No ACA plan in KC will include Children's Mercy
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Kansas City-area families who buy their own health insurance could lose in-network access to Children's Mercy next year as Medica exits the market.
Why it matters: Parents whose children are battling cancer or other serious illnesses could face much higher medical bills or have to change doctors in the middle of treatment.
Driving the news: Children's Mercy told families Tuesday that marketplace plans in the metro will no longer include it starting Jan. 1, urging them to call their insurers and ask about their options.
Zoom in: Kasey Jackson of Johnson County, whose videos about the change have drawn hundreds of thousands of views, chose Medica because it was the only plan that covered her 13-year-old son's leukemia treatment at Children's Mercy.
- "If we didn't have Children's Mercy, we literally would not be able to get care for our son," she told KSHB.
Zoom out: The ACA marketplace is a federal website where people who don't get health insurance through a job or Medicaid shop for their own plans.
- Each plan has its own network of hospitals, negotiated by the insurer, that customers can use at in-network prices.
Between the lines: Missouri insurers didn't suddenly drop Children's Mercy. Most marketplace plans have left it out for years, Missouri's insurance department tells Axios. Medica was the only one that included it this year, according to the hospital's coverage list.
- Medica is pulling out of the Kansas and Missouri sides of the metro next year, according to its June announcement and the Missouri department.
- Kansas and Missouri regulators estimate around 325 Children's Mercy patients are affected in Johnson and Wyandotte counties and around 300 on the Missouri side.
- The department also says Children's Mercy didn't give it a heads-up before going public.
The other side: Hospital leaders told Axios in a statement that marketplace plans "have chosen not to include Children's Mercy" or "have not been willing to cover the specialized pediatric care we provide."
- The Missouri Insurance Coalition, which represents insurers, countered that a hospital that's "the only realistic option" for specialized care should be paid "the reasonable cost of providing care, not the absence of alternatives."
Reality check: Neither state can review or enforce network standards for marketplace plans, which federal regulators oversee, according to Missouri's insurance department.
- The Kansas Insurance Department tells Axios it's talking with insurers and has contacted the Centers for Medicare & Medicaid Services, which oversees those networks.
What families can do: Parents whose kids are in treatment for a serious condition can ask their insurer for a "continuity of care" exception.
- This may let them keep seeing the same doctors at in-network prices for a while, but they must arrange it before Jan. 1, the Missouri Department said.
What's next: Families can start shopping for 2027 plans Nov. 1 and have until Dec. 15 to pick one that starts Jan. 1.