By CELIA LLOPIS-JENSEN
Kansas News Service
TOPEKA — The 2020 federal marketplace for individual health insurance includes more options than ever for Kansas, and premiums for some of those plans are less expensive than 2019. But for the second year in a row, all of the plans will leave consumers footing the full bill for most out-of-network care.
The silver lining: Two new insurance companies have jumped into Kansas this year, offering health plans in some of the state’s most populous counties. A third insurer that’s already active in Kansas City and its suburbs is expanding to 12 more southeast and central Kansas counties.
Statewide, five insurers are offering 82 plans for 2020 — the most insurers since 2015 and the most plans since the marketplace launched in 2014. Though availability varies by county, it’s a significant change from this year (three insurers, 23 plans).
Enrollment starts Nov. 1 and runs through Dec. 15 for insurance policies that start on Jan. 1.
For Kansans with questions about all the options, dozens of trained counselors and navigators across the state offer free guidance on comparing plans and applying.
“It is relatively easy to compare plans, but you still have to do a lot of legwork,” said University of Kansas professor Jean Hall, who directs the Institute for Health and Disability Policy Studies. “I strongly recommend that people work with the navigators.”
Check for federally designated counselors and navigators near you here and here. Search for the health insurance plans available in your county here.
Pro tip from Hall: Sometimes online information from insurers about their networks is out of date, so consider calling to confirm whether specific health care providers are still included in a given plan.
No PPOs in 2020
Preferred provider organization (PPO) plans have disappeared from the marketplace across Kansas and much of the country, according to Katherine Hempstead, a senior policy adviser at the Robert Wood Johnson Foundation in New Jersey.
Kansas also mirrors the national trend with the addition of more insurers and plans this year. Hempstead describes companies as “bullish” right now.
“They’re entering the market in more places and they’re offering more things,” she said. “There’s a lot of optimism.”
But the lack of PPOs can be especially bad for people who need specialized care, Hall said.
“If people have different types of chronic conditions,” she said, “one of their specialists may be in network but the other one may not be. And that can be a real problem.”
In 2020, most plans are exclusive provider organization (EPO) options, but some Kansans can also pick from health maintenance organization (HMO) plans. Unlike PPOs that often cost more and help with out-of-network bills, HMOs and EPOs restrict coverage to their networks. Some networks include more doctors and specialists than others. HMO plans generally require customers to go through a primary care provider to access specialists.
New options include some cheaper plans with small networks, as well as zero-deductible plans that make you pay more in cost-sharing, Hempstead said.
The new insurers on this year’s market are Oscar Insurance Company and Cigna Health & Life Insurance. They join Blue Cross Blue Shield of Kansas, Ambetter (a.k.a. Centene subsidiary Sunflower State Health Plan) and Medica.
Ambetter will expand to southeast and central Kansas.
Premiums and income-based discounts
Many Kansans will see lower rates in 2020. The benchmark silver plan for a 27-year-old is dropping $40 to an average premium of $412 in 2020, according to the Centers for Medicare and Medicaid Services.
Ambetter rates in particular will drop more than 8% after the company gave hefty rebates this fall to customers who overpaid on 2018 premiums.
Many people may not realize they qualify for discounts. Last year, more than 85% of people got income-based tax credits, the Kansas Health Institute* says. With those, the institute pegs a net average premium at $76 a month.
This federal tool checks whether you might qualify for tax credits and other help.
Navigators and other ACA help
Navigators, who help people choose plans, used to be more common, but the Trump administration cut most funding for them. Still, there are dozens of certified application counselors across the state that serve the same function without the navigator label.
Healthcare.gov also operates a hotline (1-800-318-2596).
Shannon Little-Haines, who oversees navigators at Ascension Via Christi in Wichita, recommends people bring plenty of specifics to the conversation.
“We generally ask that they bring a list of their medications, any specialists and doctors that they see,” she said. “Then we can compare the plans side-by-side.”
*The Kansas Health Institute receives support from the Kansas Health Foundation, a funder of the Kansas News Service.
Celia Llopis-Jepsen reports on consumer health and education for the Kansas News Service. You can follow her on Twitter @Celia_LJ or email her at celia (at) kcur (dot) org. The Kansas News Service is a collaboration of KCUR, Kansas Public Radio, KMUW and High Plains Public Radio focused on the health and well-being of Kansans, their communities and civic life.