If you have further questions, please contact the KID Consumer Assistance Division by calling 1-800-432-2484 or through the online form.
The Affordable Care Act in Kansas
Frequently Asked Questions
The following information is provided as a service of the Kansas Insurance Department. Remember to also check the documents and links on our main Affordable Care Act page.
Questions and Answers:
Q: Will Medicare change?
A: The law does not cut benefits to regular Medicare beneficiaries. It is supposed to save $500 billion over the next 10 years. The savings is to come from (1) reducing federal payments to insurance companies that offer Medicare Advantage plans (which are private Medicare plans that offer regular Medicare benefits plus other company benefits); (2) reduced increases in provider payments; and (3) actions to reduce waste, fraud and abuse. Also, more preventive services are now covered, and the “doughnut hole” for prescription drug coverage gets smaller each year until it closes completely by 2020.
Q: What major parts of the law are in effect right now?
A: Under most health insurance plans today, you can receive preventive services with no out-of-pocket costs; children with pre-existing conditions can’t be turned down for coverage; insurance companies can no longer cancel your coverage just because you made an honest mistake; young adults up to age 26 can stay on their family health insurance; lifetime dollar limits on health benefits no longer exist; and insurers must give refunds to consumers if companies spend less than 80 or 85 percent of their premium dollars on medical care (the percentage depends on what kind of coverage you have).
Q: I own a small business with fewer than 50 full-time employees. Do I have to provide health insurance for them?
A: No. The law says starting in 2014 any company with 50 or more full-time employees has to provide coverage or pay a penalty. Under the law, about 50,000 Kansas small businesses will not be required to provide coverage for their employees. The law does offer small companies with fewer than 25 full-time employees a tax credit, however, if they pay at least half the cost of their employees’ health insurance coverage.
Q: What is a health insurance exchange?
A: A health insurance exchange is an online marketplace set up under the law where individuals and small businesses can shop for health plans from private insurance companies. The plans have to meet the law’s requirements and other standards established by the operator of the exchange. Each state’s exchange is set to offer coverage beginning Jan. 1, 2014. People may seek federal financial assistance when they apply, and the exchange operators will determine their eligibility. If a person qualifies for Medicaid instead, he or she will be referred to the state Medicaid program.
Q: Why is the insurance department so involved in this law?
A: The Kansas Insurance Department is the state agency that regulates insurance in the state. With the law, we have a lot of information to gather so that government and legislative leaders can make informed decisions. We want to work to provide the best options for Kansans, and that means planning.
Q: What parts of the Affordable Care Act (ACA) will go into effect in 2014?
A: In 2014, the ACA requires insurance companies to provide coverage to anyone who applies – you can’t be turned down because you have health problems. The premium you pay will be based only on your age, whether you use tobacco products, where you live, and whether you are buying insurance just for yourself or for your family. Rates will not be based on your health condition or gender. Also, you will be able to buy insurance online through a health insurance exchange.
Q: How will a health insurance exchange work?
A: The online exchange will be similar to a shopping website. Consumers can compare insurance plans that are available based on where they live and their income. Tax credits and other payment help will be available to individuals and families who qualify and want to use the assistance. Lower income consumers will be directed to Medicaid services. There will be people to assist you if you don’t have a computer.
Q: Who will run the exchange, the state or the federal government?
A: The ACA gives each state the option to set up an exchange. So far, 16 states have indicated they want to run their own exchange. In a state exchange, many decisions are left up to the state. The law requires the federal government to set up an exchange for any state that chooses not to. The federal government will either run that exchange entirely or will form a partnership with the state so the state can operate some parts of the exchange. In Kansas, I hope to enter into a partnership so our insurance department can continue to approve insurance rates, as well as approve policies offered on the exchange, and assist consumers with their complaints.
Q: I'm a veteran. What will happen to my health care coverage?
A: Nothing. The law does not make any changes to VA benefits.
Q: I hear people say the health law kills jobs? Is that right?
A: No one is certain about the future, but many have made predictions. A California study said that the law will create more than 100,000 jobs in California alone, since more people will be able to access health care services. An Urban Institute study said there would be no noticeable effect on net levels of employment, since most companies are not affected, and gains and losses in the economy will even out. A Heritage Foundation study said 700,000 jobs will be lost, primarily those workers making close to minimum wage. The Congressional Budget Office says that about 800,000 people could take advantage of the law’s provisions for health care coverage and retire earlier, go to part-time work, or start their own small business.
Employment decisions are made by business owners. The impact of the ACA will be difficult to measure for many years. I believe the Urban Institute conclusions to be the most likely – some jobs will be created, some will be lost.
Q: I don't want to take a handout (subsidy) from the government. What can I do?
A: You may continue to buy an individual policy as you have in the past. If you don’t want government assistance, you do not have to accept it. You can simply buy a health insurance policy that meets your needs, as long as the policy meets the minimum benefits that are required.
Q: Is a health insurance exchange a government takeover of health care?
A: The ACA says that exchanges will need to be set up in every state by either the state or federal government. However, the plans offered in that exchange will be sold by many of the same private insurance companies that already do business in Kansas. They will pay the doctors and hospitals much like today. The government will not operate any of those insurance plans.
Q: Are we going to have health care rationing?
A: The law doesn’t talk about health care rationing. Insurance companies will continue to decide whether services recommended by your doctor are covered under the plans they sell. Our department will continue to help consumers appeal insurance company decisions, just like we do now.
Q: Will I pay more for my health coverage because of the law?
A: The answer to this will vary from person to person. All people enrolled in a particular health plan share the costs associated with that plan. Since the ACA requires that nearly every adult purchase health insurance or pay a penalty, more people may be enrolling in coverage. If more individuals enroll in your plan, the costs will be spread among a larger group, and your costs could go down. Costs may increase for some. For others costs might stay the same or be lower, depending on how many people are enrolled in their plan and how much their health care costs.
Q: Will we need more doctors and nurses?
A: As more people are covered by insurance, it is safe to assume they will want to visit a doctor to get the health care they need. The Association of American Medical Colleges has estimated that by 2020 the United States will need up to 90,000 more doctors than will be available. The ACA addresses this concern by offering scholarships to new medical students and student loan forgiveness programs to new doctors who are willing to live in parts of the U.S. that currently do not have enough working doctors. Some 2011 reports show record numbers enrolling in medical school and increased nursing school applications. And, the opportunity for PAs (Physician Assistants) and ARNPs (Advanced Registered Nurse Practitioners) to provide services will increase.
Q: How much control will I have over my health insurance choices in 2014?
A: If you currently buy your health insurance on your own (not through your employer), you will still be able to keep your current coverage, or you will be able to buy a different plan inside the exchange.
If you get your insurance through your employer, your employer may choose to keep the same health insurance coverage offered to you now, or the business may choose to offer coverage through the exchange. You may have a choice of more than one insurance plan to meet your needs.
If, in 2014, you do not have insurance or want to make a change in your coverage, you will be able to buy insurance through the exchange, even if you have a health condition that has made it difficult to get private insurance coverage in the past. Plans bought on the exchange will be sold by different insurance companies and will offer different levels of coverage for a range of prices.
The exchange will also tell you whether your doctor or local hospital is included in plans you are interested in. People who buy their health insurance through the exchange may be eligible to get tax credits or other assistance to help pay for their health insurance. This assistance will not be available to anyone who buys insurance outside of the exchange. No one, however, will be required to take the tax credit or assistance.
Q: I buy my own health insurance for my family and myself. How will this law help me?
A: Some benefits of the law, like allowing a child to remain on a parent’s policy until age 26 and the removal of lifetime dollar limits, are already in place. Starting January 1, 2014, most Kansas health insurance plans will offer minimum coverage requirements called “essential health benefits.” The plans will be priced in levels that relate to how much of your health care costs the health insurance company will pay. The levels are labeled bronze, silver, gold and platinum. The cost of coverage varies from level to level; the essential health benefits, however, remain the same in each level. This should make it easier to compare plans when shopping for health insurance. Also, depending on your income, you may qualify for a tax credit (federal prepayment for premiums) and/or a subsidy (reduced out-of-pocket payments) if you are buying coverage on the health insurance exchange.
Q: I've heard that young people are going to pay more for coverage. Why is that?
A: The Affordable Care Act requires premiums for older individuals to be no more than 3 times the amount young people pay. Today, the difference in premiums is often much greater. With the change, some people may pay more and others may pay less. One part of the law that may be financially helpful to people under the age of 30 is their option to purchase a “catastrophic” health plan. This plan will provide coverage in the event of serious illness or injury. It will be cheaper than comprehensive coverage, but it will provide limited primary care and preventive benefits.
Q: What about dental coverage under the law?
A: The ACA only requires health insurance plans to include “pediatric (children’s) dental” benefits in the approved plans. We expect adult dental plans and riders may also be offered as optional coverage on the exchange, and they will also be available for purchase outside the exchange, just as they are now.
Q: All I hear about the Affordable Care Act involves exchanges and insurance. Is there anything in the law to make health care affordable?
A: While health insurance exchanges and insurance get most of the attention, there are many other parts to the law. The ACA uses private health insurance to provide coverage for those who are uninsured. That means that competition determines the price. There are new programs to find ways to improve the quality of care, to lower costs, and improve access to healthcare. Some involve improvements in the Medicare and Medicaid programs; others encourage finding ways to help people stay healthy throughout their lifetimes. There are also parts of the law that crack down on health care fraud. To increase access to care, new scholarships will be available to medical students who agree to work in underserved areas. And, the law expands funding for specialized public dental health training for dentists and community health centers.
Q: I want health insurance but I can't afford it. What can I do?
A: The law specifically assists people who have not been able to afford coverage in the past. Depending on your annual income, you may qualify for tax credits and/or subsidies to help pay for health insurance premiums and out-of-pocket costs. These will be available for people who have incomes up to 400 percent of the federal poverty level (FPL). There is a sliding scale of income to determine the 400 percent level of FPL. It is based on the number of family members. For example, in 2012, 400 percent of the FPL is $44,680 for an individual and $92,200 for a family of four.