Kansas, and all the states, will be making alterations in their insurance regulations over the next two years to comply with the provisions of the 2010 Patient Protection and Affordable Care Act. Changes already in place include the stipulation that children cannot be excluded from coverage due to a pre-existing condition and they can remain on their parents’ health policy to age 26, regardless of educational or marital status.
Additionally, the states have been charged with forming high-risk insurance pools to remain in place until January 1, 2014, at which time the new health care exchanges will go into effect.
General Insurance Regulations
Kansas was one of the first states to implement a guaranteed renewability clause. Insurers cannot revoke coverage for patients with chronic illnesses or who have suffered injuries so long as the premiums on their coverage have been paid on time. Residents also have the right to access new health policies immediately if switching from a group to an individual plan with no excessive waiting periods.
Currently, insurers can look back into an applicant’s medical history for an undefined period of time to discover pre-existing conditions, and they are allowed to exclude coverage for such conditions for up to 24 months. Companies are required, however, to cover the costs of cancer and osteoporosis screenings for women and the expense of reconstructive surgery for mastectomies.
Health Care Exchange
There has been no concrete progress toward the establishment of the required health care exchange in Kansas, and no bill was introduced for that purpose in the legislature in 2011. In May 2011, however, the governor did sign a law which prohibits any health plan operating under a Kansas health exchange from offering abortion services unless the pregnant woman’s life is in danger. Optional riders to cover abortion are not allowed on exchange plans either. Currently any other measures are on hold pending the decision of the Supreme Court in 2012 regarding the constitutionality of the Affordable Care Act’s requirement that all citizens carry health insurance. Kansas has until January 1, 2013 to form an exchange, and if it does not do so, the federal government will assume that responsibility.
Pre-Existing Condition Insurance
Kansas citizens who are eligible can apply for the state’s Pre-Existing Condition Insurance Plan program run by the Kansas Health Insurance Association, which provides benefits for hospitalization as well as for primary and specialty care and prescription drugs. Premiums range from $349 to $417 for non-smokers with a deductible of $2500 and an out-of-pocket limit of $5950.
Medicaid eligibility is figured according to percentages of the Federal Poverty Level, which in Kansas is 150% for infants under age 1, 133% for the 1-5 age group, and 100% for age 6-19. Pregnant women qualify at 150%, parents at 30%, and non-elderly disabled Social Security recipients at 74%.
Kansas also offers low-income residents the Kansas HealthWave Program, which is open to any U.S. citizen who has a three-month work history with a steady income. Applicants must be under 200% FPL. HealthWave offers low co-pays and no premiums for eligible adults, and HealthWave 21 provides higher coverage and no prohibitions on pre-existing conditions.
There are more than 416,000 Kansas residents enrolled in Medicare, with $6,900 spent per enrollee on average. (Senior Health Insurance Counseling for Kansas (SHICK), provides information to those who receive or who are eligible to receive Medicare and its related services.)