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Kansas exchange overview
Kansas uses the federally run health insurance exchange. Eight insurers are offering plans for 2023 in the exchange, up from seven in 2022. All of the available plans are EPOs. UnitedHealthcare rejoined the Kansas exchange for 2023, offering coverage in 21 counties, after previously offering coverage in the exchange in 2016.
During open enrollment for 2023 coverage, a record-high 124,473 Kansans enrolled in private individual market plans through the Kansas exchange (the previous record high was set the year before, when 107,784 enrolled).
The family glitch fix makes subsidies available to more people in 2023. And the Inflation Reduction Act has extended the subsidy enhancements that were implemented in 2021, ensuring that coverage continues to be more affordable than it was in previous years.
The open enrollment period for individual/family coverage runs from November 1 to January 15 in Kansas. Outside of open enrollment, a qualifying event is necessary to enroll or make changes to your coverage.
If you need to buy your own health insurance, our comprehensive guide to open enrollment will answer questions you may have about how open enrollment works. And our comprehensive guide to special enrollment periods will explain what you need to know about enrollment opportunities outside the annual open enrollment period.
For 2023, there are eight insurers that offer exchange plans in Kansas, which is a record high for the Kansas exchange. UnitedHealthcare, which previously offered coverage in 2016, rejoined the Kansas exchange for 2023, and the seven insurers that already offered coverage in 2022 are continuing to offer coverage for 2023.
The following insurers offer 2023 coverage through the Kansas exchange, with plan availability varying from one location to another:
- Medica
- Blue Cross Blue Shield of Kansas
- Blue KC (Blue Cross Blue Shield of Kansas City)
- Oscar
- Cigna
- US Health & Life Insurance Company
- Ambetter from Sunflower Health Plan/Celtic
- UnitedHealthcare Insurance Company
(Ambetter from Sunflower Health Plan/Celtic was new as of 2022, but was essentially a transition from Sunflower State Health Plan’s HMO product to Celtic’s EPO product)
Seven insurers offer plans in the Kansas exchange for 2022, which is a record high. There has been quite a bit of shifting in the insurer exchange landscape in Kansas over the last few years. Here’s a summary of insurer participation by year:
- 2014: Aetna/Coventry, and Blue Cross Blue Shield of Kansas Solutions
- 2015: Aetna/Coventry, and Blue Cross Blue Shield of Kansas Solutions
- 2016: UnitedHealthcare, and Blue Cross Blue Shield of Kansas Solutions
- 2017: Blue Cross Blue Shield of Kansas Solutions (in all but two counties), Blue Cross Blue Shield of Kansas City (aka Blue KC, available only in Johnson and Wyandotte counties), and Medica.
- 2018: Blue Cross Blue Shield of Kansas (formerly called Blue Cross Blue Shield of Kansas Solutions), Medica, and Sunflower/Ambetter/Centene.
- 2019: Blue Cross Blue Shield of Kansas, Medica, and Sunflower/Ambetter/Centene.
- 2020: Medica, Blue Cross Blue Shield of Kansas, Sunflower/Ambetter, Oscar, and Cigna
- 2021: Medica, Blue Cross Blue Shield of Kansas, Blue KC, Sunflower/Ambetter, Oscar, and Cigna
- 2022: Medica, Blue Cross Blue Shield of Kansas, Blue KC, Sunflower/Ambetter/Celtic (EPOs), Oscar, Cigna, and US Health & Life
- 2023: Medica, Blue Cross Blue Shield of Kansas, Blue KC, Sunflower/Ambetter/Celtic (EPOs), Oscar, Cigna, US Health & Life, and UnitedHealthcare
And some highlights regarding insurer participation:
Aetna/Coventry initially participated in the exchange in Kansas, but exited the exchange at the end of 2015. They later filed plans to rejoin the Kansas exchange for 2017, but in August 2016, Aetna announced that they were putting the brakes on their plans to expand into five additional exchanges—including Kansas—in 2017. As a result, the proposed Coventry plans did not become available in the Kansas exchange for 2017.
UnitedHealthcare did not participate in 2014 and 2015, but joined the exchange for 2016. They then exited the entire individual market in the state at the end of 2016. But they have returned to the Kansas exchange, in 21 counties, as of the 2023 coverage year.
Medica joined the exchange in 2017. Their plans became available state-wide in 2018, including an expansion into Johnson and Wyandotte counties, where Medica didn’t offer coverage in 2017 (Medica only offered EPOs in Johnson and Wyandotte counties, and PPOs throughout the rest of the state).
Blue KC exited the individual market (on- and off-exchange) in Kansas and Missouri at the end of 2017, amid concerns about market stability. Blue KC noted that they had lost more than $100 million in the ACA-compliant market through 2016, a level that they deemed unsustainable. Blue KC’s exit had a bigger impact in Missouri, where Blue KC plans were offered in 30 counties in 2017. But it had a significant impact in Johnson and Wyandotte counties in Kansas, where Blue KC offered coverage in 2017 (Blue KC was only available in those two counties in Kansas in 2017; the rest of the state was covered by Blue Cross Blue Shield of Kansas Solutions). Between the two states, roughly 67,000 people had to secure new coverage for 2018.
At that point, the only other option for 2018 coverage in the Kansas side of the Kansas City metro area was slated to be Medica, which had filed plans for statewide availability in the Kansas exchange in 2018. Medica first joined the Kansas exchange in 2017, and had a 10,000 member enrollment cap that year. They did not initially say whether they would continue to implement an enrollment cap in 2018, although they later confirmed that there would be no enrollment cap for 2018 (an enrollment cap would have been a problem in the Kansas City area if Medica had been the only participating insurer for 2018, as there were 32,000 ACA enrollees just in Johnson and Wyandotte counties alone in 2017).
But in June, 2017, Centene announced that they would enter the exchange in Kansas and Missouri, along with Nevada. Centene already offered Medicaid managed care coverage in Kansas under the name Sunflower State Health Plan, but 2018 was the first year they offered private plans for sale in the exchange. Sunflower State Health Plan (Ambetter from Sunflower Health) began offering plans in Johnson and Wyandotte counties, filling the gap left by Blue KC’s exit.
Blue Cross Blue Shield of Kansas also filed plans to remain in all of the counties where they offered 2017 coverage (everywhere except Johnson and Wyandotte counties), but the Kansas Insurance Department noted that they would be offering all new plans for 2018. Their products are EPOs, rather than the HMO Solutions products that were offered for 2017 (and the word “Solutions” has been dropped from the end of the name, so it’s now just Blue Cross Blue Shield of Kansas). As described below, Kansas enacted legislation in 2016 making it easier for insurers to offer EPOs, and those have been the only product type offered in the Kansas exchange in 2022 and 2023.
When health insurance plans terminate at the end of the year, their members are eligible for a special enrollment period. For those with on-exchange coverage, HealthCare.gov maps these enrollees to new plans if they don’t pick their own replacement plan during open enrollment. But even after they’ve been mapped to new plans, the people whose coverage terminated at the end of the year are still eligible for a special enrollment period that extends for 60 days after the plan termination date. Plan terminations obviously include situations in which a carrier exits the market, but they also include scenarios like BCBS of Kansas had at the end of 2017, when all of their HMOs were replaced with EPOs.
So the only Kansas plans that weren’t terminated at the end of 2017 were Medica’s, and they only insured 7,574 members in 2017, including on and off-exchange. So out of more than 86,000 total exchange enrollees, the vast majority were enrolled in plans that terminated at the end of 2017, and the off-exchange market was also predominantly BCBS of Kansas Solutions and Blue KC.
All of these individuals had until March 1, 2018 to pick a replacement plan for 2018, regardless of whether they were mapped to a new plan or not.
The three insurers that offered plans in 2018 all continued to do so in 2019, so enrollees had much more continuity heading into 2019 than they’d had the year before.
As of 2020, Oscar and Cigna joined the marketplace in Kansas, and both continue to offer plans in 2021.
For 2021, Blue KC rejoined the exchange in Kansas.
For 2022, US Health & Life Insurance Company joined the exchange in Kansas. And Ambetter from Sunflower Health Plan/Celtic also joined the exchange, with EPO plans. But that’s a replacement for Sunflower State Health Plan’s HMOs, which discontinued as of the end of 2021.
For 2023, UnitedHealthcare rejoined the exchange, bringing the participating number of insurers to eight.
According to the federal rate review site and the Kansas Insurance Department, the insurers that offer plans in the Kansas exchange implemented the following average rate changes for 2023 (for some insurers, the final rates differed from what was initially proposed):
- Medica: 1.81% increase
- Blue Cross Blue Shield of Kansas: 14.1% increase
- Blue Cross Blue Shield of Kansas City (Blue KC): 20.8% increase
- Oscar: 1.04% increase
- Cigna: 18.1% increase
- Ambetter from Sunflower Health Plan/Celtic: 4.18% increase
- US Health & Life Insurance Company: 0.74% decrease
- UnitedHealthcare: New for 2023, so no applicable rate change.
These rate changes amounted to roughly a 7.2% overall increase.
It’s important to understand, however, that average rate changes aren’t reflective of how most enrollees’ actual premiums changed for 2023. Most people who have coverage in the exchange are receiving premium subsidies, which are much larger and more widely available than they used to be. The overall average rate changes described above only apply to full-price premiums, and most people don’t pay full price. For people who get subsidies, year-over-year rate changes also depend on how their subsidy changes, which can be affected by the entry of new insurers.
It’s also important to note that average rate changes don’t account for the fact that premiums increase with age. Even if your insurer doesn’t change its rates at all from one year to the next, your premiums will go up just because you’re a year older.
For perspective, here’s a summary of how average premiums have changed in Kansas over the last several years:
- 2015: Premiums on the Kansas marketplace were up just 4% from 2014 rates, according to a comprehensive study completed by The Commonwealth Fund. Nationally, rates were flat. However, the zero percent average increase masked 10+ percent increases in 10 states and 10+ percent decreases in 14 states.
- 2016: Across the full individual and small group market in Kansas, the average final rate changes ranged from a 9.4% increase to a 25.4% increase. But Coventry subsequently announced their exit from the exchange, so their rate increase (25.2%) no longer applied in the exchange. However, more than half of the exchange enrollees in Kansas had to select a new plan for 2016.
- 2017: For Blue Cross Blue Shield of Kansas Solutions, average rates increased by 47.4%. For Blue Cross Blue Shield of Kansas City, average rates increased by 28.1%. Medica was new to the exchange for 2017, so they had no applicable rate change (Medica capped their enrollment at 10,000 for 2017, but lifted the cap for future years).
- 2018: Rate changes for 2018 were based on the (correct) assumption that cost-sharing reduction (CSR) funding would not continue (the additional cost to cover CSR was added to silver plans). Medica’s average premiums increased by 29%. Blue Cross Blue Shield of Kansas technically didn’t have an official rate change for 2018, because they terminated all of their plans (HMOs) and replaced them with new plans (EPOs) at the end of 2017. Sunflower State Health Plan (Ambetter/Centene) also didn’t have an applicable rate change, as they were new to the Kansas market for 2018.
- 2019: For 2019 coverage, Medica increased their average premiums by 4.3%; Blue Cross Blue Shield of Kansas increased average premiums by 8.3%; Sunflower State Health Plan/Ambetter from Sunflower State (Centene) increased premiums by 2.7% (plans available in the Kansas City area). As they did for 2018, Kansas insurers continued to add the cost of cost-sharing reductions (CSR) to silver plan rates for 2019, resulting in lower after-subsidy premiums for bronze and gold plans (versus their cost prior to 2018).
- 2020: For 2020 coverage, Medica and Ambetter/Sunflower both decreased their average premiums (by an average of 3.2% and 8.7%, respectively). Blue Cross Blue Shield of Kansas increased their average premiums by about 3%. Because BCBSKS has the largest market share, the average rate change was a very slight increase, amounting to just o.3%. Oscar and Cigna both joined the Kansas marketplace as of 2020: Oscar in two counties in the Kansas City area, and Cigna in eight counties in the Kansas City and Wichita areas. Medica offers plans statewide, BCBSKS offers plans in all but Johnson and Wyandotte counties, and Ambetter/Sunflower offers plans in 16 counties.
- 2021: According to the federal rate review site, the insurers that offered coverage in the Kansas exchange implemented average rate changes that varied from a decrease of about 8% (Oscar) to an increase of about 10% (Cigna). The other insurers had rate changes somewhere in the middle: An 8% increase for Medica, an increase of less than 1% for BCBSKS, and a decrease of less than 1% for Sunflower State Health Plan. Blue KC rejoined the Kansas exchange for 2021, after exiting at the end of 2017.
- 2022: Average premiums increased by about 6%, but this was an unweighted average.
Enrollment in the Kansas exchange hit another record high in 2023, as was the case in many states. Kansas followed the same general trend we’ve seen in many states, with an initial enrollment peak in 2016, declining enrollment for the next few years, and then rebounding enrollment in 2021, a new record high in 2022, and another record high in 2023. Here’s a summary of how enrollment numbers (during open enrollment) have changed over the years in the Kansas exchange:
Five insurers currently offer dental plans through the Kansas marketplace. Learn about dental coverage options in Kansas.
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Kansas enacted legislation (HB2454) in 2016 that allows health insurance carriers to offer EPO plans, and to allow those plans to include a “gatekeeper” requirement similar to HMOs.
EPOs don’t cover any out-of-network care except for emergencies, and they typically don’t require a referral from a primary care doctor (ie, gatekeeper) to see a specialist, as long as the specialist is in the plan’s network. In Kansas, carriers can offer HMOs, but they have to pay an HMO privilege fee, which lawmakers increased in 2015.
As a result of HB2454, Kansas insurers can offer EPOs with narrow networks and gatekeeper requirements. The plans can be functionally very similar to HMOs, but aren’t subject to the HMO privilege fee. The bill had support from Aetna, UnitedHealthcare, and Blue Cross Blue Shield of Kansas City, and passed unanimously in both the House and Senate.
All of the plans available in the Kansas exchange are EPOs. This has been the case since 2022, and continues to be true for 2023.
Narrower networks are one of the ways that carriers can curtail costs and create plans with lower premiums. They also tend to be popular among healthy applicants — who are more concerned with premiums than with the scope of the plan’s network.
Farm Bureau health plans (not compliant with the ACA) became available as of 2020
Kansas passed legislation (H.B.2209, passed with a veto-proof majority and enacted without Governor Kelly’s signature) in 2019 that exempts Farm Bureau health plans from being regulated by the Kansas Insurance Department. Under the new legislation, Farm Bureau can market plans that don’t include all of the ACA’s essential health benefits, and that use medical underwriting to determine eligibility for coverage. Since the plans are not considered health insurance, they are not subject to insurance laws or regulations (the text of HB2209 regarding farmer’s cooperative plans is the same as S.B.32, which was backed by Farm Bureau earlier in 2019).
Kansas Farm Bureau Health Plans became available for enrollment starting October 1, 2019, with coverage effective January 2020. Farm Bureau membership is required in order to enroll in the health plans, but it’s simply a matter of signing up and paying dues (which vary by county)—members do not need to be actively involved in any sort of farming activity. This differs from neighboring Nebraska, where Farm Bureau plans are only available to people who are actively engaged in agriculture.
The Kansas Farm Bureau plans are able to impose pre-existing condition exclusions or waiting periods, and can reject applicants altogether if they aren’t considered healthy enough. This is how most individual market health plans operated in most states prior to 2014, but the ACA changed those rules. There are still people who have pre-ACA grandmothered and grandfathered plans that used medical underwriting, but Kansas is now allowing similar plans to be sold once again, via Farm Bureau.
The legislation applies to entities that have been “organized as a farmer’s cooperative” since at least 1983, so it only applies to Farm Bureau and does not allow new farmer’s cooperatives to enter the market.
The legislation was controversial, and while it was supported by Farm Bureau and GOP lawmakers, it was opposed by the state’s ACA-compliant health insurers, who noted that it isn’t fair to allow one organization to play by a different set of rules.
The new Farm Bureau plans in Kansas are similar to the plans that became available in Iowa as of 2019, and to the plans that Tennessee has allowed to be sold for many years. But they are not the same as the Farm Bureau plans in neighboring Nebraska, which are only available to people who are actively engaged in agriculture, do not use medical underwriting, and can only be obtained during an annual open enrollment window (as opposed to the plans in Iowa, Tennessee, Indiana, South Dakota, Texas, and Kansas, which are available year-round to people who are healthy enough to make it through the medical underwriting process).
H.B.2209 also changed the state’s regulations for association health plans (AHPs), making it easier for AHPs to offer coverage to more people. As a result, in 2020, Land O’Lakes began offering AHP coverage to farmers in Kansas who were members of one of 18 CO-OPs in the state. Land O’Lakes stopped offering AHP coverage in Nebraska because the federal rules that allowed them to do so were overturned by a judge in the spring of 2019. But they continued to offer AHP coverage to agriculture CO-OP members in Minnesota, and also branched into Kansas as of 2020, because state laws allow it.
The Kansas Farm Bureau estimates that 42,000 people will eventually enroll in the new plans. Some of these people are currently uninsured, and medically underwritten coverage is far better than being without coverage. But the Farm Bureau plans will also appeal to currently insured individuals who are healthy and who either don’t qualify for premium subsidies or qualify for only minimal subsidies. However, subsidies are now more widely available than they used to be, thanks to the American Rescue Plan and the Inflation Reduction Act. When subsidies are larger and available to more people, fewer people have to turn to non-ACA-compliant health plans like Farm Bureau’s coverage.
How Kansas approached marketplace implementation
Kansas opted to use HealthCare.gov rather than implement a state-run marketplace. The decision against a Kansas-run exchange came despite the efforts of then-Insurance Commissioner Sandy Praeger and some early support from then-Governor Sam Brownback. Brownback, while critical of the Affordable Care Act, initially supported Praeger’s exchange planning efforts.
However, Brownback grew less and less supportive over time. In August 2011, Brownback returned a federal grant intended to help the state develop technical infrastructure for running the exchange. The return of the grant effectively quashed a state-run exchange, so Praeger began recommending state-federal partnership as a way for the state to retain some control.
In November 2012, Brownback announced that the state would default to a federally operated exchange, issuing a statement that said in part, “My administration will not partner with the federal government to create a state-federal partnership insurance exchange because we will not benefit from it and implementing it could cost Kansas taxpayers millions of dollars.”
During the 2014 legislative session, Kansas lawmakers debated a bill (SB 362) that would have subjected anyone who wanted to serve as a navigator to requirements above and beyond those at the federal level. Kansas navigators would have been subjected to criminal background checks, been fingerprinted, required to disclose their credit histories, and charged an annual $100 registration fee. The bill would have also prohibited navigators from recommending a specific insurance policy for a consumer. The bill passed the Senate, but failed to clear a House committee.
Kansas health insurance exchange links
HealthCare.gov
800-318-2596
State Exchange Profile: Kansas
The Henry J. Kaiser Family Foundation overview of Kansas’ progress toward creating a state health insurance exchange.
Kansas Insurance Department, Consumer Assistance Division
Assists consumers who have purchased insurance on the individual market or who have insurance through an employer who only does business in Kansas.
(800) 432-2484 / Local: (785) 296-7829
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
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