2027 Marketplace Insurance Changes: What Families Need to Know

Starting January 1, 2027, ACA Marketplace health plans sold in the Kansas City area will not include Children’s Mercy as an in-network provider. If your family buys insurance through HealthCare.gov, this could change what you pay for your child’s care at Children’s Mercy and affiliated practices like ours next year.


We know this news is stressful, especially if your child sees Children’s Mercy specialists or is in the middle of treatment. Our goal is to help you understand what is changing and what you can do before open enrollment closes. Because our practice is a Children’s Mercy affiliate, this change applies to our office too. Starting January 1, 2027, visits with our pediatricians will also be out-of-network for these Marketplace plans. Your child’s care with us remains our priority, and we are here to help you plan.


Who is affected

This change applies only to families with individual plans bought through the ACA Marketplace (HealthCare.gov) for 2027. It does not affect families with:

  • Insurance through an employer (yours or a spouse’s)
  • Medicaid or CHIP, including KanCare and MO HealthNet
  • TRICARE or other government coverage

If you are not sure which kind of plan you have, check your insurance card or call the member services number on the back.


What this means for visits with our practice: As a Children’s Mercy affiliate, our practice is part of the Children’s Mercy network. That means if your family has a 2027 Marketplace plan, well visits, sick visits, and other care in our office will be billed as out-of-network, just like care at Children’s Mercy hospitals and specialty clinics. Out-of-network care usually costs more and may have a separate, higher deductible, or may not be covered at all. Please check with your insurer about your plan’s out-of-network benefits. [Practice to confirm: any self-pay or payment-plan options to mention here.]


Please note: our office does not accept Medicaid at this time. This includes KanCare and MO HealthNet. Children’s Mercy accepts these plans, so if your child moves to Medicaid coverage, they can keep seeing Children’s Mercy specialists in-network, but you would need a primary care pediatrician who accepts your child’s Medicaid plan. We’re happy to help make that transition as smooth as possible, including sharing your child’s records.


What to do now

  1. Confirm your plan type. Find out whether your coverage comes from the Marketplace, an employer, or Medicaid/CHIP.
  2. Call your insurance company. Ask how your 2027 plan will cover Children’s Mercy, including out-of-network costs and deductibles.
  3. Ask about continuity of care if your child is in active treatment. If your child is being treated for a serious or complex condition, contact your insurer right away and ask for a continuity-of-care exception. In some cases, plans allow care to continue at in-network rates for a transition period, but it must be arranged before the change takes effect.
  4. Compare all your options before December 15. Check whether an employer plan is available to anyone in your household. Ask whether your child may qualify for KanCare (Kansas) or MO HealthNet/CHIP (Missouri), which accept applications year-round.
  5. Double-check networks before choosing a plan. Verify that your child’s pediatrician, specialists, and hospital are listed, and recheck before any planned surgery or procedure.
  6. Plan ahead for specialist care. Talk with us about upcoming referrals, scheduled procedures, and prescriptions so there are no surprises in January.


Where to get help

  • Our office: Call 816-587-3341 or message us through the patient portal
  • Children’s Mercy Patient Access – Financial Clearance: 816-302-1650
  • Missouri Department of Commerce and Insurance: Consumer hotline 800-726-7390 or insurance.mo.gov
  • Kansas Insurance Department: insurance.kansas.gov
  • HealthCare.gov: Compare plans, check provider networks, and enroll. Free local enrollment assistance is available through HealthCare.gov’s “Find Local Help” tool


For more updates and information, visit https://www.childrensmercy.org/your-visit/billing-and-insurance/insurance/aca-marketplace-2027-faq/.