Marketplace Enrollment Increased Slightly for Kansas in Early 2021

Key Points

• • Six insurers offered 100 plans on the Kansas marketplace for the 2021 plan year. All counties in Kansas had at least two insurers offering coverage.
  • A majority (85.8 percent) of Kansas enrollees selecting a plan during the 2021 plan year open enrollment received Advance Premium Tax Credits (APTC) to reduce the cost of their monthly premium payments.
  • The average monthly premium for Kansans selecting a plan during the 2021 plan year open enrollment and receiving APTC rose to $116 per member per month compared to $76 in 2019 and $101 in 2020. The average monthly premium for Kansas enrollees without APTC was $567, which was lower than the 2019 and 2020 amounts ($596 and $579, respectively).
  • Generally, enrollees in Kansas saw average monthly premiums that were 10 to 25 percent higher than the average monthly premium for enrollees across all 36 states (including Kansas) operating on the federally facilitated marketplace.

Introduction

During the 2021 plan year open enrollment period (OEP) that ended December 15, 2020, 88,627 Kansans selected or were automatically re-enrolled in a health insurance plan through the federally facilitated marketplace. That represents an increase of 2,790 (3.3 percent) Kansans compared to the previous year. Around the country, 12.0 million consumers enrolled during the 2021 OEP, which is approximately a 5 percent increase from 11.4 million the previous year, but not as high as the peak enrollment of 12.7 million in 2016.

Total enrollment in 2021 is expected to increase because of a special enrollment period (SEP) for the COVID-19 pandemic, which runs from February 15 through August 15, 2021, and additional financial assistance available through the American Rescue Plan Act of 2021. Consumers also may enroll for marketplace coverage outside of the open enrollment period if they experience a qualifying “life event” (e.g., job loss or change in family status) and select a plan within 60 days of the qualifying event.

This brief provides summary data from the 2021 OEP on enrollment, enrollee characteristics, plan selection, financial assistance, premiums and stand-alone dental insurance in Kansas. Like last year, the 2021 OEP lasted 45 days from November 1, 2020, through December 15, 2020, for coverage beginning on January 1, 2021. The data were released by the Centers for Medicare and Medicaid Services (CMS), a federal agency within the U.S. Department of Health and Human Services (HHS), on April 21, 2021.

The other 8 in 10 (79.1 percent or 70,080) were enrolled last year. Of these returning enrollees, there were 51,220 active re-enrollees, of which 4 in 10 (39.4 percent or 20,206) switched plans. The remaining 18,860 returning enrollees were automatically re-enrolled by the marketplace in the same or a similar plan to the previous year.

Plan Selection

During the 2021 plan year, six insurers offered 100 insurance plans that were bronze, expanded bronze, silver and gold plans, and two also offered catastrophic plans on the Kansas marketplace. For the fourth consecutive year, there were no platinum plans offered. The companies and number of counties in which they offered plans include Medica Insurance Company (105 counties); Blue Cross and Blue Shield of Kansas (103 counties); Ambetter from Sunflower Health Plan (87 counties); Cigna Health and Life Insurance Company (eight counties); Oscar Insurance Company (two counties); and Blue Cross and Blue Shield of Kansas City (two counties), which returned to the marketplace in 2021 after leaving in 2018. Like 2020, all counties in Kansas have at least two insurers offering coverage.

During the 2021 OEP, one-fifth (18.6 percent or 16,466) of Kansas enrollees selected a gold plan, which covers about 80 percent of health care expenses for a typical population; almost half (46.7 percent or 41,381) selected a silver plan, which covers about 70 percent of health care expenses; and another one-third (34.0 percent or 30,158) selected a bronze plan, which covers about 60 percent of health care expenses (Figure 3).

For bronze plan enrollees, Kansans can choose a standard or expanded bronze plan. Standard bronze plans offer a lower monthly premium but higher out-of-pocket cost when enrollees seek care. The expanded bronze plans either meet the requirements to be a high-deductible health plan or cover and pay for at least one major service (e.g., primary care visits, specialist visits, emergency room services, generic drugs) in addition to preventive services before the deductible begins.

Similar to previous years, a small percent (0.7 percent) of enrollees selected a catastrophic plan, which covers essential health benefits and has no out-of-pocket cost for certain preventive services. Catastrophic plans have low monthly premiums and very high deductibles. The plans are available for people under age 30 or of any age with a hardship or affordability exemption.

Plan selection in Kansas during the 2021 OEP was similar to plan selection nationally for catastrophic and bronze plans but was lower for silver plans (46.7 percent compared to 54.7 percent nationally; Figure 3) and higher for gold plans (18.6 percent compared to 8.3 percent nationally). However, the number of Kansans selecting a gold plan for 2021 decreased by nearly one-fourth (5,324 enrollees) compared to the 2020 plan year. The decrease in gold plan selection corresponds with an increase in bronze (4,855 enrollees) and silver plan (3,192 enrollees) selection. The reason for the shift in enrollment between plan types requires further analysis. The data from the special enrollment period, which will include plan selections with the expanded premium tax credit under the American Rescue Plan Act of 2021, will likely clarify whether the increase in bronze and silver plan enrollment was temporary or indicates a change in the Kansas marketplace.

Financial Assistance

Kansas marketplace enrollees with household income between 100 and 400 percent of the federal poverty level (FPL; $26,200 to $104,800 for a family of four in 2020) may have been eligible for Advance Premium Tax Credits (APTC) to reduce the cost of their monthly premium payments during the 2021 OEP. Kansas enrollees with income between 100 and 250 percent of FPL ($26,200 to $65,500 for a family of four in 2020) also may be eligible for Cost-Sharing Reduction (CSR) subsidies, which reduce out-of-pocket costs such as deductibles, co-payments and co-insurance.

The average premium for Kansas enrollees without APTC was 4.9 times higher than for those receiving APTC ($567 compared to $116). Generally, Kansas enrollees paid monthly premiums that were 10 to 25 percent higher than the average monthly premium paid by enrollees across all 36 states (including Kansas) operating on the federally facilitated marketplace.

Figures 6 and 7 provide information on average monthly premiums in the seven rating areas across Kansas. Among those selecting a plan during the 2021 OEP and receiving APTC, enrollees living in Northwest Kansas had the highest average monthly premium of $162, which was 62.0 percent higher than enrollees living in Southwest Kansas and receiving APTC, who had the lowest average monthly premium of $100.

Stand-Alone Dental Insurance

For the 2021 plan year, there were 12 stand-alone dental policies offered by four insurers on the Kansas marketplace and 12,357 Kansans selected a standalone dental plan — a 5.0 percent decrease compared to 2020.

Looking Ahead

While enrollment in the Kansas marketplace had steadily declined since 2016, when 101,555 enrollees selected a plan, there was a slight uptick in enrollment for the 2021 OEP compared to 2020. Total enrollment in the 2021 plan year is expected to increase further due to the SEP which began on February 15, 2021, in response to the COVID-19 pandemic and runs through August 15, 2021. During this SEP, individuals who were not able to sign up for marketplace coverage during the previous open enrollment period that ended in December 2020 can enroll and current Kansas enrollees can reevaluate their coverage and enroll in a different plan. The SEP also is an opportunity for uninsured residents to enroll in coverage, as well as people who are covered under non-ACA-compliant plans, such as short-term plans, Farm Bureau plans, or health care sharing ministries.

On March 11, President Biden signed the American Rescue Plan Act of 2021 (ARP) into law, which includes provisions that expand access to and increases the dollar value of the premium tax credit in 2021 and 2022. The increased tax credit eliminates insurance premiums for households with income between 100-150 percent FPL. Additionally, households with income above 400 percent FPL that were previously not eligible for APTCs will now be eligible and will have their premiums capped at 8.5 percent of their income. However, APTC is still not available for people with family income below 100 percent FPL, leaving the so-called coverage gap in states that have not expanded Medicaid. Current enrollees will need to reapply for coverage to take advantage of the expanded tax credit provisions in the ARP.

Health Insurance Plans in Kansas by Rating Area

Using data from the Centers for Medicare and Medicaid Services (CMS), the map in Figure 6 shows the counties in each rating area, the number of plans available, marketplace enrollment and the average premium paid during the 2021 open enrollment period.Kansans purchase health insurance plans through the federally facilitated marketplace created by the Affordable Care Act (ACA) in one of seven rating areas based on their home county.

Premiums for each rating area depend on many factors including local area health care costs, competition between insurers, enrollee plan selections and population characteristics. Figure 7 presents by rating area the average premium paid with and without Advanced Premium Tax Credits (APTC), and the number of people receiving APTC or Cost-Sharing Reduction (CSR) subsidies during the 2021 open enrollment period. CSRs lower out-of-pocket costs (i.e., deductibles, co-payments and co-insurance) for eligible individuals or families who elect to use it and enroll in a silver plan.

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