Common questions about our
ACA plans and benefits
Have questions about Blue KC benefits or plan details? Here are answers to all your commonly asked questions. From details on Spira Care to our behavioral health services to our value-added benefits, you’ll find information on all things Blue KC related. For answers to your general health insurance questions, visit 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.
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.
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.
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 app, Blue KC Virtual Care, or BlueKCVirtualCare.com (from a computer with camera and sound enabled), allows members to choose from either 24/7 urgent care visits or scheduled 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.
If your doctor doesn’t offer a telehealth video option, and you can’t/don’t want to leave home or you are traveling, you can still see another doctor with the Blue KC Virtual Care app (or BlueKCVirtualCare.com with camera and sound enabled) for common sick care needs.
Often times the cost for virtual visits are the same as seeing a doctor in their office. All plans are different, please refer to your benefits for what you may owe.
However, many virtual care PCP and behavioral health therapy visits are available for a $10 copay. These $10 virtual visits are when you use the Blue KC Virtual Care app, your in-network primary care doctor, and for behavioral health therapy visits. For any other therapy, specialists, or provider virtual visit the cost will be the same as in your in-office copay.
In addition, for our Spira Care members, virtual visits are at no cost with Spira Care providers, the Blue KC app, and in-network behavioral health providers. If Spira Care members visit an in-network PCP, those virtual visits are $10.
Blue KC offers $10 virtual care visits for the following:
- through our app, Blue KC Virtual Care, or on your computer at BlueKCVirtualCare.com (with camera and sound enabled
- your in-network primary care provider (BlueSelect or BlueSelect Plus)
- in-network behavioral health providers
For virtual visits with a specialty provider or other types of therapy your cost will be the same as an in-office visits. Please refer to your benefits for what you may owe.
In addition, many of our in-network providers offer virtual visits and their technology varies. Please talk with your doctor’s office to understand how they deliver virtual care.
No appointment is needed for convenient, secure, 24/7 access to urgent care providers. We encourage you to download the Blue KC Virtual Care app on your smartphone before you need a visit, that way you are ready when sick happens. Or you can use your computer and go to BlueKCVirtualCare.com. Please note when using the website, your computer or laptop needs to have both a camera and microphone enabled.
For behavioral health therapy visits, an appointment is needed.
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 couch or when you’re travelling away from home.
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 Blue KC Virtual Care App or at BlueKCVirtualCare.com.
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.
This site is for comparing and learning about Blue KC ACA plans available in your area. When you’re ready to enroll in your Blue KC ACA plan, simply click on the “Enroll Now” link. This will connect you with our trusted third-party enrollment site to complete the enrollment process.
Due to COVID-19, you will be able to shop for and enroll in an ACA health plan during the extra open enrollment period. This extra open enrollment period will last from February 15th to August 15th. When you enroll during this time, your coverage will begin on the first day of the month following your enrollment date.
Starting February 15th, the government is holding an extra enrollment period due to COVID-19. You can shop and enroll in a Blue KC ACA health plan from this day until August 15th. This extra enrollment period is just like the original open enrollment period and the enrollment process is the same.
After August 15th, if you need health coverage, you will need to qualify for a Special Enrollment Period. If you’ve experienced a qualifying life event such as loss of coverage, you will be able to enroll in an ACA health plan with this Special Enrollment Period.