Your Source
For Information
We want to help you understand the law and how it will affect you.
The Affordable Care Act works to help people get health coverage and to lower overall costs. Find out how health care mandates may impact you, whether you're insured through your employer or you buy your own plan.
The Affordable Care Act (ACA) has significantly changed the U.S. health care system, bringing guaranteed issue of coverage, tax credits, and the Health Insurance Marketplace. Here's what Kansans like you need to know right now:
The ACA provides greater access to health insurance by making it possible for anyone, regardless of their current or previous health condition, to purchase health insurance. It also mandates that all plans offered on the Marketplace include the same essential health benefits and preventive services.
No matter what plan you purchase, you are guaranteed to have essential health benefits including coverage for: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse disorders, prescription drugs, rehabilitative and habilitative services, laboratory services, preventive and wellness services, chronic disease management, and pediatric services, including oral and vision care.
Plans sold on the Marketplace also include preventive services you can receive with no cost-sharing involved. So things like breast and colon cancer screenings, screening for diabetes, blood pressure and high cholesterol, and routine vaccinations will all be provided without you having to pay a copay, deductible or coinsurance as long as the primary purpose of the visit was for the recommended preventive service.
A number of Kansans will qualify for government assistance through an Advanced Premium Tax Credit or cost-sharing reductions. The tax credit is applied directly to your monthly payments.
Blue Cross and Blue Shield of Kansas provides many options to help put you in control of your health care. When you choose a health insurance plan, you want to get the most out of your health care dollars. That is why you can purchase a plan directly from us with a short application process you can complete online!
If you're eligible for a tax credit, you'll need to go through the Marketplace. Benefits and pricing are the same, and you will have several options to consider.
Health insurance plans offered through the Marketplace and Blue Cross and Blue Shield of Kansas have different levels of coverage called “Metal Levels.” Levels are defined by the amount you pay in monthly premiums and how much your plan pays when you need care.
Open enrollment is only available Nov. 1 until Dec. 15 each year. During all other times of the year, you will be able to get coverage under special enrollment periods, but only for life changing events such as:
The premium tax credit is an advance, refundable tax credit designed to help eligible individuals and families with low or moderate income afford health insurance purchased through the Marketplace. You can choose to have the credit paid in advance to your insurance company to lower what you pay for your monthly premiums, or you can claim all of the credit when you file your tax return for the year.
The benefit levels of many government assistance programs are based on federal poverty levels (FPL). You would be eligible for tax credits if your income falls between 100 percent and 400 percent of the FPL.
You are eligible for the premium tax credit if you meet all of the following requirements:
Healthcare.gov - Health and Human Services' site dedicated to health care reform and home of the Health Insurance Marketplace
IRS.gov - Learn about tax implications associated with health care reform
Kaiser Family Foundation - Health policy, research and analysis tied to health care reform
Employer Responsibility Under the Affordable Care Act - As of 2015, larger employers will face penalties if they don't make affordable health benefits coverage available. This flowchart illustrates how those employer responsibilities work.
Health Insurance Marketplace calculator - Helpful tool from KFF that illustrates how tax credits will be calculated
Kansas Insurance Department - Find details specific to the State of Kansas Health Insurance Marketplace
WhiteHouse.gov - Special section on health care reform from the White House
Blue Cross Blue Shield Association - Perspectives and information from the national association
