KanCare vs Kansas Marketplace: Which Health Insurance Is Right for You?
Confused about whether you should apply for KanCare or shop the Kansas health insurance marketplace? You're not alone. This comprehensive guide breaks down the key differences, eligibility requirements, costs, and coverage to help you make the best choice for your family.
Elmag Insurance Team
Kansas Insurance Specialists
If you're a Kansas resident searching for health insurance, you've likely come across two main options: KanCare (Kansas's Medicaid program) and the Health Insurance Marketplace (also called the ACA marketplace or HealthCare.gov). But which one is right for you?
The answer depends on your income, household size, and health needs. In this guide, we'll compare KanCare vs Kansas marketplace plans side-by-side, explain who qualifies for each program, and help you determine which option will save you the most money while providing the coverage you need.
📋 Quick Comparison Overview
| Factor | KanCare (Medicaid) | Kansas Marketplace |
|---|---|---|
| Income Limit | Up to 138% FPL | No upper limit (subsidies up to 400% FPL) |
| Monthly Premium | $0 | Varies ($0-$800+ with subsidies) |
| Deductible | $0 | $0-$8,000+ |
| Enrollment Period | Year-round | Nov 1 - Jan 15 (or SEP) |
| Coverage Level | Comprehensive | Bronze to Platinum tiers |
What Is KanCare?
KanCare is Kansas's name for its Medicaid program—a government health insurance program that provides free or very low-cost coverage to eligible low-income individuals and families. Unlike some states, Kansas has not expanded Medicaid under the Affordable Care Act, which means eligibility is more limited than in expansion states.
Who Qualifies for KanCare?
KanCare eligibility in Kansas is restricted to specific groups:
✓ Who Qualifies
- Children under 19: Up to 238% FPL (~$73,000 for family of 4)
- Pregnant women: Up to 196% FPL (~$60,000 for family of 4)
- Parents with dependent children: Up to 38% FPL (~$11,700 for family of 4)
- Elderly (65+) or disabled adults: Special income/asset rules
- Certain other groups: Foster children, SSI recipients, etc.
✗ Who Does NOT Qualify
- Most childless adults: Kansas has not expanded Medicaid
- Adults without disabilities: Unless pregnant or parents of dependents
- Parents above 38% FPL: Very low income threshold (~$11,700/year for family of 4)
💡 If you don't qualify for KanCare, the marketplace with subsidies is likely your best option.
⚠️ Important: Kansas is one of 10 states that has not expanded Medicaid. This means non-disabled, non-pregnant adults without dependent children generally cannot get KanCare, regardless of how low their income is. However, they may qualify for marketplace subsidies instead.
What Does KanCare Cover?
KanCare provides comprehensive health coverage including:
- ✓ Doctor visits and checkups
- ✓ Hospital care and surgery
- ✓ Emergency services
- ✓ Prescription medications
- ✓ Lab tests and X-rays
- ✓ Mental health and substance abuse treatment
- ✓ Pregnancy and childbirth care
- ✓ Pediatric services
- ✓ Preventive care and screenings
- ✓ Vision and dental (for children)
- ✓ Medical equipment and supplies
- ✓ Home health services
Best of all: KanCare has $0 premiums, $0 deductibles, and minimal copays for most services.
What Is the Kansas Health Insurance Marketplace?
The Kansas Health Insurance Marketplace is where Kansas residents can shop for private health insurance plans during Open Enrollment (November 1 - January 15). Kansas uses the federal marketplace at HealthCare.gov, where you can compare plans from multiple insurance companies and apply for premium tax credits and cost-sharing reductions based on your income.
Who Qualifies for Marketplace Plans?
Anyone can purchase a marketplace plan, but financial assistance is available based on income:
💰 Premium Tax Credit Eligibility (2025)
If your household income is between 100% and 400% of the Federal Poverty Level, you likely qualify for subsidies that reduce your monthly premiums:
- • Individual: $15,060 - $60,240/year
- • Couple: $20,440 - $81,760/year
- • Family of 3: $25,820 - $103,280/year
- • Family of 4: $31,200 - $124,800/year
Enhanced subsidies available through 2025 mean even middle-income families can get significant savings.
Marketplace Plan Tiers
Kansas marketplace plans come in four "metal" tiers that balance premiums with out-of-pocket costs:
Bronze Plans
60% coverageLowest premiums, highest deductibles ($6,000-$8,000). Best for healthy individuals who rarely see a doctor.
Average: $350-$450/month (before subsidies)
Silver Plans
70% coverageBalanced premiums and deductibles ($4,000-$5,500). Best value for most people, especially those earning under 250% FPL (extra savings available).
Average: $450-$550/month (before subsidies)
Gold Plans
80% coverageHigher premiums, lower deductibles ($2,000-$3,500). Good for those with regular medical needs or chronic conditions.
Average: $550-$700/month (before subsidies)
Platinum Plans
90% coverageHighest premiums, lowest out-of-pocket costs ($0-$1,500 deductible). Best for frequent healthcare users.
Average: $650-$850/month (before subsidies)
KanCare vs Kansas Marketplace: Detailed Comparison
Cost Comparison
| Cost Factor | KanCare | Kansas Marketplace |
|---|---|---|
| Monthly Premium | $0 | $0-$800+ (after subsidies: $20-$400) |
| Annual Deductible | $0 | $0-$8,000+ |
| Doctor Visit Copay | $0-$5 | $20-$75+ |
| Prescription Copay | $0-$10 | $10-$50+ (after deductible) |
| Out-of-Pocket Maximum | Very low or $0 | $2,000-$9,450+ |
Coverage & Benefits Comparison
✓KanCare Advantages
- ✓ $0 premiums and deductibles
- ✓ Minimal or no copays for most services
- ✓ Comprehensive coverage including dental/vision for kids
- ✓ No annual enrollment period (apply anytime)
- ✓ Coverage starts quickly after approval
- ✓ No surprise medical bills
✓Marketplace Advantages
- ✓ Available to everyone regardless of income
- ✓ Wider provider network in some areas
- ✓ More plan choices and customization
- ✓ Premium tax credits reduce costs significantly
- ✓ Cost-sharing reductions for lower incomes
- ✓ Can switch plans annually
Real-World Cost Examples
👤 Scenario 1: Single parent with 2 kids, earning $25,000/year (Wichita)
KanCare Option:
Kids qualify for KanCare (income well below 238% FPL)
Parent income at 38% FPL: May qualify for parent coverage
Total cost: $0/month
Marketplace Option:
Silver plan with subsidies
Premium: ~$100-150/month (for parent only, if kids on KanCare)
Deductible: $2,000-3,500
✓ Best choice: KanCare (if eligible for parent coverage)
👫 Scenario 2: Childless couple, ages 35 & 40, earning $45,000/year (Kansas City)
KanCare Option:
Does NOT qualify
Kansas has not expanded Medicaid
Childless adults without disabilities don't qualify
Marketplace Option:
Qualifies for premium tax credits
Silver plan after subsidies: ~$150-250/month
Cost-sharing reductions available
✓ Best choice: Kansas Marketplace (only option available)
👨👩👧👦 Scenario 3: Family of 4, earning $65,000/year (Topeka)
KanCare Option:
Income exceeds 38% FPL limit for parents
Kids qualify (under 238% FPL)
Kids: $0/month | Parents: Not eligible
Marketplace Option:
Entire family qualifies for subsidies
Silver plan after subsidies: ~$250-400/month
Deductible: $4,000-5,500
✓ Best choice: Marketplace family plan (or kids on KanCare + parents marketplace)
How to Choose Between KanCare and Kansas Marketplace
Here's a simple decision tree to help you determine which option is best for your situation:
✅ Decision Framework
Check if you qualify for KanCare first
Are you: a child under 19, pregnant, a parent with dependent children earning under 38% FPL, elderly (65+), or disabled? If yes, apply for KanCare—it's free and comprehensive.
If you don't qualify for KanCare, check marketplace subsidies
Visit HealthCare.gov to see if you qualify for premium tax credits (income between 100%-400% FPL). Most Kansans earning $15,000-$125,000 (family of 4) will get significant savings.
Compare actual costs side-by-side
If you qualify for both (rare, but possible for parents near income limits), calculate your total annual costs including premiums, deductibles, and expected medical expenses.
Consider provider networks
Check if your preferred doctors and hospitals accept KanCare (UnitedHealthcare, Aetna Better Health, Sunflower Health) or your chosen marketplace plan.
💡 Pro Tip: Mixed Coverage for Families
It's common for Kansas families to have children covered by KanCare while parents purchase marketplace plans. This is often the most cost-effective approach since KanCare children's coverage is free and comprehensive, while parents can get subsidized marketplace plans.
How to Apply for KanCare or Kansas Marketplace
Applying for KanCare
Online Application
Apply 24/7 at kancare.ks.gov or through the DCF Customer Service Center portal
Processing time: 30-45 days typically
By Phone
Call the Kansas Customer Service Center: 1-888-369-4777
Monday-Friday, 8am-5pm CT
In Person
Visit your local DCF office in Wichita, Kansas City, Topeka, or other Kansas cities
Bring proof of income, residency, and identity
Applying for Kansas Marketplace Plans
HealthCare.gov
Create an account and complete your application at HealthCare.gov
You'll see if you qualify for subsidies immediately and can compare plans
Marketplace Call Center
Call 1-800-318-2596 for help enrolling
24/7 assistance available (TTY: 1-855-889-4325)
Licensed Insurance Agent
Work with a licensed agent at no cost—we'll help you compare plans and enroll
Personalized guidance based on your needs and budget
📅 Important Deadlines
- • KanCare: Apply year-round (no deadline)
- • Marketplace: Open Enrollment November 1 - January 15 annually
- • Special Enrollment Period: Available year-round if you have a qualifying life event (job loss, marriage, birth, move, etc.)
Frequently Asked Questions
Q:Can I have both KanCare and a marketplace plan?
No, you cannot be enrolled in both simultaneously. If you're eligible for KanCare, you're generally not eligible for marketplace premium tax credits. However, family members can have different coverage—for example, children on KanCare while parents have marketplace plans.
Q:What if my income changes during the year?
You should report income changes to both KanCare and the marketplace within 10 days. If you lose marketplace subsidy eligibility due to income drop, you may become eligible for KanCare. Conversely, if your income increases, you may need to switch from KanCare to a marketplace plan.
Q:Is KanCare accepted by most doctors in Kansas?
KanCare is managed by three health plans: UnitedHealthcare, Aetna Better Health of Kansas, and Sunflower State Health Plan. Each has a large network, but not all providers accept all plans. Check with your doctor's office to confirm they accept KanCare before enrolling.
Q:Why hasn't Kansas expanded Medicaid?
Kansas is one of 10 states that has not expanded Medicaid under the Affordable Care Act. This means adults without children, disabilities, or pregnancy generally don't qualify for KanCare regardless of income. Advocates continue pushing for expansion, but as of 2025, it has not been implemented.
Q:Can I switch from marketplace to KanCare mid-year if I become eligible?
Yes! KanCare has year-round enrollment, so if your circumstances change (income drop, pregnancy, new child, etc.) and you become eligible for KanCare, you can apply and switch immediately. You may also cancel your marketplace plan once KanCare coverage begins.
Q:Which insurance companies offer marketplace plans in Kansas?
Major insurers offering marketplace plans in Kansas include:
- • Blue Cross Blue Shield of Kansas
- • Ambetter from Sunflower State Health Plan
- • Oscar Health
- • Medica
Availability varies by county, so check HealthCare.gov for plans in your area.
Next Steps: Getting Your Kansas Health Insurance
Now that you understand the differences between KanCare and the Kansas marketplace, here's your action plan:
✅ Your 5-Step Action Plan
- 1.Determine Your Eligibility: Check if you qualify for KanCare first. If not, you'll likely qualify for marketplace subsidies.
- 2.Calculate Your Costs: Use the HealthCare.gov calculator to estimate your marketplace premiums after subsidies, and compare with KanCare's $0 cost if eligible.
- 3.Check Provider Networks: Make sure your doctors and hospitals accept your chosen coverage option.
- 4.Gather Required Documents: Proof of income (pay stubs, tax returns), ID, Social Security numbers, and proof of Kansas residency.
- 5.Apply Before Deadlines: KanCare applications accepted year-round. Marketplace Open Enrollment is November 1 - January 15.
💚 Need Expert Help Choosing?
Our Kansas health insurance specialists can help you navigate KanCare vs marketplace options, compare plans, and enroll in the coverage that saves you the most money—at no cost to you.
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