies that offer insurance through the marketplace will also let you come directly to them and buy a plan,” Norris said. “You can totally do that, but the same open enrollment period applies. You have to do it between Nov. 1 and Dec. 15. Outside of that, they will not sell you a plan unless you have a qualifying event. And you cannot get any subsidies if you go directly to those insurance companies, so that’s really only a good alternative if you know you earn too much money to qualify for subsidies.”
Kansans may search for and purchase ACA-compliant plans through the federally run site healthcare.gov. However, the Kansas Insurance Department approves plans, reviews rates and provides consumer assistance, according to the department’s website.
Coverage purchased during this year’s open enrollment period goes into effect Jan. 1, 2021.
Additional information about health insurance options in Kansas can be found online at healthinsurance.org or at insurance.kansas.gov/health-life/.