The second year of the Affordable Care Act’s online health insurance marketplace begins Saturday.
Under the controversial health care law, health insurance is required for most people or they will have to pay a fine as part of their taxes.
The website was riddled with problems at the beginning of open enrollment last year. However, by the end of the extended open enrollment period, more than 8 million Americans – including more than 57,000 Kansans – signed up for health coverage.
Four companies offered plans through the marketplace in Kansas during its first year: Blue Cross and Blue Shield of Kansas, Blue Cross of Kansas City, Coventry Life and Health, and Coventry Health Care of Kansas. Coventry is offering both a PPO and an HMO product, which is the reason for the two different companies.
This year another company, Blue Cross and Blue Shield of Kansas Solutions Inc., a health maintenance organization, will also offer plans.
Plans vary from state to state, but all plans on the marketplace must include certain “essential health benefits” that have varying amounts for out-of-pocket costs and premiums.
There are four regular plans – bronze, silver, gold and platinum – that have different levels of premiums and out-of-pocket costs associated with them. All have to cover emergency services, hospitalization, maternity and newborn care, mental health and substance-use disorder services, prescription drugs, laboratory services, preventive and wellness services, chronic disease management and pediatric services, as well as oral and vision care.
People who meet certain income requirements may be eligible for government subsidies to help cover their health insurance cost.
Because the Affordable Care Act was designed to accompany an expansion of Medicaid, states like Kansas that didn’t expand Medicaid have a “Medicaid doughnut hole,” health care officials say, where some people make too much to qualify for Medicaid but not enough to afford insurance.
The federal government passed a rule that those in the “hole” won’t have to pay penalties if they don’t purchase health insurance under the individual mandate. But that will still leave a portion of the population uninsured.
The law also mandates that people cannot be denied health insurance because of a pre-existing condition.
For more information, visit www.HealthCare.gov.