Kansas Health Insurance Consumer Guide

You must meet certain criteria to qualify for health coverage through the Marketplace in Kansas. Generally, you’re eligible to apply if you:²

• Live in Kansas and are lawfully present in the U.S.
• Are not incarcerated
• Are not enrolled in Medicare

By those standards, most Kansas residents can use the Marketplace. But eligibility for financial assistance is also an important factor. To be eligible for income-based subsidies, you must:

• Not be eligible for affordable, comprehensive employer-sponsored health insurance
• Not be eligible for KanCare (Medicaid/CHIP)
• Not be eligible for premium-free Medicare Part A.³
• If married, file a joint tax return.⁴
• Not be able to be claimed by someone else as a tax dependent.⁴

To buy an ACA-compliant individual or family health insurance in Kansas, sign up between November 1 and January 15 during open enrollment. 

Enroll by December 15 for your coverage to become effective on January 1. But if you enroll from December 16 to January 15, your coverage will start on February 1.⁵

Outside of open enrollment, you can get coverage through the Marketplace if you have a qualifying life event that triggers a special enrollment period (SEP).⁶ Examples of qualifying life events include loss of health coverage, getting married, or permanent relocation.  

Subsidy-eligible applicants can enroll in a Marketplace health plan at any time during the year if their household income doesn’t exceed 150% of the federal poverty level.⁷

People who lose Medicaid or CHIP between March 31, 2023 and November 30, 2024 may also be eligible for a temporary extended SEP.⁸  

American Indians and Alaska Natives enroll in an ACA exchange plan year-round.

If you’re eligible for an ACA Marketplace plan, there are a few ways to enroll, with or without free assistance: 

• Online through HealthCare.gov
• By phone at (800) 318-2596
• With the help of an agent/broker, navigator, or certified application counselor (help is available online, over the phone, or in person)
• Via an approved enhanced direct enrollment entity.⁹

In Kansas, you can find affordable individual and family health insurance through HealthCare.gov – the ACA Marketplace. 

Of the roughly 165,000 people who had effectuated coverage through the Kansas Marketplace in early 2024, nearly 156,000 — 94% — were receiving premium subsidies (advance premium tax credits, or APTC) that averaged $561/month. After the subsidies were applied, the average Kansas Marketplace enrollee was paying about $103/month for their coverage.¹⁰

(The numbers above are based on effectuated enrollment; the chart below has some different metrics, and uses data from all enrollments submitted during the open enrollment period for 2024 coverage.)

In addition to APTC, if your household income isn’t more than 250% of the federal poverty level, you may also be eligible for cost-sharing reductions (CSR), as long as you select a Silver-level plan in the Marketplace.¹¹ CSRs help reduce deductibles and out-of-pocket expenses. 

Source: CMS.gov¹²

You may also find affordable coverage through Medicaid (KanCare) if you’re eligible.

Kansas has not yet implemented the ACA’s expansion of Medicaid for low-income adults. However, children may be eligible for Medicaid or CHIP even if their parents aren’t. For certain families, enrolling children in Medicaid or CHIP while parents get coverage through the Marketplace can be an affordable way to obtain family coverage.  

Kansas had been considering changes to its essential health benefits (EHB) benchmark plan starting with the 2025 plan year (recommendations included coverage of hearing aids, bariatric surgery, and applied behavior analysis for autism).¹³ But appropriations legislation enacted in 2023¹⁴ prohibited the state from using any funds to make changes to the EHB benchmark plan. As a result, the state halted the process of changing its EHB benchmark plan.¹⁵

For 2025, seven insurers will offer plans through the Kansas health insurance Marketplace.¹⁶

This is down from eight in 2024,¹⁷ as Ascension Personalized Care (US Health & Life) is exiting the market at the end of 2024.¹⁸ People enrolled in an Ascension Personalized Care plan in 2024 will need to select a new plan for 2025, during the open enrollment period that begins in November 2024.

There were also eight participating insurers in 2023, but there were some changes for 2024: Aetna was new to the Marketplace in Kansas for 2024, and Cigna stopped offering coverage in the Kansas Marketplace at the end of 2023.

For 2025, the following average rate changes have been proposed by Kansas Marketplace insurers,¹⁹ (Rates are under review by state regulators and will be finalized before open enrollment begins in November 2024.)

Source: Federal Rate Review Summary¹⁹

Rate changes apply to full-price premiums. Since most people using the Kansas exchange receive premium tax credits, they don’t pay the full premium amount.¹⁰ If you qualify for subsidies, your actual rate change will depend on your plan and the subsidy amounts. Factors such as your age can affect your premium too. 

If the cost of your current plan increases, you can explore other health plans in the exchange that may be more affordable and offer comparable benefits.

For perspective, here’s a summary of how overall average premiums have changed over the years for the individual/family market in Kansas, before any subsidies were applied:

• 2015: Average increase of 4%²⁰
• 2016: Average increase of 23%²¹ (carrier with largest rate increase ultimately left the market)
• 2017: Average increase of 36.6%²²
• 2018: Average increase of 29%²³ (BCBSKS rate change wasn’t counted because their plans (HMOs) were terminated and replaced with EPOs) 
• 2019: Average increase of 5.3%²⁴
• 2020: Average increase of 0.3%²⁵
• 2021: Average increase of 7.8%²⁶ (unweighted average)
• 2022: Average increase of 6%²⁷ (unweighted average)
• 2023: Average increase of 7.2%²⁸
• 2024: Average increase of 7.3%²⁹  

During the open enrollment period for 2024 coverage, a significant new record high enrollment was reached in Kansas, with 171,376 people signing up for private plans through the Kansas Marketplace. ³⁰

The previous record high had come the year before, when 124,473 people signed up during the open enrollment period.³¹ 

As with many states, Kansas experienced a pattern where many people signed up in 2016, fewer in the following years, then rebounding enrollment in 2021. This growth trend continued with record highs in 2022, 2023, and 2024. (See chart below that shows year-by-year enrollment.)

The recent increase in enrollment is due in large part to the American Rescue Plan (ARP). Under the ARP, ACA’s premium subsidies are larger and more widely available. ARP has been extended through 2025 by the Inflation Reduction Act.³¹

And the enrollment growth for 2024 is also partially due to the Medicaid disenrollments that resumed in 2023, after being paused for three years during the pandemic. CMS reported that by April 2024, more than 31,000 Kansas residents had transitioned from Medicaid to Marketplace coverage since the disenrollments began in the spring of 2023.³²

Source: 2014,³³ 2015,³⁴ 2016,³⁵ 2017,³⁶ 2018,³⁷ 2019,³⁸ 2020,³⁹ 2021,⁴⁰ 2022,⁴¹ 2023,⁴² 2024⁴³

Healthcare.gov: This is the ACA Marketplace where you can enroll in a health insurance plan online. You may also get help by calling (800) 318-2596. 

Kansas Insurance Department: Call the Consumer Assistance Hotline at (800) 432-2484 in Kansas or (785) 296-7829 if out of state. 

Senior Health Insurance Counseling for Kansas (SHICK): SHICK offers help with questions about Medicare.  

Medicaid (KanCare): Though Kansas has not expanded Medicaid, certain people who meet the income limits may qualify.