Kansas State University


Issues in Health Reform

Category: Online marketplace – Exchanges

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




Time for ACA Open Enrollment: State vs Federal Exchanges

In the past week a new distinction in implementation success between states that had chosen to facilitate their own new insurance marketplaces (also called Exchanges) and those that did not has become apparent.  Previously much was written about how much it really did NOT matter if the Exchange was going to be run by a state or run by the feds.  After all, there were going to be marketplaces with a collection of new insurance policies for consumers to choose regardless of who was doing the facilitating.  Negotiating with the different insurance companies happened.  States have lots of policies being offered in these Exchanges.  But getting access to them online has been quite a different experience for those trying to access a state facilitated Exchange vs those accessing healthcare.gov to get to their states’ federally facilitated Exchanges.

Early on it was apparent that the burden of having the feds do it for over half of the states was going to take its toll on the administrators.  But beside that, things were going to be fairly equal.

Well, not so.  The federal website is experiencing all sorts of glitches and delays.  It is unfortunate since those who have been able to create and account and see what their states’ insurance offerings are have been satisfied. We now see evidence that running such a massive online site, with apparently outdated government type computer services, is more problematic than having states put together smaller Exchanges. Check out this article explaining the differences: http://www.nytimes.com/2013/10/09/us/politics/uninsured-find-more-success-via-health-exchanges-run-by-states.html?_r=0

Kansas families who have not been able to register or submit an application to consider a policy being offered in the Kansas Exchange can at least get a glimpse of what the premiums and tax credits might be for them in Kansas by going to insureks.org

There one enters county, household size, income, and ages of family members to be covered and a cost estimator gives expected monthly costs based on premiums and tax credits that are true to the cost of premiums in their region of Kansas.


Resources for the Kansas Exchange: Health insurance premiums and other options

There are several excellent resources available for consumers trying to make sense of what the Marketplace/Exchange in Kansas looks like.

The Kansas Insurance Department has a consumer friendly site that helps individuals and families understand the new Marketplace and offers some resources for support in making decisions.

Our colleagues at the Kansas Health Institute have a very informative map on their home page that shows what the ranges of prices for health insurance premiums through the Exchange are in Kansas.  HHS reports that the average monthly premium for a middle of the road plan in Kansas is $260/month, less than the US average of $328/month, the fifth lowest rates in the nation.

The Kansas Health Institute also has an issue brief on the Marketplace.  The brief includes

  • a summary of the 65 types of plans being offered to individuals and
  • tables showing examples of costs depending on region of state, age, and income level including the range of monthly savings for those receiving tax credits (between $100 and $1000/month depending on age and income level).


How the Marketplace works even in spite of delayed employer mandate

Much has been made about the Obama administration’s recent decision to delay till Jan 1, 2015 the implementation of the employer mandate (requirement that all businesses over 50 full time employees provide adequate and affordable health insurance to their workforce).  This thoughtful piece from Wendell Potter (former insurance company CEO) of the Center for Public Integrity states well how this issue is being overblown from the perspective of having insurance available for citizens.  Many believe that the Marketplace will be ready to open in October for plans to begin January 1 and it is that marketplace that offers new potentials for consumers:  anyone can purchase insurance regardless of a pre-existing condition and workers will no longer be job locked because of health insurance benefits leading to the potential for more small business start ups (covered in an earlier blog).

Wendell does not deal with the individual mandate and how that will “encourage” the purchase of insurance (weak disincentive in the form of relatively minimal fines if one does not participate).  Not surprisingly, we are now seeing calls to delay the individual mandate timing to balance the delay in the employer mandate.  The NY Times had this to say about those Republican efforts.

I agree with Wendall that many of the few who work for large firms that will take advantage of this delay will welcome having an alternative Marketplace where they can go to purchase insurance and, depending on income, receive tax credits (basically have Uncle Sam share the premium bill with them).

One issue that I’ve not yet seen discussed has to do with how this is likely to increase the costs borne by the federal budget.  All along ACA has been predicated on the success of three different legs of the stool that make up how Americans are to be insured: employer-based insurance, public insurance, and now the Marketplace.

Employer-based insurance is a major leg of that stool.  Part of ACA’s success in reining in costs was the expectation that larger employers would help foot the bill by offering insurance as a work benefit.  Prices of products and services those businesses sell have always been impacted by how much their insurance costs are.  That will continue, unless and until health care prices are better controlled.

However, if some of this leg is less strong because some of the businesses over 50 don’t have to participate for another year, that means that workers may be looking to another leg of the stool, the Marketplace.  How much that Marketplace may cost the federal government may now be a heightened concern.

The initial ACA cost estimates for the federal portion of Marketplace costs were based on a certain number of individuals using the Marketplace and being eligible for tax credits.   The delay in the employee mandate is likely to increase the numbers looking to the Marketplace (after all, most Americans would have been buying insurance if it had been affordable and they had not been denied coverage).  And many of those new ones in the Marketplace will be eligible for tax credits where they would not have been had they be in employer sponsored plans.  So the costs of the delay of implementation of the employer mandate may result in a larger burden for cost sharing on the part of the federal government.

An interesting benefit of all of this is that we will be able to see more clearly just how much is really being spent on health care, at least as much as we translate the cost of premiums to be a reflection of the cost of care.  Right now many of the costs for the uninsured, the uncompensated care, get built into the cost of premiums for those of us who do purchase insurance.  And the costs borne by businesses are buried in the costs they charge for their products and services.  Perhaps more transparency of what it really is costing us for health care, and what we are really getting for those dollars (not very good population health outcomes) will help us ask the more difficult questions about the quality of what we are buying.  All thoughts for another day.


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”

How different states are collaborating in setting up the federally sponsored marketplaces

This report from the Urban Institute looks at the roles 3 states, Alabama, Michigan, and Virginia are playing in the implementation process in their states of federally-facilitated marketplaces/Exchanges. The other states, including Kansas, are not detailed but one can assume similar types of variations in style of collaboration.

The paper’s findings include:

  • Two of the three states are actively engaged in their exchange’s development, although some stakeholders noted they need more information from the government to complete the exchange and prepare themselves in a timely manner.
  • State Departments of Insurance view the regulations and their role in the exchanges as a continuation of their work pre-reform.
  • States are at different stages of readiness, Alabama for instance is lagging as a result of political/administrative hurdles the state faced and they have no plans to assist in the exchange’s development.
  • Consumer assistance programs will need to be created to help people navigate the exchange, although clearing political hurdles will be a challenge in the acquisition of federal funds to pay for such programs.

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 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.