2020 Affordable Care Act Health Insurance Marketplace

Key Points

• • Consumers shopping for a 2020 plan on the Kansas marketplace are able to choose from among 82 health insurance plans offered by five insurers.
  • Following the trend from previous years, all of the plans offered for 2020 have a “narrow network” of providers which generally covers only services provided in-network, except in an emergency.
  • The average monthly premium decreased slightly in Kansas for 2020 to: $426 for a single adult age 27; $1,660 for a family of two 40 year-old parents with two children; and $2,205 for a 60 year-old couple.
  • Advance Premium Tax Credits (APTC) may reduce the cost of premiums paid by consumers with family income between 100 and 400 percent of the federal poverty level (FPL).
  • Out-of-pocket costs continue to increase. While consumers with family income less than 250 percent of FPL receive additional assistance to reduce out-of-pocket costs, a family of four with an annual income just above 250 percent FPL ($64,375 in 2019) could be expected to pay up to $16,300 in out-of-pocket costs in addition to their premiums.

Plan Options

Consumers shopping for a 2020 plan on the Kansas marketplace are able to choose from among 82 health insurance plans offered by five insurers (Figure 1). For plan year 2019, 23 plans were available from three insurers.

For 2020, two new insurers, Cigna and Oscar Insurance Company, joined the three insurers who offered plans in 2019, Ambetter from Sunflower Health Plan, Blue Cross and Blue Shield of Kansas and Medica Insurance Company. All five insurers are offering bronze, silver and gold plans, and two also are offering catastrophic plans. For the third consecutive year, there are no platinum plans being offered on the Kansas marketplace. All counties in Kansas have at least two insurers offering coverage.

Some of the available plans include both health and dental coverage. Dental coverage is an essential health benefit for children enrolled in a plan, but not for adults. One premium covers both health and dental coverage for such plans and is eligible for Advance Premium Tax Credits (APTC).

A total of 12 stand-alone dental plans are available on the marketplace from four insurers. When buying a stand-alone dental plan, consumers also must be enrolled in a health plan and will be responsible for two premiums. APTC does not apply to stand-alone dental plan premiums.

Continuing the trend over the past few years, all plans offered have a “narrow network” of providers which generally covers only services provided in-network, except in an emergency. These plans are typically exclusive provider organizations (EPO) and health maintenance organizations (HMO). There are no preferred provider organizations (PPO) offered on the Kansas marketplace.

Health Insurance Premiums

After several years of increases, health insurance premiums being offered on the marketplace for 2020 have either decreased or risen only slightly from 2019. Monthly premiums reported in (Figure 2) are the 2020 average statewide premiums for the silver benchmark plan, which is considered “middle-of-the-road” in terms of cost and coverage among available plans on the marketplace. However, there is considerable variation in the cost of insurance premiums across the seven “rating areas” in Kansas based on regional factors such as the cost of care, cost of living and number and type of providers available (Figure 4).

The premiums also vary based on characteristics of persons being covered: their age, where they live, whether or not they smoke and how many people are covered. Higher rates cannot be charged based on gender or for people with pre-existing conditions.

Advance Premium Tax Credits

The premium amount paid by people covered with insurance through the Kansas marketplace may be reduced substantially through subsidies available to those with income between 100 and 400 percent of the federal poverty level (FPL) through Advance Premium Tax Credits (APTC). The APTC is based on the cost of the “benchmark plan,” which is the second lowest-cost silver plan, but may be used to purchase any metal level coverage available on the marketplace. APTC may not be used to purchase coverage outside of the marketplace. The impact of the APTC on reducing the premium amount actually paid by Kansans qualifying for the subsidy is shown in (Figure 5).

Out-of-Pocket Costs Continue to Rise

Since the ACA was implemented in the fall of 2013, health policy analysts and consumer advocates have studied both the cost and quality of health insurance provided to consumers on the marketplace. Concern has been expressed about the increasing financial burden of health care, even for those who are insured, and especially among those with low and moderate incomes. The cost of health care for consumers depends on both the insurance premiums they pay, as well as the out-of-pocket costs they incur for deductibles, copays and co-insurance.

Under the ACA, insurers are required to limit the amount of annual out-of-pocket expenses that certain “eligible” consumers have to spend for in-network essential health benefits covered in ACA-compliant plans sold through the marketplace. These eligible consumers include individuals and families with household income between 100 and 250 percent of FPL who enroll in a silver plan. This additional cost-sharing reduction is not available with any other metal level.

Based on the most recent federal guidance, a family of four with annual income just above 250 percent FPL ($64,375 in 2019) could be expected to pay up to $16,300 in out-of-pocket costs in addition to their premiums in 2020. How the cost-sharing limits have changed over time is shown in (Figure 3).

Reduced Navigator Funding

Under the ACA, the health insurance marketplace is required to establish navigator programs for outreach and education for consumers who are interested in purchasing marketplace health insurance coverage. Navigators are typically organizations, such as health systems, patient advocacy organizations, universities and other trusted local organizations that have existing relationships with uninsured or underinsured consumers who are likely eligible to enroll in the marketplace.

Since passage of the ACA, the federal government has provided funding to states using Healthcare.gov for navigator programs through grants to organizations in each state. For plan year 2020, a total of $10 million to 34 organizations was awarded nationally, down from $67 million for 105 organizations in 2014. Kansas received $213,317 for two organizations in 2020, down from $886,085 for three organizations in 2014. The two Kansas organizations will be serving primarily 17 counties throughout northeast, central and western Kansas.

Looking Ahead

Enrollment in the Kansas marketplace has decreased slightly over the last few years. Uncertainty about the future of the ACA overall, ongoing legal battles about specific parts of the law and increased attention to immigration enforcement are among the likely reasons. Enrollment in the Kansas marketplace peaked at 89,566 in 2016 and was 84,304 in 2019. The addition of more plans and insurers to choose from and the moderation of premium price increases could be expected to increase enrollment in 2020. A continued strong economy and the availability of lower-cost options outside the marketplace could be expected to decrease enrollment. Watching the trends in insurance coverage and carefully assessing the cost and adequacy of the coverage available are important responsibilities of states in this rapidly changing health care environment.