Need health insurance for you and your family? Get the basics of the ACA in simple terms

More people than ever are seeking health insurance on the Health Insurance Marketplace offered through the Affordable Care Act (ACA) during the Open Enrollment Period (OEP) that happens between Nov. 1 and Dec. 15.

The ongoing coronavirus (COVID-19) pandemic has significantly impacted Kansans, as more than half of the adult population is dependent on their employer or a family member’s employer for their health insurance. A growing number of newly unemployed Kansans have lost their health benefits along with their jobs and are navigating the Marketplace for the first time.

We know you likely have a lot of questions and we’re here to help.

What is the ACA?

The ACA provides health insurance by making it possible for anyone, regardless of their current or previous health condition, to purchase health insurance. It mandates that all plans offered on the Marketplace include the same essential health benefits and preventive services.

Essential health benefits

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.

Preventive services

Plans sold on the Marketplace also include preventive services you can receive with no cost-sharing involved. Services 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.

What is the cost of health insurance?

Three levels offer coverage and cost options

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.

You may get financial assistance

Nearly 86 percent of Kansans will qualify for government assistance through a premium tax credit or cost-sharing reductions. The tax credit is applied directly to your monthly payment.

The premium tax credit

When you apply for health insurance on the Marketplace, you can see if you qualify for a “premium tax credit” to lower the amount you pay each month for the insurance plan.

Income requirements for the advanced premium tax credit

The amount of premium tax credit depends on your estimated household income for the year you want coverage. You would be eligible for tax credits if your income falls within a certain range.

Eligibility for the advanced premium tax credit

You are eligible for the premium tax credit if you meet all the following requirements:

  • Purchase coverage through the Marketplace
  • Have household income that falls within a certain range
  • Are not able to get coverage through a government program like Medicaid, Medicare, CHIP or TRICARE
  • File a joint return, if married
  • Cannot be claimed as a dependent by another person
  • Do not have access to qualified coverage through an employer.

How do I enroll in a health insurance plan?

Find Blue Cross on the Marketplace

If you’re eligible for a tax credit, you’ll need to go through the Marketplace and look for BlueCare options. Benefits and pricing are the same, and you will have options to consider. Blue Cross does not offer dental plans on the Marketplace so you’ll need to enroll at bcbsks.com/dental separately. There is no subsidy for dental coverage either on or off the Marketplace.

Enroll directly with Blue Cross

Blue Cross provides 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!

What if I need coverage after enrollment ends?

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:

  • Marriage
  • Birth
  • Adoption
  • Loss of other coverage

We’re here for you!

Getting health insurance for you and your family is an important step to better health and well-being. Deciding which plan is best for you can be a big decision. And we’re here to help you navigate by clearly explaining the coverage in terms you can understand. Call us today at 866-679-7824.

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