How It Works and Who It’s For

The Marketplace is for individuals and families who do not have access to affordable employer coverage, are self-employed, early retirees under 65, or need to buy their own insurance. It is also the main way to access premium tax credits and cost-sharing reductions, which are not available for off-exchange plans. The Marketplace screens applicants for Medicaid and CHIP eligibility and refers them to KanCare if appropriate.

Open Enrollment Period in Kansas

• Open Enrollment for 2025: November 1, 2024 – January 15, 2025.

• Enroll by December 15 for coverage starting January 1, 2025.

• Enroll between December 16 and January 15 for coverage starting February 1, 2025.

• After January 15, you can only enroll or change plans if you qualify for a Special Enrollment Period (SEP).

Special Enrollment Period (SEP) Rules

A SEP is available if you experience a qualifying life event, such as:

• Loss of other health coverage

• Marriage or divorce

• Birth or adoption of a child

• Change in residence

• Change in household income

You typically have 60 days from the event to enroll in a new plan.

Types of Health Insurance Plans Available

Marketplace plans are divided into four “metal” tiers, plus catastrophic coverage for those under 30 or with a hardship exemption:

• Bronze: Lowest premiums, highest out-of-pocket costs.

• Silver: Moderate premiums/costs; required for cost-sharing reductions.

• Gold/Platinum: Higher premiums, lower out-of-pocket costs.

• Catastrophic: For young adults and hardship cases; low premiums, high deductibles, and covers all essential benefits after the deductible is met.

Plan Types:

• HMO: Lower premiums, limited network, referrals required.

• PPO: Higher premiums, broader network, out-of-network coverage, no referrals.

• EPO: Must use network providers, no out-of-network coverage except emergencies, no referrals needed; all 2025 Kansas Marketplace plans are EPOs.

Eligibility for Subsidies and Cost Assistance

• Premium Tax Credits: Available for incomes between 100% and 400% of the federal poverty level (FPL), with some expanded eligibility through 2025. Tax credits are only available for plans purchased through the Marketplace.

• Cost-Sharing Reductions (CSR): For incomes up to 250% FPL on Silver plans, reducing deductibles, copays, and coinsurance.

• Medicaid/CHIP: KanCare (Medicaid) covers children and low-income adults; CHIP covers children in families with higher incomes. Kansas has not expanded Medicaid, so some adults may fall into a coverage gap.

How to Compare and Choose a Plan in Kansas

When comparing plans, consider:

• Premiums: Monthly cost

• Deductibles/Out-of-Pocket Maximums: What you’ll pay before coverage kicks in

• Provider Networks: Ensure your doctors and hospitals are in-network

• Drug Formularies: Check if your medications are covered

Tips:

• Self-employed: Consider high-deductible plans with HSAs for tax benefits.

• Families: Look for pediatric dental/vision, family out-of-pocket limits.

• Retirees: Marketplace coverage bridges the gap until Medicare at 65.

Top Insurance Providers on the Kansas Exchange

For 2025, seven insurers offer Marketplace coverage in Kansas:

• Ambetter from Sunflower Health Plan (affordable EPO options)

• Blue Cross and Blue Shield of Kansas (broad network)

• Blue Cross and Blue Shield of Kansas City (for Johnson and Wyandotte counties)

• Aetna Life Insurance Company

• Medica

• Oscar

• UnitedHealthcare

All counties have at least two insurers offering coverage, and all plans are EPOs.

Navigating Kansas’s Online Enrollment Portal

How to Apply:

Visit the federal enrollment website and create an account.

Enter household and income information to check eligibility for subsidies or programs.

Compare available plans by premiums, coverage, and network.

Select a plan and complete enrollment.

Pay your first premium to activate coverage.

Where to Get Help:

• Certified Navigators are available statewide for free, in-person, phone, or virtual assistance. Local help is available through community organizations.

Alternatives to the Marketplace

• Short-term health plans: Available for up to four months; not ACA-compliant, may exclude pre-existing conditions.

• Off-exchange private plans: Purchased directly from insurers; no subsidies available.

• Faith-based health-sharing ministries: Not insurance, lack ACA protections, but may be an option for some.

Common Mistakes to Avoid During Enrollment

• Waiting until the last minute to enroll

• Not comparing multiple plans or checking network/drug coverage

• Overlooking financial assistance eligibility

• Not updating income or household information if it changes during the year

• Choosing the wrong metal tier for your needs

• Not seeking professional assistance if you need help

State-Specific Health Programs or Initiatives

• KanCare: Kansas Medicaid and CHIP program.

• Medicaid Expansion: Kansas has not expanded Medicaid, leaving some adults in a coverage gap.

• Navigator Assistance: Free enrollment help is available statewide.

• Enhanced Premium Tax Credits: Temporary enhancements continue through 2025 under federal law, making coverage more affordable for many.

Kansas’s Marketplace offers a variety of plans, robust consumer protections, and strong assistance resources for residents seeking affordable health coverage.