ACA 101: What Is the ACA Marketplace and Who Is Eligible?

October 20, 2020

Access to affordable and high-quality healthcare coverage is critical, especially as we consider the impact COVID-19 has had on our physical and behavioral health. At Blue KC, we understand that the need for affordable health insurance has never been greater as our community continues to see high levels of unemployment amid an ongoing battle against the COVID-19 pandemic. Our hope is that by participating in the 2021 Affordable Care Act (ACA) marketplace, we will be able to better support and improve the health of our community. We recognize that choosing a healthcare plan through the ACA can be a difficult process to navigate, so in this post we aim to simplify commonly asked questions about what the ACA marketplace is, who is eligible and if it’s right for you.  

What is the ACA Marketplace?

The purpose of the Affordable Care Act (ACA) is to expand healthcare coverage, better control healthcare costs and improve the healthcare delivery system. The term “marketplace” is a shortened version of “Health Insurance Marketplace” and is often used interchangeably with the term “exchange.” So if you hear someone refer to the “Health Insurance Marketplace,” the “ACA marketplace,” or the “ACA exchange,” they are referring to a service that allows people to shop for health care insurance plans and enroll in these plans through websites, call centers, and even in-person help.

Health insurance plans offered through the ACA marketplace are offered through private health insurance companies and are regulated by the Centers for Medicare and Medicaid (CMS). To enroll in a plan through the ACA, you may be able to purchase insurance through healthcare.gov. Some states also have their own exchanges, known as State Based Exchanges (SBEs),  that allow you to review and purchase plans through their services. However, neither Missouri nor Kansas have SBEs.  Or, you may be able to purchase a plan directly from the healthcare insurance provider.

This differs from the type of enrollment services you might have if you receive healthcare insurance through your employer. The ACA marketplace is available to all eligible U.S. citizens to shop and enroll regardless of their employment status.    

So, Who is Eligible?

CMS has certain requirements to determine eligibility for ACA coverage. The basic qualifications include that you:

  • Must live in the United States
  • Must be a U.S. citizen or national (or be lawfully present)
  • Cannot be incarcerated

There are also restrictions based on whether you can receive healthcare coverage through another entity. For instance, if you qualify for or have Medicaid or Medicare coverage, you are not eligible to use the ACA marketplace to buy health or dental insurance plans. Similarly, if your employer offers healthcare insurance, you are not eligible for ACA coverage.

You may be eligible for ACA coverage if you are:

  • Self-employed
  • Unemployed and do not qualify for Medicaid or Medicare coverage
  • Are a part-time employee but do not qualify for healthcare coverage through your employer

Am I Qualified for Blue KC’s Products?

In the larger Kansas City area, residents in our 32-county coverage area are eligible for our ACA plans which include plans designed specifically for residents in the Kansas City metro and in our 27 Missouri counties where we provide insurance.  

  • Metro Plans are high-value, low-cost plans designed for individuals and families in Clay, Jackson, and Platte Counties in Missouri and Johnson and Wyandotte Counties in Kansas. These plans include our highly rated Spira Care offerings and our more traditional products.
  • Rural Plans are offered in the other 27 Missouri counties and provide an array of affordable and high-quality plans like First Gold. All Rural Plans include access to Blue KC’s Preferred-Care Blue network which includes 50 in-network hospitals and about 6,200 in-network physicians.

Residents can explore pricing and plans beginning November 1, 2020, and enroll during Open Enrollment from November 1 through December 15, 2020. The coverage for all plans sold during this time period will begin on January 1, 2021. Learn more about the ACA marketplace by visiting Healthcare.gov.

When reviewing your Blue KC plan options in the ACA marketplace, please feel free to contact our sales team at 816-395-2683. Visit BlueKCForYou.com to learn more about ACA plans and programs and what you will need in order to enroll.