Kansas State University


Issues in Health Reform

Category: Consumer information about enrolling in marketplace

If Open Enrollment in the Marketplace is through Feb 15, why is Dec 15, 2014 so important?

It is true that consumers have until Feb 15, 2015 if they intend to find and enroll in an insurance plan through the Kansas Health Insurance Marketplace. However, for benefits to begin Jan 1, 2015, you must sign up by Monday Dec. 15. Otherwise, benefits won’t begin until Feb 1, or March 1.

So the time is now to enroll. Go to healthcare.gov or all 1-800-318-2596 24/7 to start your application or renewal today.  You can find more information at:  https://www.healthcare.gov/keep-or-change-plan/

If you signed up last year, you will be automatically re-enrolled in the plan you had UNLESS it is no longer available OR you actively choose a new plan.  Since plans change it is wise to review your coverage and the network of health care providers to see if you still have the plan you want.  If you had assistance paying for premiums make sure that that assistance will continue in 2015.  If you allowed the Marketplace to access your tax records, you should still be eligible.  If you did not, you will have to resubmit income information.

Remember almost all are required to be insured and report it on with their tax returns. For the year 2014, your status will be reported on the return you file before April 2015. Your insurance status for this coming year will be reported April 2016.



How do I get health insurance before the next open enrollment period starting Nov 15, 2014?




Everyone with few exceptions (see https://www.healthcare.gov/exemptions) must have health insurance or may have to pay a penalty. Medicare Tri-Care, VA and Indian Health Service all remain the main insurance for those eligible for those programs. Because these programs qualify as insurance beneficiaries are not subject to penalties for being uninsured.

 Here are health insurance options for you to consider.

Your Job

 •   Your insurance stays the same unless your employer decides to make changes. If this work-based insurance is not affordable (costs more than 9.5% of your household income for a single policy) you may be eligible for financial help if purchasing a policy in the Marketplace.

 The Marketplace at healthcare.gov

 •   The Marketplace refers to a place for specific kinds of insurance policies that have been approved by the federal government to offer policies in Kansas.  Most think of it as the website where those policies can be found but it exists regardless of the website.  People can enroll via phone, mail, in person, or yes at the website.  The website offers an easy way to view and compare plans for providers, services and price. Anyone can shop in the Marketplace however, open enrollment is closed for 2014.

  •   Open enrollment for 2014 ended March 31. Only people with special circumstances can purchase in the Marketplace now   marketplace.cms.gov/help-us/enroll-limited-circumstances.pdf

  On November 15, 2014 the Marketplace will reopen for everyone else. KHN has a good story about those circumstances http://www.kaiserhealthnews.org/Stories/2014/May/09/Andrew-reader-question-on-insurance-between-open-enrollments .aspx?utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email &utm_medium=email&utm_contnt=12736814&hsenc+p2ANqtz-8xGUxlk04t5iCJ8D7Y8Jwxuv9SS7HSFMuLR4B3eRiCwWSwqRzCZzABM9aYnlvSyRfYLombN4pnWb0OtxE6FVYARW2m7A&_hsmi=12736814

  •   U.S. citizens, nationals and lawfully present immigrants living in the United States and not in prison can enroll in health insurance in the Marketplace.

  •   If you purchase in the Marketplace AND your household income is less than 400% of the federal poverty level (FPL), you may get tax credits to reduce the cost of the premium.  If it is less than 250% of FPL, you may also get help paying for out-of-pocket costs. This is not true for those who have work-based insurance that is considered adequate and affordable. Adequate means that the plan pays on average 60% of all your medical costs in a given year. Affordable is considered less than 9.5% of your annual household income. If work based insurance meets those criteria than you are not eligible for tax credits.

 KanCare at http://www.kancare.ks.gov/

 •   KanCare is the Kansas Medicaid program for U.S. citizens and lawfully present immigrants of low income who are over 65, under 18, or disabled.

 •   Children and pregnant women may be eligible with household incomes less than 225% FPL.

  •      Those over 65 have both income and asset limits, depending on the specific program.

  •   Check eligibility at http://www.kancare.ks.gov/ or the Marketplace healthcare.gov

  Additional options for young adults

  •   Stay on parents’ policies until age 26.

  •   Buy a catastrophic plan (for those under age 30 or with special financial circumstances).

  •   For higher education students, ask about student health insurance.

  Buy a private plan from an agent or broker.

  To get help or learn more to enroll in the Marketplace or KanCare

 •   Call the National Help Center at 1-800-318-2596 available 24/7.


Marketplace Eligibility Monthly Income

Marketplace Eligibility Monthly Income

Group Size

Up to 250% FPL Help with out-of-pocket costs

Up to 400% FPL Income limit for Tax Credits










For each additional person add

For each additional person add




Lessons learned from launching Medicare Part D

An interesting new RWJ funded report from The Center on Health Insurance Reforms, Georgetown University Health Policy Institute, discusses the similarities between the launching of the Medicare Part D program and the online marketplace exchanges, particularly as they are going to impact enrollment.

The report “draws lessons from the launch of the Medicare prescription drug plan in 2003 to put the challenges facing health insurance exchanges today in to context. The authors say that while Medicare Part D is still not perfect, those implementing the program were successful in addressing problems as they arose, which they say may also bode well for the implementation of the health insurance exchanges.

The report looks at four key areas in which officials implementing insurance exchanges should look to Medicare Part D for lessons:

  • Wariness before program implementation
  • Education and outreach
  • Eligibility and enrollment
  • Consumer assistance”

Potential purchases of coverage in the Kansas Health Insurance Exchange: Who is likely in and who not?

The Kansas Health Institute report, “Insurance Exchange will provide many Kansas consumers with new options” estimates numbers for the state as a whole.  While more than 500,000 Kansans may consider purchasing insurance through the Exchange, only

  • 193,000 are most likely since they will qualify for tax credits/premium discounts;
  • 75,000 less likely because they don’t qualify for these;
  • 245,000 whose purchase behavior is unknown depending upon what their employers do; and
  • an additional 43,000 who will qualify for tax credits if Kansas does not expand Medicaid.  This latter population unfortunately will find insurance unaffordable even with the tax credit.

Summary from report:

2014, the Affordable Care Act’s individual mandate will require nearly all U.S. citizens to have health insurance. The health reform law also requires each state to have an online marketplace known as a health insurance exchange where people can obtain insurance.


This new issue brief — the eighth in a series focusing on health reform — examines which Kansans would be most likely to use a health insurance exchange.


Key findings of the brief include:


• More than 500,000 Kansans would have some reason to consider using the health insurance exchange to obtain coverage, though some are more likely to use it than others.


• About 1.7 million Kansans are likely to continue with the coverage they have now.


• The exchange will provide small employers and their workers with more options.


• The exchange will serve as a gateway for determining eligibility for federal tax credits as well as Medicaid and the Children’s Health Insurance Program.”

What does the public know or understand about ACA?

The Kaiser Family Foundation poll results are detailed in this KFF brief. Their summary highlights why this is a public education challenge for those of us working with communities:

As government officials, community organizations and advocates gear up the consumer information and assistance efforts that will surround this fall’s open enrollment for the health insurance exchanges created under the Affordable Care Act (ACA), much of the public remains confused about the status of the health law, according to the April Kaiser Health Tracking Poll. Four in ten Americans (42 percent) are unaware that the ACA is still the law of the land, including 12 percent who believe the law has been repealed by Congress, 7 percent who believe it has been overturned by the Supreme Court and 23 percent who don’t know whether or not the ACA remains law. And about half the public says they do not have enough information about the health reform law to understand how it will impact their own family, a share that rises among the uninsured and low-income households. When it comes to where they are getting information about the law, Americans most commonly cite friends and family, “newspapers, radio news or other online news sources”, and cable news. About one in ten report getting information from a health insurer, their doctor, an employer, or a non-profit organization. Similar shares say they have gotten information from “federal agencies such as the Department of Health and Human Services” or “state agencies such as your state Medicaid office”.”

What role for Extension in consumer enrollment in the online health insurance marketplaces?

Our national colleagues have been giving quite a bit of thought to this.  There is a fact sheet those folks put together to help guide Extension leadership on thinking about Extension’s role in the Navigator program.  Health Insurance Navigator Fact Sheet 4 30 13  It defines what a navigator is and lays out the different options for Extension systems.

Know that in Kansas there are currently several groups considering submitting a proposal to the feds to be funded as one of the navigators.  Kansas will be awarded two grants, one has to go to a consortium type group.  Total funding will be $600,000.  That is likely not enough money to do the task so folks that extend the reach of those dollars, perhaps through train the trainer initiatives (yes, Extension) may be viable partners in these efforts.

Also useful is the J of Extension commentary published in the Oct issue by our Maryland colleague Bonnie Braun for thinking more broadly about Extension’s role in other aspects of the Affordable Care Act.

Further, you can link to this webinar, specifically the section done by my Wisconsin colleague Mary Meehan-Strub and myself on what role for Extension in all of our program, starting at hour 1:27. “Implications for UW Extension and county colleagues.”

The need for consumer assistance enrolling in online marketplace (the Exchanges)

January 1, 2014 is the day that the new insurance plans begin for consumers who will be enrolling for those plans through the online marketplace (the Exchange).  In Kansas as many other states the federal government is responsible for designing what that online marketplace will look like.

Enrollment in those plans will be Oct 1, 2013 – March 31 2014 (the extended date currently for this first year only).  This article today basically lays out the herculean task of getting so many new people enrolled.  I trust Kaiser Health News to put together fact based stories. http://www.kaiserhealthnews.org/Stories/2013/May/05/insurance-exchanges-marketplaces-navigators-consumers.aspx

Though the information is not specific to Kansas we will not be all that different.  We have over 368,000 uninsured, some percentage of which are expected to need assistance in enrolling.  See this Kansas Health Institute publication for details on how many folks are expected to enroll.