For a family whose child is already receiving specialized care, open enrollment is not simply a comparison of premiums, deductibles and monthly bills. It is a question of whether the doctors and hospital who know the child’s medical history will still be reachable at a cost the family can afford.
That question is becoming urgent in the Kansas City area. Children’s Mercy says the Select by Medica Affordable Care Act Marketplace plan will no longer be offered in the region beginning January 1, 2027. The hospital says other individual Marketplace plans serving the Kansas City metropolitan area currently do not include Children’s Mercy in their networks. It estimates that roughly 400 current patients may be affected.
The distinction matters. Families are not necessarily losing health insurance altogether. They may, however, lose affordable and continuous access to the pediatric hospital their children already use.
Children’s Mercy is a major regional pediatric institution, with more than 800 doctors, clinics across Kansas and Missouri, and more than half a million patient visits each year, according to the hospital’s published information. Its services include highly specialized care for children with cancer, neurological conditions, congenital diseases and other complex needs.
A plan that lists hospitals and doctors on paper may still be a poor fit for a child who needs a particular specialist, treatment team, laboratory, imaging service or coordinated follow-up schedule. For those families, the practical value of coverage depends on more than whether a plan is available on HealthCare.gov.
What is changing in Kansas City
Children’s Mercy says the Select by Medica plan will continue through December 31, 2026. Families using that plan must choose new coverage during open enrollment if they want a plan beginning January 1. The federal enrollment period begins November 1, 2026, and runs through January 15, 2027. The deadline for coverage beginning January 1 is December 15.
The hospital advises families to compare plans, ask insurers about network exceptions and investigate Medicaid eligibility where appropriate. It also says that families in active treatment should contact the hospital’s financial-clearance team about obtaining approval for care in 2027. A network exception may allow a child to continue receiving care out of network at more favorable cost-sharing levels, but approval depends on the insurer and is not guaranteed.
The Missouri Department of Commerce and Insurance describes the situation somewhat differently. In an October 21 statement, the department said it was not aware of an insurer newly removing Children’s Mercy from an existing 2027 network. Its explanation was that Medica is leaving the Kansas City individual Marketplace, while Children’s Mercy has already been out of network for most individual plans in Missouri.
Those descriptions are not necessarily contradictory. The immediate result for many families may be the same: the one individual Marketplace plan that included Children’s Mercy is disappearing, and the remaining individual options do not currently provide ordinary in-network access to the hospital.
Emergency care is not the same as ongoing care
Children’s Mercy says emergency services at the hospital must be covered at the plan’s in-network benefit level, subject to the plan’s deductible, copayments and coinsurance. That protection is important, but it does not solve the problem facing children who need planned care.
Emergency protections do not answer whether a child can afford oncology follow-up, neurological testing, specialty surgery, therapy, imaging, laboratory work or chronic-disease management. They do not guarantee that a child can keep seeing the same team or that a family will avoid a new deductible and higher out-of-pocket exposure.
For a child in the middle of a treatment cycle, an insurance change can create a second layer of work during an already difficult period. Parents may have to obtain new authorizations, confirm pharmacy benefits, transfer records, appeal denials and prove that an equivalent in-network specialist is unavailable.
The financial consequences will vary. A child needing one annual consultation is not in the same position as a child receiving weekly treatment or relying on several specialists who coordinate care through one hospital system. A hospital-reported estimate of 400 affected patients does not establish how many are in active treatment, how many will qualify for exceptions or how many will face higher costs.
A broader Marketplace problem, but not a national verdict
The Kansas City situation is a particularly clear example of a broader market problem: insurance choice can become less useful when networks narrow or insurers leave a region.
KFF reported on October 28 that 11 carriers had announced plans to exit ACA Marketplaces in at least some states for 2027, while seven had announced entries into new state markets. Those changes do not mean that every family will lose access to a preferred hospital. They do show why annual plan selection can produce a different provider landscape from one year to the next.
Federal Marketplace officials emphasize the number of plans and premiums available. The Centers for Medicare & Medicaid Services says more than 75 percent of HealthCare.gov users will have access to premiums of $50 or less in 2027 and that consumers will have access to an average of 100 plans.
Those figures describe financial availability, not necessarily clinical usefulness. A low-premium plan is not an adequate substitute for a more expensive plan if it excludes the pediatric hospital capable of treating a child’s condition. Conversely, a broad-looking network is not enough if listed providers are not accepting new patients, do not offer the needed specialty or cannot coordinate complex care.
Federal network-adequacy standards may evaluate provider categories, geographic distance and information submitted by insurers. They do not necessarily guarantee access to one particular regional children’s hospital or to every pediatric subspecialty a family may need.
Who carries the burden?
In practice, families are being asked to perform work that is difficult even for people who understand insurance. They must verify whether the hospital is in network, check individual specialists, confirm laboratory and pharmacy coverage, ask about referral rules and determine how a network exception would affect deductibles and coinsurance.
That burden falls unevenly. Self-employed parents, small-business workers, seasonal employees and families whose income is too high for Medicaid or CHIP but too low to absorb large medical bills may have fewer alternatives. Families managing a serious diagnosis have less flexibility to wait for a new appointment or travel several hours to another provider.
Missouri’s insurance department says consumers should verify network status with both the insurer and the provider, and reconfirm it before major services. The department also says Missouri law does not give it authority to review or enforce network-adequacy standards for individual Marketplace plans; federal regulators oversee those qualified health plans instead.
That creates an accountability gap. A plan may be legally offered, its premium may be affordable and its directory may contain many providers, while a family still cannot obtain timely, reasonably priced access to the pediatric specialty system it needs.
What families should do during open enrollment
Families affected by the Kansas City change should not assume that an out-of-network designation automatically ends care at Children’s Mercy. They should ask the insurer and hospital about continuity-of-care protections, network exceptions and the exact cost-sharing that would apply.
- Check the hospital and each important specialist in the plan’s current provider directory.
- Call the insurer to confirm that the provider is accepting patients under the specific plan being considered.
- Ask whether an exception is available because an equivalent pediatric specialist is not in network.
- Request written information about deductibles, coinsurance, prior authorization and pharmacy coverage.
- Ask the child’s current care team what records, referrals and treatment authorizations will be needed after January 1.
- Compare Marketplace options with employer coverage, Medicaid or CHIP if the family may qualify.
Families should keep records of calls, names, reference numbers and written approvals. Network directories and verbal assurances can change, and an exception approved for one service or time period may not cover every future appointment.
The larger lesson is that insurance is not only a financial product. For families managing serious childhood illness, it is also a system of relationships, records, referrals and clinical continuity.
Open enrollment asks parents to choose a plan before they know exactly how a new network will work in practice. In Kansas City, that choice is unusually stark: families may be able to buy coverage, but still have to fight to preserve access to the children’s hospital their children already depend on.
