2024 Affordable Care Act Health Insurance Marketplace

Key Points

• For plan year 2024, eight insurers are offering 98 health insurance plans on the Kansas marketplace.
• The average monthly premium for a benchmark silver plan in Kansas for a family of four in 2024 before applying Advance Premium Tax Credits increased by 3.5 percent, which was less than the 4.0 percent increase nationally.
• The deductible for the benchmark silver plan ranges from $2,500 to $8,395 for an individual and $7,000 to $16,790 for a family of four in 2024.
• Under the Inflation Reduction Act, which extends the enhanced premium tax credits of the American Rescue Plan Act, consumers with household income between 100 to 150 percent of the federal poverty level may qualify for a free or nearly free plan if they enroll in a benchmark silver plan.

Introduction

The eleventh annual open enrollment period (OEP) for the Kansas health insurance marketplace created by the Affordable Care Act (ACA) and operated by the federal government through Healthcare.gov began on Nov. 1, 2023, and ended on Jan. 16, 2024. For plan year 2024, coverage for individuals who enrolled by Dec. 15 became effective Jan. 1, 2024. Coverage for individuals who enrolled after Dec. 15 but by Jan. 16 became effective on Feb. 1, 2024.

For plan year 2024, the Inflation Reduction Act of 2022 continues to make it possible for individuals enrolling for plan year 2024 to benefit from the enhanced Advance Premium Tax Credits (APTC) made available in 2022 through the American Rescue Plan Act (ARPA) of 2021. The Inflation Reduction Act extends the temporary enhancements of the ARPA through plan year 2025.

This brief provides information about plan options offered for the 2024 plan year, health insurance costs, financial assistance options and factors impacting enrollment.

Plan Options

For the 2024 plan year, eight insurers are offering 98 health plans on the Kansas marketplace (Figure 1) ─ a decrease from 2023 when 128 plans were available from eight insurers. The companies include Blue Cross and Blue Shield of Kansas, Inc. (103 counties); Ambetter from Sunflower Health Plan insured by Celtic Insurance Company (91 counties); UnitedHealth Care Insurance Company (84 counties); Medica Insurance Company (42 counties); Aetna Life Insurance Company (19 counties); Oscar Insurance Company (16 counties); US Health and Life Insurance Company (4 counties) and Blue Cross and Blue Shield of Kansas City (2 counties).

The reduction in the number of health plans available on the Kansas marketplace for 2024 is due, in part, to Cigna Health and Life Insurance Company, which offered 25 plans across eight counties in 2023, choosing not to offer plans in Kansas for 2024. Aetna Life Insurance Company, new to the Kansas marketplace for 2024, is offering only nine plans across 19 counties.

All eight insurers are offering expanded bronze, silver and gold plans. One insurer is offering a bronze plan, and three insurers are also offering catastrophic plans. For the seventh consecutive year, there are no platinum plans being offered to individuals on the Kansas marketplace. Like in 2023, all counties in Kansas have at least two insurers offering coverage and all plans offered are exclusive provider organization (EPO) plans, which only cover services provided in-network by a “narrow network” of providers, except in an emergency.

Under the ACA, dental coverage is an essential health benefit for children enrolled in an ACA-compliant health plan and is included in the premium cost, but not for adults.

Some insurers offer policies with both health and dental coverage for adults, meaning the premium covers both health and dental policies and APTC can be applied.

Alternatively, adults can purchase a stand-alone dental plan, but they also must be enrolled in an ACA-compliant health plan and will be responsible for two separate premiums. APTC cannot be applied to stand-alone dental plan premiums. There are a total of 15 stand-alone dental plans available from five insurers for 2024.

Health Insurance Costs

The consumer’s health care cost depends on their monthly insurance premiums and their out-of-pocket costs for deductibles, co-payments, coinsurance and uncovered services.

Premiums on the Kansas marketplace increased in plan year 2024. The average premium for a benchmark silver plan in Kansas for a family of four is 3.5 percent higher than it was in plan year 2023. The increase in the average benchmark silver plan premium in Kansas for a family of four was lower than the 4.0 percent increase nationally. Figure 2 shows average monthly premiums across all counties in Kansas for the benchmark silver plan.

As shown in Figure 3, there is considerable variation in monthly premiums across counties. For example, in rating area 7 the difference in premiums for the benchmark silver plan for a couple age 60 is around $360 and premiums can be as much as $2,410 per month for a couple age 60 before the APTC is applied. Premiums vary based on regional factors such as the cost of care, cost of living and number and type of providers available. Premiums also vary based on specific characteristics of the person being covered, including age, where they live, whether they smoke and how many people in their family are covered. Higher rates cannot be charged based on gender or for people with preexisting health conditions.

In addition to the monthly premium paid, consumers are responsible for certain out-of-pocket expenses, including deductibles, co-payments and coinsurance when they use services. Except for certain preventative and other services specified by plans, consumers must pay the deductible amount for covered services first before the insurance plan starts to pay. Co-payments or coinsurance are usually required after the deductible is met. The deductible for the benchmark silver plan ranges from $2,500 to $8,395 for an individual, and $7,000 to $16,790 for a family in 2024. Almost half of counties (51 counties) have a $5,900 deductible for an individual with a benchmark silver plan. The deductible amount is generally doubled for a family plan.

ACA marketplace plans also are required to state a maximum out-of-pocket cost, which is the most that consumers could pay for covered services in the plan year. This maximum amount varies by the consumer’s income. However, regardless of income (if eligible for marketplace coverage), the maximum amount a consumer could be expected to pay for covered services is up to $9,450 for an individual or up to $18,900 for a family of four.

Financial Assistance

The ACA made financial assistance available to marketplace enrollees at certain income levels to help pay monthly premiums and out-of-pocket expenses. Prior to enactment of the ARPA and the Inflation Reduction Act, consumers with household income between 100 and 400 percent of the federal poverty level (FPL) ($26,500 to $106,000 for a family of four in 2021) were eligible for APTC and spent between 2.0 to 9.83 percent of their income for their insurance premiums.

Under the ARPA, and now the Inflation Reduction Act, in 2024 consumers with household income between 100 and 400 percent FPL ($30,000 to $120,000 for a family of four in 2023) will spend between 0 and 8.5 percent of their household income on premiums for a benchmark silver plan. Households with income above 400 percent FPL also are eligible for APTC that cap their premiums for a benchmark silver plan at 8.5 percent of their income. Consumers with household income between 100 and 150 percent FPL ($30,000 to $45,000 for a family of four in 2023) may qualify for a free or nearly free marketplace plan. People under 100 percent FPL are generally not eligible for financial assistance on the marketplace. These enhanced marketplace subsidies were set to expire at the end of 2022 but were extended by the Inflation Reduction Act to the end of 2025.

APTC are based on the cost of the benchmark silver plan but may be used to purchase any plan available on the marketplace, regardless of the metal level. APTC cannot be used to purchase a catastrophic plan. With APTC, consumers could be better off with a more benefit-rich gold plan with a lower deductible. For example, the least expensive gold plan in Sedgwick County could have a monthly premium of $400 before APTC (or $142 after APTC) and a deductible of $750 for an individual with household income of 250 percent FPL. In comparison, the same individual can purchase the least expensive silver plan with a lower monthly premium of $379 before APTC (or $121 after APTC) but would have a higher deductible of $5,900. Examples of reduced premiums from APTC in 2024 are shown in Figure 4.

Under the ACA, the rules for cost-sharing reduction (CSR) subsidies remain the same. Consumers with household income between 100 and 250 percent FPL ($30,000 to $75,000 for a family of four in 2023) who enroll in silver plans continue to be eligible for CSR subsidies to lower their out-of-pocket expenses. CSR subsidies are not available with any other metal level. For example, an individual in Sedgwick County with income between 151 and 200 percent FPL could see their deductible lowered to $1,600 or less with co-payment/coinsurance for a benchmark silver plan. The deductible would be lowered to $550 or less with co-payment/coinsurance for a benchmark silver plan for an individual in Sedgwick County with income between 100 and 150 percent FPL.

Factors Impacting Enrollment on the ACA Marketplace

For 2024, several factors may impact enrollment.

• Continuation of enhanced APTC provided in the ARPA and the Inflation Reduction Act through 2025.
• Special Enrollment Period for individuals who lose their Medicaid or CHIP coverage between March 31, 2023, through July 31, 2024, due to the unwinding of the continuous coverage provided during the COVID-19 public health emergency.
• Special Enrollment Period throughout plan year 2024 for consumers with household income up to 150 percent FPL ($21,870 for an individual and $45,000 for a family of four) that are eligible for APTC. In Kansas, most individuals below 100 percent FPL do not qualify for marketplace tax credits.
• The percentage for determining affordability of employer-sponsored health coverage under the ACA is 8.39 percent, lower than the 9.12 percent in plan year 2023 and the original 9.61 percent from plan year 2022. This reduction in the affordability percentage may increase the number of individuals who are eligible to receive APTC if they enroll in a marketplace health plan.