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Health Insurance Marketplace

You can find answers to questions about the Healthcare Insurance Marketplace for all states online at healthcare.gov. If you need specific information about coverage available in Kansas or Missouri, call 800-318-2596.

Health Insurance Marketplace FAQs

  • The marketplace is an online portal where you can shop for health insurance plans that fit your or your family's needs. You can compare plans based on price, benefits, quality and other features important to you before you decide which plan to purchase.
  • If you live in Kansas or Missouri, visit healthcare.gov for the Health Insurance Marketplace.
  • Kansas and Missouri residents can call toll-free 800-318-2596. Representatives are available 24 hours a day, seven days a week to assist you.
  • Most people will be eligible for health coverage through the Health Insurance Marketplace. To be eligible for health coverage through the marketplace, you:

  • Having health coverage can help protect you from potentially high costs associated with healthcare. Insurance coverage protects you from high medical costs two ways:

    • Out-of-pocket maximum: This is the total amount you'll have to pay if you get sick. For example, if your plan has a $3,000 out-of-pocket maximum, once you pay $3,000 in deductibles, coinsurance and copayments, the plan will pay for any covered care above that amount for the rest of the year.

    • No yearly or lifetime limits: Health plans in the marketplace can't put dollar limits on how much they will spend each year or over your lifetime to cover essential health benefits. After you've reached your out-of-pocket maximum, your insurance company must pay for all of your covered medical care with no limit.
  • No matter how you buy your health insurance – through the marketplace, directly from an insurance company or with the help of an agent or broker – all plans for individuals and small groups must cover the same set of essential health benefits. These benefits include certain doctor visits, hospital stays, preventive services, prescription drugs, mental health and other categories of coverage.

    Plans will not be able to charge you more or refuse to cover you if you have a preexisting condition.

    Most plans also must offer the consumer rights and protections provided under the healthcare law. When you apply for marketplace coverage, you'll find out whether you qualify for lower costs on your premiums or out-of-pocket costs. These savings are based on your household income and size. An individual making up to about $45,000, or a family of four making up to about $94,000, may qualify for these lower costs.

  • The marketplace cost-sharing reduction lowers the amount you have to pay for out-of-pocket costs like deductibles, coinsurance and copayments. These are costs you have to pay when you get care. Savings are based on your income and family size.
  • Being sick won't keep you from getting health coverage. An insurance company can't turn you down or charge you more because of your condition. Once you have insurance, it can't refuse to cover treatment for preexisting conditions. Coverage for your preexisting conditions begins immediately. This is true even if you have been turned down or refused coverage due to a preexisting condition in the past.

    The only exception is for grandfathered individual health insurance plans – the kind you buy yourself, not through an employer. They do not have to cover preexisting conditions.

    If you have one of these plans, you can switch to a marketplace plan during open enrollment and immediately get coverage for your preexisting conditions.

  • If you're unemployed, you may qualify for Medicaid, the Children's Health Insurance Program or lower costs on Health Insurance Marketplace plans based on your income.

    Your household size and income, not your employment status, will determine what health coverage options you're eligible for and how much help you get paying for coverage. When you apply for marketplace coverage, you will report your current income and estimate your income.

  • Most health insurance plans offered in the marketplace have networks of hospitals, doctors, specialists, pharmacies and other healthcare providers. Networks include healthcare providers that the plan contracts with to take care of the plan's members. Depending on the type of policy you buy, care may be covered only when you get it from a network provider.

    When comparing plans in the marketplace, you will see a link to a list of providers in each plan's network. If staying with your current doctor is important to you, check to see if they are included before choosing a plan.

  • Learn about the different types of health coverage. Through the marketplace, you'll be able to choose a health plan that gives you the right balance of costs and coverage. You can be better prepared if you understand the types of coverage you'll choose from.

    • Make a list of questions you have before it's time to choose your health plan.
    • Make sure you understand how coverage works, including things like premiums, deductibles, out-of-pocket maximums, copayments and coinsurance. You'll want to consider these details while you're looking for health insurance.
    • Gather basic information about your household income. Most people using the marketplace will qualify for lower costs on monthly premiums or out-of-pocket costs. To find out how much savings you're eligible for, you'll need income information, like the kind you get on your W-2, current pay stubs or your tax return.
    • Set your budget. There will be different types of health plans to meet a variety of needs and budgets. You'll need to figure out how much you want to spend on premiums each month.
    • Ask your employer if the company plans to offer health insurance. If not, you may need to get insurance through the marketplace or from other sources. If you don't have coverage, you may have to pay a fee.
    • Explore current options. You may be able to get help with getting coverage now through existing programs. Learn more about health insurance for children up to age 26, and programs for people and children in families with limited incomes, like Medicaid and the Children's Health Insurance Program. Medicare covers people who are 65 and older or who have certain disabilities.
    • Find out which marketplace will serve you. If your state has its own health insurance website, use it to compare your options and enroll in coverage. If your state doesn't have a health insurance website, use healthcare.gov.
  • Yes. Employer-sponsored coverage is generally minimum essential coverage. If an employee enrolls in employer-sponsored coverage for themselves and their family, the employee and all the covered family members have minimum essential coverage.
  • No. You, your spouse and your dependent children do not have to be covered under the same policy or plan. However, you, your spouse and each dependent child for whom you may claim a personal exemption on your federal income tax return must have minimum essential coverage or qualify for an exemption, or you will owe a payment when you file.
  • Yes. Grandfathered group health plans provide minimum essential coverage.
  • Yes. Retiree health plans are generally minimum essential coverage.
  • Yes. Employer-sponsored coverage is minimum essential coverage regardless of whether the employer is a governmental, nonprofit or for-profit entity.
  • No. You will be treated as having minimum essential coverage for a month as long as you have coverage for at least one day during that month.
  • Individuals are treated as having minimum essential coverage for a calendar month if you have coverage for at least one day during that month. Additionally, as long as the gap in coverage is less than three months, you may qualify for an exemption and not owe a payment.

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