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If you have further questions, please contact the KID Consumer Assistance Division by calling 1-800-432-2484 or through the online form.
National Health Insurance Reform
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 Health Reform page.
When will the health insurance reform law take effect?
The health insurance reforms adopted as part of the Patient Protection and Affordable Care Act (PPACA), and the subsequent reconciliation bill, are phased-in over the next 5 years. Most provisions will not take effect until Jan. 1, 2014. However, some new protections must be included in health plans issued or renewed on or after Sept. 23, 2010.
For more information on when certain provisions become effective, you can visit the NAIC Health and Managed Care Committee web page (http://www.naic.org/committees_b.htm) and look for the PPACA charts or the Kaiser Family Foundation website (http://www.kff.org/healthreform/8060.cfm).
FAQ Category: Consumers
Will I be required to give up my current coverage?
Health plans in effect as of March 23, 2010, are "grandfathered" under the law and will be considered "qualified coverage" that meets the mandate to have health insurance that begins January 2014. However, changes made to a plan that involve an increase in cost-sharing (e.g., co-payments, co-insurance, or deductibles) may result in a loss of a plan's grandfathered status. You should consult with your insurance company for further information regarding the status of your plan.
FAQ Category: Consumers
When can my 21 year-old be added to my plan?
The health reform law requires that insurers and employers providing dependent coverage to children make that coverage available to adult children of enrollees up to their 26th birthday. This requirement becomes effective for "plan years" beginning on or after Sept. 23, 2010, so you will be able to enroll your child in group coverage at the first open enrollment period following this date. Since the term "plan years" is generally used in the group health insurance market, the term "policy year" is substituted for plan year in determining when an adult child may be enrolled as a dependent on an individual health insurance policy.
The term "policy year" is defined as the 12-month period that is stated in the individual coverage policy document or, if the policy document does not designate a policy year, then the policy year is the deductible or the limit year or the calendar year if deductibles or other limits are not imposed on a yearly basis.
An insurer may charge an additional premium for coverage of adult children depending on the terms of the policy with regard to coverage for dependents. If the child is age 19 or older, the health plan may exclude coverage of pre-existing conditions for a period of time, as allowed by existing state and federal law until the prohibition on pre-existing condition exclusions takes effect in 2014.
FAQ Category: Consumers
When can I enroll my 10 year-old who has a pre-existing condition?
The health reform law, and regulations released on June 28, 2010, prohibit insurance plans from denying coverage to children based on pre-existing conditions. This ban includes both benefit limits (e.g., an insurer or employer health plan refusing to pay for certain services because of the child's pre-existing condition) and denial of coverage (e.g., an insurer refuses to offer a policy to the family for the child because of the child's pre-existing medical condition).
FAQ Category: Consumers
What are "Exchanges"? Can I still purchase coverage through my agent?
Exchanges are the "web-based marketplace" created by the health reform bill to help individuals and small businesses purchase health insurance coverage. Beginning in 2014, an Exchange will be established in each state to help consumers make valid comparisons between plans that meet federal requirements for quality and affordability. The Exchanges will also administer the new health insurance subsidies and facilitate enrollment in private health insurance, Medicaid and the Children's Health Insurance Program (CHIP). Nobody will be required to purchase health insurance through the Exchange, though subsidies will only be available for plans sold through the Exchange. Under the provisions of the federal law, insurance agents and brokers will be able to assist individuals and small businesses purchase health insurance through the Exchange and continue to purchase plans that are not included in the Exchange. In addition, agents and brokers will be able to assist individuals and small businesses with applying for cost-sharing reductions and premium tax credits for plans sold through the Exchange.
FAQ Category: Consumers
I have been denied coverage because I have a pre-existing condition. What will this law do for me?
You may be able to qualify for coverage in the new federal Preexisting Condition Health Plan - KS (PCIP-KS), which is being administered by the Kansas Health Insurance Association. Under federal law individuals who are U.S. citizens or legal residents, who have not had coverage for at least six months, and who have a preexisting health condition, which may have prevented them from obtaining coverage in the past, may be eligible to participate in this new Plan. The PCIP-KS will provide coverage that immediately covers pre-existing conditions at premiums that are capped at the average cost of private coverage in Kansas' individual health insurance market. Kansans who want to obtain additional information or apply for enrollment in the new PCIP-KS may call 1-877-505-0511 or visit the KHIA website at www.khiastatepool.com and click on the link under "Pre-existing Condition Insurance Plan - KS (PCIP-KS)."
In 2014, when the Exchanges become operational, insurers will be prohibited from discriminating against individuals with pre-existing conditions in offering or pricing health insurance policies. In addition, for those with qualifying incomes, subsidies will be available to reduce premiums and cost-sharing for plans purchased through the Exchange.
FAQ Category: Consumers
I am single, have no children and earn less than $11,000 per year. What coverage choices will be available to me?
Beginning in 2014, single adults earning between $10,830 and $14,400 will be able to choose whether to enroll in Medicaid or to purchase coverage through the Exchange with a federal subsidy. Those earning less than $10,830 will be eligible for their state?s Medicaid program, but not for subsidies in the Exchange.
FAQ Category: Consumers
My family income is about $45,000, but my employer does not subsidize our health insurance and we cannot afford it on our own. What will the new law do to make coverage more affordable?
Low- and moderate-income individuals and families whose employers do not subsidize health insurance coverage will be eligible for financial subsidies to help them purchase coverage through the Exchange in their state. The amount of these subsidies, which will reduce premiums and out-of-pocket costs for deductibles, co-payments and coinsurance, will depend upon the size of your family and your household income.
FAQ Category: Consumers
What should I do if my insurance company rescinds my coverage?
If your insurance company "rescinds," or retroactively cancels, your health insurance coverage, it will be required, in plan years beginning on or after Sept. 23, 2010, to provide advance notice of its intention to do so, and may only do so if you committed fraud or made an intentional misrepresentation of an important fact on your application. If your insurance company notifies you that it wants to rescind or cancel your policy, and you have not done either of these things, request more information from the company. If you are not satisfied with their explanation, immediately contact the Consumer Assistance Division of the Kansas Insurance Department.
FAQ Category: Consumers
How will the law improve access to preventive care?
Beginning on or after Sept. 23, 2010, plans that became effective after March 23, 2010, must, upon renewal, eliminate any cost-sharing for preventive services covered under the contract. Plans that were in effect on or before March 23, 2010, referred to as "grandfathered" plans, are not required to provide this additional benefit at this time unless or until their grandfathered status is lost. Additional information regarding the preventative services that must be covered without cost-sharing is available at http://www.healthcare.gov/law/about/provisions/services/index.html.
FAQ Category: Consumers
Can I still have a Health Savings Account (HSA)?
Yes, you will still be able to contribute to your HSA because nothing in the new federal law prevents an individual from contributing to a Health Savings Account (HSA), or discourages an individual from doing so. The minimum level of coverage required to meet the individual mandate was specifically designed to allow for the purchase of a qualified high deductible plan that would complement the HSA. See our document Federal Health Care Reform and Health Savings Accounts for more information.
FAQ Category: Consumers
What is the new small business tax credit and how do I know if I am eligible?
The Small Business Tax Credit is available beginning with the 2010 Tax Year. Businesses with fewer than 25 full-time equivalent employees (FTE) and average annual wages less than $50,000 per employee may qualify. To receive the tax credit, an employer must have a group health plan and must pay at least 50% of the premium.
The tax credit is equal to a percentage of what the employer pays and is based on the average premium in the small group market in the state. For tax years 2010 through 2013, the maximum credit in each year is 35% of the employer's contributions (25% for nonprofit employers). Beginning tax year 2014, the maximum credit is 50% of the employer's contribution (35% for nonprofit employers). The full 35% tax credit (50% in future years) is available for a business with 10 or fewer full time equivalent workers and average annual wages of $25,000 or less. The tax credit phases out completely at 25 workers (FTEs) or average wages of $50,000. See our document Questions and Answers on the Federal Small Employer Health Insurance Tax Credit for more information.
FAQ Category: Employers
I have five employees. Will I be required to provide insurance for my employees?
No. The employer responsibilities under the health reform law do not apply to employers with fewer than 50 employees. However, you will be able to enroll your employees in coverage by contacting your local insurance agent or through the Exchange beginning in 2014.
FAQ Category: Employers
I have 75 employees. Will I be required to provide insurance for my employees?
Yes. An employer that fails to offer "minimum essential coverage," as defined by the Secretary of Health and Human Services, to its employees will be subject to a penalty of $2,000 for each of their employees beyond the first 30. In your case, this penalty would be $2,000 x (75-30) = $90,000. If an employee's share of the premium for coverage provided by an employer exceeds 9.5% of his or her household income, employers that do offer minimum coverage will be assessed a penalty of $3,000 per employee that receives a subsidy through the Exchange.
FAQ Category: Employers
I am self-employed. Will the new law impact my health insurance choices?
Yes. Beginning Jan. 1, 2014, self-employed individuals and their families must be included in the small group market in all states and will have the option of purchasing coverage through the Exchange. This will increase plan choices and include the self-employed in a more stable pool.
FAQ Category: Employers
Will I be required to drop my current coverage?
Group health plans in effect as of March 23, 2010, are "grandfathered" under the law and will be considered "qualified coverage" that meets the requirement to have health insurance that begins January 2014. Employees and dependents can be added to the policy without losing grandfather status, but changes made to a plan that involve an increase in cost-sharing (e.g., co-payments, co-insurance, deductibles, or reduction in the percentage of premium plaid by employer) may result in a loss of a plan's grandfathered status. You should consult with your employer, agent, broker, or insurance company for further information regarding the status of your plan.
FAQ Category: Employers
As an employer, must I go to the Exchange to purchase insurance, or can I continue to purchase through my insurance agent?
The federal law specifically states that businesses are not required to purchase through the small business Exchange.
FAQ Category: Employers
Can I continue to provide assistance to my employees through flexible spending accounts?
Yes, nothing in the PPACA would eliminate or discourage these options. However, beginning in 2011, over-the-counter drugs are no longer considered qualified medical expenses that may be reimbursed. In addition, beginning in January 2013, the amount an employee may annually contribute to a flexible spending account is limited to $2,500/year, subject to adjustments for inflation in subsequent years.
FAQ Category: Employers
Will my Medicare benefits be cut under the new law?
No, the Patient Protection and Affordable Care Act (PPACA) does not eliminate or reduce benefits provided under Medicare.
FAQ Category: Seniors
I currently have a Medicare Advantage plan. Will I be able to keep it?
Yes. The PPACA does not require individuals to drop their Medicare Advantage coverage. It should be noted, however, that Medicare Advantage plans are not guaranteed renewable. Carriers may pull out of a market at the end of the year, forcing enrollees to change carriers or return to Medicare. The PPACA does cut payments to Medicare Advantage plans, which could result in carriers pulling out of more areas.
FAQ Category: Seniors
My prescription drug costs push me into the "doughnut hole" every year. Will I receive any relief under the new law?
Seniors who reach the gap in prescription drug coverage known as the "doughnut hole" will receive a $250 rebate in 2010. Over time, Medicare will gradually phase in additional subsidies in the coverage gap for brand name drugs, beginning in 2013, and generic drugs, beginning in 2011, until the gap is completely eliminated in 2020.
FAQ Category: Seniors
When will the new preventive care improvements begin?
Under the PPACA, all Medicare beneficiaries will receive preventive services without cost-sharing beginning Jan. 1, 2011. In addition, Medicare beneficiaries will be given access to a comprehensive health risk assessment and creation of personalized prevention plan.
FAQ Category: Seniors
I have a Medicare Supplement (Medigap) plan. Must I make any changes to my plan under the new law?
No, the PPACA does not require seniors to change their Medigap coverage. However, the law will be adding cost-sharing requirements to plans C and F that are sold after Jan. 1, 2015.
FAQ Category: Seniors