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Frequently Asked Questions When Selecting a Healthcare Plan

As part of the Affordable Care Act, all Americans must have health insurance as of 2014.

Options include:

  • Get it through your employer.

  • Buy it on the Health Insurance Exchange at www.healthcare.gov.

  • Buy it from an insurance company, agent or broker.

  • Apply for Missouri or Kansas Medicaid. Click here for Missouri or here for Kansas.

Since all Americans are now required to have health insurance, the Health Insurance Marketplace at www.healthcare.gov was designed to meet that requirement. The Marketplace (also called an Exchange) is a one-stop shop to find, compare and buy private health insurance options.

Neither Missouri nor Kansas have their own state exchange, so you'll find your options on the federal Health Insurance Marketplace at www.healthcare.gov. The next open enrollment (enrollment for anyone) starts Nov. 1, 2017 and ends Dec. 15, 2017.

Open enrollment (enrollment for anyone) is Nov. 1, 2017 – Dec. 15, 2017. But, you may enroll year-round if:

  • You qualify for or are renewing Medicaid (MO HealthNet or KanCare) coverage.

  • You are an American Indian/Alaska Native who is an enrolled member of a federally recognized Tribe or Alaska Native Corporation.

  • You are enrolling in the Small Business Health Options Program (SHOP).

  • You experience certain life events like:

    • Getting married

    • Having a child

    • Moving to a new area

    • Losing health coverage

    These may qualify you for a special enrollment period. You can see if you qualify for any of these at www.healthcare.gov/screener/.

More details and updated dates available at www.healthcare.gov/marketplace-deadlines.

It depends on what type of insurance you have for your child. Do you have coverage through one of the following plan types? (www.healthcare.gov)

If you buy health insurance on the Health Insurance Marketplace that covers your child, Children's Mercy is currently not covered by all of the plans. Children's Mercy is covered in most plans EXCEPT:

Medical

  • Ambetter from HomeState Health Plan (MO)

  • Ambetter from Sunflower Health Plan (KS)

  • Blue Access (BCBS of Kansas City)

  • BlueCare/BlueChoice/SolutionsChoice (BCBS of Kansas)

  • Blue Select (BCBS of Kansas City)

  • Pathway/Pathway X (Anthem Blue Cross)

  • Prime Healthcare (Anthem Blue Cross)

Behavioral Health

  • Magellan Healthcare

Dental

  • Dental Health & Wellness Network offered through Sunflower Health Plan (KS Medicaid) and Home State Health Plan (MO Medicaid).

Home Care

  • CareCentrix

  • Humana

Therapy

  • TheraMatrix (BCBS of Michigan)

Vision

  • March Vision Network, offered through United Healthcare Community Plan - Missouri, United Healthcare Community Plan - Kansas, and Missouri Care.

Other insurance plans (outside of Exchange or through your employer)

When choosing any plan, even a plan purchased through your employer or outside of the Exchange, you should always make sure Children's Mercy is an in-network provider so that your child can continue care or get care here in the future. See the full list of all plans that include Children's Mercy.

Those plans that exclude essential providers like Children's Mercy (called narrow networks) have two deductibles: One for services at in-network providers and one for services at out-of-network providers. Out-of-pocket costs could be higher if your child visits a provider who is out-of-network with your insurance plan.

When comparing, consider these things:

  • What is covered?

  • What is my monthly cost?

  • What is my deductible?

  • What is my coinsurance and copay?

  • Which providers can I see with this plan?

  • Annual out-of-pocket maximum for in-network services and annual out-of-pocket maximum for out-of-network services?

You can always contact your insurance provider. You can also contact any number of navigators, whose services help ensure your family has adequate coverage.

You are the best advocate for your child. We encourage you to call the Department of Insurance (DOI) with concerns; the providers your insurance recommends; the timeframe for getting a response; or anything else about your health insurance. The DOI oversees the insurance industry and protects you as an insurance consumer.

We continue to negotiate with insurance companies. Despite our best efforts, we have found that some companies have chosen not to contract with us.

Our hope is that all health insurance plans will cover Children's Mercy, especially since many services are not provided elsewhere in the region, so we can serve your child and all children in Kansas and Missouri.

Contact your employer or insurance provider and tell them you think Children's Mercy is an essential provider for any health plan network.

Please contact our financial counselors at (866) 572-0157 and they can help.

Please contact our financial counselors at (866) 572-0157 and they can help.