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Affordable Care Act

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We want to help you understand the law and how it will affect you.

Affordable Care Act


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The Affordable Care Act works to help people get health coverage and to lower overall costs. Find out how health care mandates may impact you, whether you're insured through your employer or you buy your own plan.

Affordable Care Act Answers

  • What do I need to know?

    The Affordable Care Act (ACA) has significantly changed the U.S. health care system, bringing guaranteed issue of coverage, tax credits, and the Health Insurance Marketplace. Here's what Kansans like you need to know right now:

    Quality coverage for all

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

    Health insurance for all

     

    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. So things 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.

    You may get financial assistance

    A number of Kansans will qualify for government assistance through an Advanced Premium Tax Credit or cost-sharing reductions. The tax credit is applied directly to your monthly payments.

    Cost assistance is available

     

    You may face a penalty if you don't enroll

    This federal income tax penalty would either be two and a half percent of your household income that is above the tax return threshold for your filing status, or a flat dollar amount of $695 per adult and $347.50 per child (maximum of $2,085), whichever is greater.

  • Two ways to shop for health insurance

    You can purchase a plan directly from us!

    Blue Cross and Blue Shield of Kansas provides many 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!

    You'll find us on the Marketplace

    If you're eligible for a tax credit, you'll need to go through the Marketplace. Benefits and pricing are the same, and you will have several options to consider.

    Two ways to shop for health insurance

     

    Finding a plan that fits

    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.

    Find the right plan

     

    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
  • How do I get an advanced premium tax credit?

    The advanced premium tax credit

    The premium tax credit is an advance, refundable tax credit designed to help eligible individuals and families with low or moderate income afford health insurance purchased through the Marketplace. You can choose to have the credit paid in advance to your insurance company to lower what you pay for your monthly premiums, or you can claim all of the credit when you file your tax return for the year.

    Income requirements

    The benefit levels of many government assistance programs are based on federal poverty levels (FPL). You would be eligible for tax credits if your income falls between 100 percent and 400 percent of the FPL.

    Cost assistance is available

     

    Eligibility

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

    • Purchase coverage through the Marketplace
    • Have household income that falls between 100 percent and 400 percent of the federal poverty level
    • 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
  • What is the tax penalty this year?

    You may face a penalty if you don't enroll

    This federal income tax penalty would either be two and a half percent of your household income that is above the tax return threshold for your filing status, or a flat dollar amount of $695 per adult and $347.50 per child (maximum of $2,085), whichever is greater.

  • ACA Resources

    Healthcare.gov - Health and Human Services' site dedicated to health care reform and home of the Health Insurance Marketplace

    IRS.gov - Learn about tax implications associated with health care reform

    Kaiser Family Foundation - Health policy, research and analysis tied to health care reform

    Employer Responsibility Under the Affordable Care Act - As of 2015, larger employers will face penalties if they don't make affordable health benefits coverage available. This flowchart illustrates how those employer responsibilities work.

    Health Insurance Marketplace calculator - Helpful tool from KFF that illustrates how tax credits will be calculated

    Kansas Insurance Department - Find details specific to the State of Kansas Health Insurance Marketplace

    WhiteHouse.gov - Special section on health care reform from the White House

    Blue Cross Blue Shield Association - Perspectives and information from the national association

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