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Questions about our ACA plans and benefits
You’re not alone
If you’d like to know more about Blue KC benefits or plan details, you have plenty of company. And here, you have answers to the most commonly asked questions—from Spira Care specifics to behavioral health services to value-added benefits. You’ll find answers to your general health insurance questions at our helpful Insurance Basics page.
Blue KC is offering plans with exclusive access to Spira Care. These plans give you access to Spira Care Centers for primary care services, behavioral health consultations, routine lab draws, and more. They provide members with Care Guides, real people with nursing and benefit backgrounds (a member’s single point of contact) to help coordinate care, answer benefit questions, and more.
This is not your typical doctor’s office. A visit to one of our Care Centers is unlike anything you’ve experienced before. The look, the experience, the primary care services offered – everything has been rethought and redesigned with one thing in mind. You.
There are currently eight Care Centers – Crossroads, Lee’s Summit, Overland Park, Liberty, Olathe, Shawnee, Tiffany Springs, and Wyandotte.
Our Care Centers offer primary care, routine preventative care, chronic condition management, sick care, behavioral health consultations, health coaching session, a select number of generic prescriptions filled on site, routine lab draws*, and digital x-rays*.
*Routine labs and X-rays taken at a Spira Care Center are done based on a primary care need and ordered from a Spira Care provider only. We do not accept or facilitate orders from providers outside a Spira Care Center.
Spira Care offers the convenience of on-site service for a limited number of select generic prescriptions. This service is intended to get you started on your medication as soon as possible based on a primary care need discussed in your visit. These prescriptions are offered at your regular copay or deductible level and can be paid for using a credit card and picked up during your appointment. Any refills will be set up through mail order or at your preferred pharmacy.
If you are written a prescription by a Spira Care physician that cannot be filled at a Spira Care Center, the Care Team will facilitate prescription services through convenient mail order or at your preferred pharmacy at your regular cost-sharing level. We only fill prescriptions ordered by Spira Care providers.
Care Guides are personal guides, with nursing and benefit backgrounds, to support you on your health journey. They can help you schedule specialty care needs outside your Care Center and explain benefits. Now you have a single point of contact for both care and coverage questions to help you find the right place, right time and right people to help you on your health journey.
This is primary care integrated with coverage. Members are covered for any procedure performed at a Spira Care Center at low or no cost. That’s how we simplify healthcare at a place that connects members to experts in care. Check your plan benefits or call a Care Guide for more information specific to the plan you are enrolled in.
While the plan is ideal for members who utilize the Care Centers members still have access to all providers in their plan’s network. Many families enjoy the convenient benefits and integrated services offered at Spira Care including adult and pediatric primary care. Families also have access to a team of Care Guides for care and coverage questions.
You have access to your plan’s network within the Kansas City metro area. For emergency situations, you are covered both in and out of your plan’s network. Services beyond Spira Care (for example, a visit to a specialist or an emergency room) are subject to a person’s plan deductible.
Behavioral health consultations are offered. We provide brief and focused interventions for members as well as consultation sessions where both a medical provider and behavioral health clinician work with you to help you address your behavioral healthcare need. If you have an ongoing or long-term behavioral health need (such as therapy), we can work with you to identify a provider in your plan's network.
Yes. The Affordable Care Act provides mental health and substance use disorder coverage. This means that most individual insurance plans, including all plans offered through the ACA, cover mental health and substance use disorder services. This law also requires coverage for rehabilitative and habilitative services that support people with behavioral health conditions.
Mindful by Blue KC is a set of new and enhanced behavioral health services to address stress, depression, anxiety, substance use and more. This ensures that Blue KC members can access and afford behavioral healthcare when needed. To learn more, members can log in at MyBlueKC.com and click on behavioral health. Not a member yet? Learn more at MindfulBlueKC.com.
The following behavioral health services are available through Mindful by Blue KC – well-being resources, online therapy, online self-guided tools, managed behavioral health, expedited access network for members in crisis, and virtual care appointments.
Yes, Blue KC offers our members a number of virtual care services – our mobile app, MyBlueKC, allows members to choose from either 24/7 urgent care visits and the convenience of scheduling behavioral therapy when it works for you. In addition, many of our Blue KC in-network providers have embraced virtual visits. Talk with your doctor to schedule your next appointment.
Yes! While it’s up to your doctor to determine how they deliver care, Blue KC offers the coverage. Additionally, the MyBlueKC mobile app can connect you to our network of virtual care providers so you can get care when you need it, using the same app you use to access your benefit information, view claims, download digital ID cards, and more.
Virtual visits give you the convenience of seeing a doctor privately and securely over your smartphone, tablet, or computer – no matter if it’s from the comfort of your home or when you’re travelling.
You can also benefit from a more diverse group of providers and the ability to learn more about your doctor by reading their bio in the MyBlueKC app.
Virtual visits allow you the flexibility to receive care easily and conveniently within your busy schedule. With a virtual visit, there is no time spent driving to and from an office, taking hours off work, or being confined to regular office hours.
Additional plan benefits
Our wellness programs include Livongo for help managing diabetes, Mindful by Blue KC for behavioral health, Healthy Companion Programs for proving support for chronic health conditions and a diabetes prevention program.
There is no additional cost to members to participate in these programs.
Health coaches are available for members enrolled in Spira Care plans.
Preventive care for ACA members is covered at no cost based on CMS guidelines (details available via our preventive care publication).
Individual dental plans are available. We do not have vision plans available through the ACA.
You can shop for and enroll in an ACA health plan during the annual Open Enrollment Period which runs from November 1, 2021 to January 15, 2022.
For health coverage needs outside of the Open Enrollment Period, you may still sign up for an ACA health plan throughout the year if you qualify for a Special Enrollment Period. A Special Enrollment Period allows you to sign up for, or change, an ACA health plan for you and your family outside of the annual Open Enrollment Period. To qualify for a Special Enrollment Period, you must experience a qualifying life event such as having or adopting a baby, getting married or divorced, moving, or losing your health coverage to name a few.
The Open Enrollment Period has ended but you can enroll in or change your plan because of a life event during the Special Enrollment Period. The effective date of your plan can vary based on your life event. Contact one of our local experts to help with all your questions.
The Open Enrollment Period has ended. You can enroll in or change your plan because of life changes during a Special Enrollment Period. You may qualify if, during the past 60 days, you’ve gotten married, had a child, moved, lost coverage due to divorce or job change, or if someone on your plan has died.
For more details on specific Blue KC ACA plans available in your area, explore plans here. If you’re ready to enroll, get a quote and complete the enrollment process.Enroll Now